Cautery Group Research Articles

Prospective, randomized trial of a novel hemostatic sealant in adenoidectomy

Problem: Floseal is a novel matrix hemostatic sealant composed of collagen-derived particles and topical bovine-derived thrombin. It is applied as a high viscosity gel for hemostasis. This study is a prospective, randomized, controlled clinical trial of Floseal sealant compared to traditional suction cautery hemostasis in children undergoing adenoidectomy. Methods: Seventy patients (mean age, 7.0 years; 45.7% male) with obstructive sleep apnea underwent traditional cold steel adenoidectomy and were then randomized to receive Floseal or cautery to obtain hemostasis. Patients were crossed over to the other technique after more than 100 mL blood loss or 15 minutes had elapsed. Objective data collected included time to hemostasis and blood loss during hemostasis. Visual analog scales (VAS) were used to record subjective data by the operating surgeon including bleeding following pack removal (0 = none, 4 = brisk) and ease of operation (1 = difficult, 6 = easy). Parents were contacted by phone at day 7 and questioned with regard to return to diet and narcotic usage. Results: Floseal patients (n = 35) had significantly shorter times to hemostasis (0.6 minutes vs 9.3; P < 0.001), less blood loss (2.5 vs 29.5 mL; P < 0.001), less subjective bleeding (0.0 vs 2.0; P < 0.001), and subjectively easier operations (2.6 vs 5.2 [mean 6-point VAS], P < 0.001). Furthermore, Floseal patients returned to regular diet earlier (2.7 vs 4.1 days, P < 0.001) and had less use of narcotics at 7 days (43% vs 69%). Finally, 3 patients in the cautery group (n = 35) were crossed over to the Floseal group. Floseal resulted in a cost savings of $104/operation. Conclusion: Floseal sealant is a safe, effective, easy, and cost-conscious technique for obtaining hemostasis in children undergoing adenoidectomy. Significance: Floseal sealant is a good tool in the armamentarium of surgeons who encounter heavy bleeding during adenoidectomy. Support: None reported.

The Impact of Colonscopic Electrocautery on Pacemaker Function

The Impact of Colonscopic Electrocautery on Pacemaker Function Navin Kumar, Hemant Roy, Alan Zunamon, Eva Gliwa, Mick Meiselman, Michael Goldberg, Tat-Kin Tsang, Randall Brand Background: While some guidelines advocate inactivation of pacemakers prior to use of electrocautery for colonoscopic polypectomy, this is not done by most endoscopists. These recommendations are based upon expert opinion, small non-blinded studies and anecdotal case reports. In order to provide evidencebased insight into this issue, we performed a pilot study analyzing the risk of electrocardiographic abnormalities during cautery. Methods: A total of 19 patients were enrolled in this study. Each patient had rhythm strips run preand post-colonoscopy, when the cecum was reached and during all episodes of cautery use. Continuous ECG rhythm monitoring was also performed during the colonoscopy. The technique (continuous vs. brief, short bursts) of cautery was dependent on the endoscopist preference. The grounding electrode was placed on the patient’’s buttock or thigh. Identified preand post-procedure strips along with either an unidentified cecal (control) or cautery strip were grouped together and evaluated by a cardiologist blinded to the cautery status of the third strip. Results: Eight of the 19 patients underwent a total of 18 polypectomies using electrocautery. No incidence of pacemaker dysfunction or change in cardiac rhythm occurred in the control or cautery groups. All 19 patients tolerated each colonoscopy without any other adverse cardiac events or complications. Conclusion: This study suggests that electrocautery use is safe in patients with pacemakers as along as the electrocautery pad is positioned on the lower part of the body away from the pacemaker. To our knowledge this is the first blinded, prospective trial demonstrating the safety of performing electrocautery during colonoscopy in patients with a pacemaker. If confirmed with larger patient numbers, this would strongly argue for new practice recommendations.

Effectiveness and Complications Associated With 2 Vasectomy Occlusion Techniques

We compared the effectiveness and complications associated with 2 common vasectomy occlusion techniques, namely clipping and excision of a small vas segment and thermal cautery with fascial interposition and an open testicular end. We retrospectively reviewed the computerized records of 3,761 men who underwent initial vasectomy at a single university hospital family planning clinic and at 2 private clinics in the Quebec City, Canada area, including concurrent and historical controls. All procedures were performed by 1 surgeon, who used the scalpel-free technique to expose the vas. The risk of vas occlusion failure in men with at least 1 semen analysis was much greater in the clipping and excision group than in the cautery, interposition and open testicular end group (126 of 1,453 or 8.7% versus 3 of 1,165 or 0.3%, OR 37, 95% CI 12 to 116). Medical consultations for hematoma or infection were more frequent in the cautery group (28 of 1,721 cases or 1.6% versus 10 of 2,040 or 0.5%, OR 3.4, 95% CI 1.6 to 6.9). Consultations for noninfectious pain were similar for the 2 techniques (71 of 1,721 cases or 4.1% versus 72 of 2,040 or 3.5%, OR 1.2, 95% CI 0.8 to 1.6). Cautery and interposition with an open testicular end are much more effective than clipping and excision. The effectiveness and morbidity associated with the components of the cautery, interposition and open testicular end technique need further evaluation.

The effectiveness of the use of electrocautery with chondroplasty in treating chondromalacic lesions: A randomized prospective study

Purpose: To determine the clinical effect of electrocautery with arthroscopic chondroplasty on chondromalacic tissue. Type of Study: A randomized, prospective study. Methods: In a prospective study, 146 patients were randomly placed in either a control group (chondroplasty alone) or a treatment group (chondroplasty and electrocautery). Intraoperative findings in both treatment and control groups were classified by both the extent of chondromalacia and the number of compartments in which chondromalacia was diagnosed. In our study, we used 6 defined compartments: medial and lateral tibial plateau, medial and lateral femoral condyles, patella, and femoral trochlea. Patients were followed up at 1 year and evaluated using the Lysholm scale. Postoperative Lysholm scores were matched against compartment involvement and compared between groups. Results: There was no significant difference in the patients with grade 2 chondromalacia in either control or cautery group (P >.5). Groups with grade 3 chondromalacia showed a significant difference favoring the control group (P <.05). A significant difference was found in comparing 2-compartment chondromalacia between the 2 treatment cohorts, again, favoring the control group (P =.01). The remaining groups of multiple compartment chondromalacia showed no significant difference, indicating that the postoperative result was independent of the use of electrocautery. Conclusions: This study shows that electrocautery as an adjunct to chondroplasty offers little benefit in the treatment of chondromalacic lesions and may, in fact, limit successful outcome.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 18, No 2 (February), 2002: pp 190–193

The effect of bipolar electrocautery on peripheral nerves.

Although bipolar cautery was designed to minimize trauma to the central nervous system, little is known about the effects of bipolar cautery on peripheral nerve tissue. This experiment was designed to study the effect of direct bipolar cautery on a peripheral nerve and the muscles innervated by that nerve. Lewis rats (n = 200) were assigned to five different groups: control, sham, and three cautery groups (duration of either 0.5, 1.0, or 1.5 seconds). The hind limb tibial nerves were isolated in the sham group and isolated and cauterized in the cautery groups. Assessments performed at 2 hours, 2 weeks, 4 weeks, and 8 weeks postoperatively included isometric contractile function studies of both a fast- and a slow-twitch muscle, muscle weights, and nerve histology/morphometry. Significant muscle weight loss and reduced muscle function were found in the cautery groups at 2, 4, and 8 weeks (p < 0.05). Histologically, the nerves of the cautery groups showed nerve damage consistent with Sunderland's type 4 nerve injury when examined at 2 weeks and showed nerve regeneration at 4 and 8 weeks. Both the fast-twitch muscle and the shorter duration cautery were associated with faster recovery relative to the slow-twitch muscles and longer duration cautery, respectively. Bipolar cautery, as administered to rat tibial nerves in this experiment, is associated with a significant injury to the nerve and loss of function of the muscles innervated by the nerve.

Anorectal Fistulae: Results of Treatment with Cauterization

The results of treatment of anorectal fistula by electrocauterization in 24 patients were compared with those obtained by ‘laying-open’ operation in another 24 patients. The two groups were matched for age, sex, fistula type and follow-up duration. In the cautery group, a fistula cautery probe was introduced into the fistulous track and the electric current was switched on for a few seconds. The laying-open operation was done in the classical way. In the electrocauterization group, recurrence occurred in 3 patients (12.5%). The procedure was done under local anesthesia, as an outpatient procedure. Mild analgesics were given to 8 patients. No antibiotics were administered. Continence was not affected. In the group undergoing laying-open operation, recurrence occurred in 4 patients (16.7%). The procedure was performed under general anesthesia with a mean hospital stay of 2.2 days. Analgesics and antibiotics were given to all patients. Temporary continence disorders occurred in 3 patients; 1 patient remained incontinent for flatus and fluid stools. In conclusion, electrocauterization for anorectal fistula is a simple, easy, safe and effective procedure. Moreover it is less expensive and performed on an outpatient basis.

Effect of the dominant follicle on regression of its subordinates in heifers

The relationship between a dominant follicle of a follicular wave and the suppression of subordinate follicles was studied during the first postovulatory wave (Wave 1) in Holstein heifers. The dominant follicle (largest follicle) was cauterized or a sham-operation was done on day 3 (day 0 = ovulation) using seven heifers per group. In the cautery group, compared to the controls, the largest subordinate follicle attained a larger diameter (11 7 vs 8 0 mm; P &lt; 0.01), reached maximum diameter at a later day (day 9.2 vs. day 3.1; P &lt; 0 01) and began to regress at a later day (day 14.3 vs. day 5.7; P &lt; 0.01). In addition, the emergence of Wave 2 was hastened (day 6.4 vs. day 9.3; P &lt; 0.05) and more heifers had more than two waves per interovulatory interval (5 of 6 vs. 2 of 7; P &lt; 0.05). In heifers with the dominant follicle eliminated, the largest subordinate grew to the diameter of a dominant follicle during Wave 1 (n = 3) or became the dominant follicle of a newly emerged wave (n = 2). A subordinate sometimes persisted as a small follicle (e.g., 5 mm) for several days before resurging. However, it was not convincingly demonstrated that a subordinate follicle could resurge after it had begun to regress (decrease in diameter). Results supported the hypothesis that suppression of subordinate follicles is a prolonged process, so that resurgence of a subordinate can occur if the dominant follicle is removed. Key words: Ovaries, follicular waves, selection, cattle, cauterization

Comparative study of Nd-YAG laser versus electrocautery for liver metastatic resection in the rat

The thermal, hemostatic and lymphostatic effects of the Nd-YAG laser suggest a benefit in the treatment of multiple liver metastases. The aim of this work was to evaluate experimentally this hypothesis in a comparative study with conventional electrocautery resection of liver metastases. The original animal model was represented by syngeneic BDIX rats inoculated under the liver capsule with 1.5×106 DHD/K12 tumour cells originating from a clone of a 1,2 dimethyl hydrazine induced rat colon cancer. One hundred and ten rats bearing three liver metastases were randomly treated by laser volatilization or electrocautery enucleation. The first group of 60 rats was used as a survival group: the laser treated rats survived significantly longer than rats treated by cautery (49.9 days vs 28.9 days) (mean values;p<0.015). In this group, the temperature elevation during operation at the edge of the treated lesion was found higher in the laser group than in the cautery group (56±4.6°C vs 8±3°C) (mean values±s.d.;p<0.001). Nd-YAG laser was also a faster procedure than cautery resection (21±4.2 s vs 57±6.1 s) (mean values±s.d.;p<0.001). At the time of autopsy, the infection rate with laser was found lower than in the cautery group (p<0.025) while no bile leakage was evident. A peritoneal tumour dissemination with ascites was noted in the majority of dead rats. In the second group of 50 rats, the metastatic recurrence was assessed. At day 7, no metastases were found in the laser treated rats while a mean number of 6.5 was found in the cautery group (p<0.001). At the 15th day, more metastases were present in the cautery group. There was a significant correlation between the total number of metastases and the time of death. Those findings suggest that the Nd-YAG laser destruction of experimental liver metastases by its specific effects on tumour cells delayed the recurrence of metastases when compared to the electrocautery resection, contributing to a longer survival of the laser treated rats.

Contact Nd: YAG tonsillectomy: Effects on weight loss and recovery

Contact Nd:YAG tonsillectomy using synthetic sapphire blades appears to meet or exceed standards established by spot monopolar cautery. Subjects' percentage of weight loss and return to work/social activities was measured and the laser group displayed less percentage of weight loss, faster return to pre-operative weight, and less recovery time than the comparative cautery group. Because of the unique nature of Nd:YAG laser light combined with sapphire blades, special consideration should be given to these accessories by physicians before attempting tissue cutting and vessel coagulation. The author believes that the extent of physician training and proficiency may be key to the success of soft tissue head and neck applications, such as tonsillectomy, which will have an effect on the outcome of clinical data.

Tubal anastomosis: pregnancy success following reversal of Falope ring or monopolar cautery sterilization

The present study reviews pregnancy outcome following tubal anastomosis in 80 previously sterilized women. Thirty of 58 women (52%) sterilized by monopolar cautery techniques delivered a living child as compared to 19 of 22 women (86%) sterilized using the Falope ring method. Cumulative pregnancy curves were calculated for the Falope ring and cautery groups using life-table methods. Following reversal of Falope ring sterilization, the estimated cumulative probability of pregnancy 6, 12, 24, and 36 months after surgery was 28.4%, 48.8%, 69.3%, and 87.2% respectively. The corresponding estimates following reversal of cautery sterilization were lower at 6, 12, 24, and 36 months following surgery: 22.7%, 37.8%, 52.4%, and 57.9%, respectively. The ectopic tubal pregnancy and spontaneous abortion rate were higher among women sterilized with monopolar cautery. A decreased pregnancy rate was associated with ampullary-isthmic anastomosis in the cautery group; however, pregnancy was least likely to occur in women with shortened oviducts of less than 4 cm.