Diathermy Forceps Research Articles

Evaluation of two liver biopsy and rectal sealing techniques in dog cadavers undergoing Natural Orifices Transluminal Endoscopic Surgery (NOTES) by transrectal access

The aim of this study was to evaluate two liver biopsy techniques by transrectal Natural Orifice Transluminal Endoscopic Surgery (NOTES) and compare tensiometric parameters of rectal sealing using 2-octyl cyanoacrylate glue or conventional rectal sutures in a dog cadaver model. In sixteen dog cadavers two liver biopsy techniques were performed via transrectal NOTES using either polypectomy diathermy forceps or endoscopic oval biopsy forceps. The cadavers were divided into two groups: Glue Group (GG) where rectal sealing was performed with 2-octyl cyanoacrylate glue and Suture Group (SG) with the rectal defect sealed with simple continuous extracorporeal 3-0 polydioxanone sutures. The rupture pressure of the seals was measured on a rectal burst test. The diathermy polypectomy endoscopic forceps biopsy technique was significantly faster (p<0.001) and provided larger diameter samples. Rectal sealing was significantly faster (p<0.001) in the GG. There was no difference between the two groups with regard to rupture pressure (258.5 mmHg) with air insufflation. Using endoscopic oval biopsy forceps, biopsy samples can only be collected from the surface of the liver, whereas polypectomy forceps with a diathermy loop can be used to collect samples from the tip of the hepatic lobe. There was no difference in rectal rupture pressure in the burst test between the cadavers where sealing was performed with rectal sutures and those where cyanoacrylate adhesive was used.

This issue of ACTA

This issue of <i>ACTA</i>

Intra-ocular diathermy forceps.

PurposeThe purpose of this study was to develop intra‐ocular diathermy forceps and test them on perfused porcine cadaver eyes.MethodsWe designed two types of 23‐gauge intra‐ocular bipolar diathermy forceps by modifying commercially available membrane peeling forceps. In the first type, the emitting electrode is connected to one‐half of the core and the return electrode to the other half, with one jaw of the forceps attached to each half. In the second type, the emitting electrode is attached to the core and both jaws of the forceps, and the return electrode to the surrounding tube. We compared the new diathermy forceps to conventional intra‐ocular diathermy, on perfused porcine cadaver eyes. First‐order retinal artery and vein closure was confirmed both by a perfusion study and by histology of the treated vessels.ResultsType 1 diathermy forceps closed retinal arteries and veins more successfully (five of five and five of five successful treatments, respectively) than Type 2 diathermy forceps (five of five and four of five, respectively) and conventional diathermy (three of five and four of five, respectively). Less energy was used with Type 1 compared to Type 2 and conventional for artery closure (1.5 ± 0.0 versus 4.6 ± 3.3 versus 2.1 ± 0.8 joules, respectively) and vein closure (1.5 ± 0.0 versus 5.4 ± 4.6 versus 2.4 ± 0.8 joules, respectively). Histology of the treated vessels confirmed the perfusion study results.ConclusionWe designed two types of a new multifunctional intra‐ocular instrument with the ability to peel membranes and to grasp, compress and coagulate retinal blood vessels. Both types pose operational advantages compared to current conventional intra‐ocular diathermy.

Sutureless thyroidectomy for controlled toxic goiter: a single-institute experience

Background Total thyroidectomy for controlled toxic goiter is usually associated with more bleeding because of high vascularity of the toxic gland. Several new instruments were developed as hemostatic tools (harmonic scalpel; LigaSure) during total thyroidectomy as an alternative to conventional hemostatic methods. This study aimed to compare the use of Harmonic Focus Scalpel to conventional hemostatic technique (classic suture ligation with standard bipolar diathermy forceps) in patients with controlled toxic goiter undergoing total thyroidectomy regarding operative time, intraoperative complications, postoperative complications, postoperative hospital stay, and return to normal daily activities. Patients and methods The present study included 50 patients with a diagnosis of controlled toxic goiter who underwent total thyroidectomy at the Department of Surgery, Medical Research Institute Hospital, Alexandria University. Candidates were randomized into two groups: group A, in which patients underwent total thyroidectomy using Harmonic Focus Scalpel, and group B, in which patients underwent total thyroidectomy using classic suture ligation and standard reusable bipolar diathermy. Results There was no significant difference between both groups regarding preoperative data (age, sex, comorbidities, and type of thyrotoxicosis). The operative time was significantly shorter in group A patients compared with group B patients (P Conclusion Harmonic Focus Scalpel can be used safely and effectively as a hemostatic tool instead of conventional hemostatic techniques in total thyroidectomy for controlled toxic goiter.

Performing Permanent Distal Middle Cerebral with Common Carotid Artery Occlusion in Aged Rats to Study Cortical Ischemia with Sustained Disability.

Stroke typically occurs in elderly people with a range of comorbidities including carotid (or other arterial) atherosclerosis, high blood pressure, obesity and diabetes. Accordingly, when evaluating therapies for stroke in animals, it is important to select a model with excellent face validity. Ischemic stroke accounts for 80% of all strokes, and the majority of these occur in the territory of the middle cerebral artery (MCA), often inducing infarcts that affect the sensorimotor cortex, causing persistent plegia or paresis on the contralateral side of the body. We demonstrate in this video a method for producing ischemic stroke in elderly rats, which causes sustained sensorimotor disability and substantial cortical infarcts. Specifically, we induce permanent distal middle cerebral artery occlusion (MCAO) in elderly female rats by using diathermy forceps to occlude a short segment of this artery. The carotid artery on the ipsilateral side to the lesion was then permanently occluded and the contralateral carotid artery was transiently occluded for 60 min. We measure the infarct size using structural T2-weighted magnetic resonance imaging (MRI) at 24 hr and 8 weeks after stroke. In this study, the mean infarct volume was 4.5% ± 2.0% (standard deviation) of the ipsilateral hemisphere at 24 hr (corrected for brain swelling using Gerriet’s equation, n = 5). This model is feasible and clinically relevant as it permits the induction of sustained sensorimotor deficits, which is important for the elucidation of pathophysiological mechanisms and novel treatments.

Performing Permanent Distal Middle Cerebral with Common Carotid Artery Occlusion in Aged Rats to Study Cortical Ischemia with Sustained Disability

Stroke typically occurs in elderly people with a range of comorbidities including carotid (or other arterial) atherosclerosis, high blood pressure, obesity and diabetes. Accordingly, when evaluating therapies for stroke in animals, it is important to select a model with excellent face validity. Ischemic stroke accounts for 80% of all strokes, and the majority of these occur in the territory of the middle cerebral artery (MCA), often inducing infarcts that affect the sensorimotor cortex, causing persistent plegia or paresis on the contralateral side of the body. We demonstrate in this video a method for producing ischemic stroke in elderly rats, which causes sustained sensorimotor disability and substantial cortical infarcts. Specifically, we induce permanent distal middle cerebral artery occlusion (MCAO) in elderly female rats by using diathermy forceps to occlude a short segment of this artery. The carotid artery on the ipsilateral side to the lesion was then permanently occluded and the contralateral carotid artery was transiently occluded for 60 min. We measure the infarct size using structural T2-weighted magnetic resonance imaging (MRI) at 24 hr and 8 weeks after stroke. In this study, the mean infarct volume was 4.5% ± 2.0% (standard deviation) of the ipsilateral hemisphere at 24 hr (corrected for brain swelling using Gerriet’s equation, n = 5). This model is feasible and clinically relevant as it permits the induction of sustained sensorimotor deficits, which is important for the elucidation of pathophysiological mechanisms and novel treatments.

Single 1-cm port laparoscopic radical prostatectomy

dissectors, diathermy forceps, stapling devices, harmonic scalpel, needle holder, camera, needle for suturing and for specimen retrieval [1–3]. Additional 5-mm ports are used based on surgeon/robot and assistant’s needs in each patient. We have improvised on simple surgical steps of this operation to allow us to carry out a laparoscopic radical prostatectomy using a single 1-cm port and four 5-mm ports. All graspers, needle holders, endoclips, diathermy forceps and harmonic scalpel are introduced and operated through 5-mm ports. The larger 1-cm port is used for introducing laparoscope, needle with suture and specimen retrieval.

Inadvertent diathermy self-injury: a cautionary tale

There are numerous reports of inadvertent injury to patients as a result of diathermy. This potential risk also applies to the surgical team. We report a case of a full thickness diathermy burn to the surgeon, occurring due to faulty diathermy forceps. Such incidents should be reported to minimize risk of injury.

Direct visual control on cord coagulation using a fetoscopy‐guided bipolar forceps. Description of a new technique

We describe a new technique to achieve permanent umbilical cord occlusion. A 3 mm in diameter bipolar diathermy forceps was built to house a 1.2 mm fetoscope, emerging between the blades of the forceps. The device can be inserted percutaneously through a 10 Fr Trocar into the amniotic cavity under local analgesia and ultrasound guidance. A monochorionic (MC) twin pregnancy with a twin reversed arterial perfusion sequence at 18 weeks of gestation underwent cord occlusion of the acardiac twin using this new device in 2004. The instrument allowed cord coagulation under direct visual control. The pregnancy continued until 33 weeks of gestation when a male infant of 1980 g was delivered by cesarean section following preterm labor. This new instrument might allow easier access to the cord and reduce operation time by direct visualization of the target and, therefore, improve the outcome after the procedure.

Standard bipolar diathermy forceps vessel ligation is safe in thyroidectomy

Bleeding is a major complication of thyroid surgery. A retrospective study was performed comparing the outcomes of patients undergoing thyroid surgery where bipolar diathermy with standard bipolar forceps was used for vessel ligation (n = 64) compared to clamp-and-tie (n = 89). Fewer drains were inserted and patients were discharged earlier when standard bipolar diathermy was used for vessel ligation in hemithyroidectomies (P < 0.001). Complication rates were similar. The use of bipolar diathermy with standard forceps for vessel ligation in thyroid surgery has been shown to be as safe and effective as the clamp-and-tie technique, while resulting in earlier patient discharge. This technique is cost-efficient as it provides the advantage of reduced inpatient stay reported using bipolar vessel sealing devices or the harmonic scalpel, but without the additional expense.

A Multicentre Audit of Single-Use Surgical Instruments (SUSI) for Tonsillectomy and Adenoidectomy

Prions are resistant to conventional sterilisation procedures and, therefore, could be transmitted iatrogenically through re-usable adenoid and tonsil surgical instruments. Using disposable instruments would avoid the risk of transmission. We present the results of a complete audit loop using BBraun single-use surgical instruments (SUSI). This was a prospective multicentre audit. Surgeons were asked to fill in a standardised questionnaire recording details including postoperative complications, and evaluation of each piece of equipment compared with their own experience of conventional re-usable instruments. In the first cycle, constructive criticisms of the instruments were noted and the manufacturers modified the instruments accordingly. A second cycle of audit was subsequently undertaken. A total of 86 patients were audited in the first cycle and 97 in the second cycle. Postoperative haemorrhage rate for both cycles was well within acceptable range. In the first audit cycle, surgeons generally found the Draffin rods, Boyle-Davis gag and bipolar diathermy forceps of poor quality and difficult to use. These were redesigned and, on repeat evaluation during the second audit cycle, were found to be just as good, if not better, than the re-usable instruments. This study suggests that SUSI may be just as good as re-usable instruments. Furthermore, they may be more cost effective.

Einsatz eines Nickel-Titan-Piston mit Memory-Eigenschaften

BackgroundThe aim of this study was to describe a new stapes prosthesis with memory characteristics for wire crimping (SMar-Piston). Patients and methodsThis technique was used in 15 patients (mean age 43.4 years; range 28–71) undergoing routine stapes surgery. SMart-Piston prostheses with a shaft diameter of 0.5 mm and length ranging from 4.25–4.5 mm were used. Heat induced wire crimping was performed by CO2 laser in five patients, and by bipolar diathermy forceps in ten patients. In 15 patients, postoperative audiological testing was performed at an average 21.9 days and in another 10 again after 435 days following surgery.ResultsThe median observed air-bone-gap (ABG) postoperatively was 8.7 dB±7.7 dB. A total of 73% of all patients had an ABG of 10 dB or less, and all patients had less than 20 dB. In the ten patients controlled after 435 days, the ABG was 4.4 dB±2.4 dB. It was lower than 10 dB in all individuals.DiscussionA critical point in every stapes surgery, the prosthesis fixation to the incus, is greatly facilitated by this novel technique. Long-term results in a larger group of patients are pending.

Vaginal hysterectomy is made easier with ERBE Biclamp® forceps

SummaryThe ratio of vaginal hysterectomy to abdominal hysterectomy in the UK is 1:3. It is well known that patients who have had a vaginal hysterectomy recover better compared with abdominal hysterectomy. However, abdominal hysterectomy is the preferred method in most hospitals because it is deemed easier to do. With ERBE Biclamp® diathermy forceps, vaginal hysterectomy could be safely and easily performed by gynaecologists. This study showed a different surgical technique for performing vaginal hysterectomy. It allowed easier and safer operations in patients with large uterus, fibroid uterus, where there was no uterine descent and narrow introitus. Also it allowed the adnexal appendages to be removed easily by the vaginal route. We compared 100 patients who had a vaginal hysterectomy performed using this method, with patients who had a vaginal hysterectomy performed by the conventional method using sutures. We found that we could safely perform vaginal hysterectomy with greater ease. Also, the need for postoperative analgesia was less and the patients were discharged earlier. Consequently, the patients' convalescence period was shorter and better.

The coagulation properties of bipolar diathermy forceps

The coagulation properties of bipolar diathermy forceps

A blinded in vitro comparison of five sets of bipolar diathermy forceps

The objective of this blinded randomized trial was to compare five sets of bipolar forceps, both single use and reusable, and discuss their potential role in postoperative complications. An animal tissue experiment was set up with standardized parameters. Results indicate larger tips give larger burns. We also found that some forceps gave suboptimal burns.

Increased post-tonsillectomy secondary haemorrhage with disposable instruments: an audit cycle.

The objective of the audit was to examine the increased morbidity associated with elective tonsillectomy with single-use instruments in a district general hospital in England. Retrospective audit of consecutive case notes of 145 patients who underwent tonsillectomy in a 6-week period after the introduction of single-use instruments was carried out. The main outcome measure was incidence of secondary haemorrhage. In total, 9.5% of patients required re-admission indicated by secondary haemorrhage, 4% required emergency surgery and 43% of the total group had haemostasis achieved with ties. None of these was re-admitted. Out of the total group, 57% had haemostasis achieved with single-use bipolar forceps; 16.8% of these patients were re-admitted, with 7% of this group requiring emergency surgery to control the haemorrhage. Animal tissue experiments and design analysis of the single-use bipolar diathermy highlighted the deficiencies of the initial single-use bipolar diathermy. This was replaced by a new design of single-use diathermy forceps. A second audit was performed which revealed a significant reduction in postoperative morbidity. Complications associated with the introduction of new instruments can be identified by repeated audit cycles.

Complicated monochorionic twin pregnancies: Experience with bipolar cord coagulation

Objective: The purpose of the study was to evaluate our experience with ultrasound-guided bipolar diathermy forceps for cord occlusion in complicated monochorionic twin pregnancies. Study Design: Seventeen consecutive cases were included: 9 cases were twin-to-twin transfusion syndrome; 2 cases were twin reversed arterial perfusion syndrome, and 6 cases were discordant for fetal abnormality. Bipolar diathermy was performed under local anesthetic with the use of 3-mm forceps with ultrasound guidance. Results: Cord occlusion was successfully accomplished in all cases between 18 and 27 weeks’ gestation. There were 2 deaths of the co-twin within 12 hours; 1 death was due to cord hemorrhage, and 1 death was unexplained. One neonatal death occurred after delivery at 27 weeks, and 1 woman with twin-to-twin transfusion syndrome elected termination of pregnancy when hydrocephaly was diagnosed 7 days after the procedure (probably related to the underlying pathologic condition). All other co-twins are alive and well, although 2 pregnancies were complicated by preterm delivery and premature rupture of membranes before 30 weeks’ gestation. Conclusion: Bipolar diathermy is an effective procedure for cord occlusion, although it still has significant morbidity and mortality rates. (Am J Obstet Gynecol 2001;185:703-7.)

New bipolar diathermy forceps with automatic dripping and flushing--technical note.

A new bipolar diathermy forceps system was developed to solve the problems of constant, pressure-limited flow rate, and one-sided irrigation. A roller pump, activated synchronously by pressing a foot switch, feeds dripping and flushing solution to the target tissue via the tip at both ends of the forceps. This system is volume-limited. Continuous compression of the foot switch first activates the flushing function, which continues for less than 1 second, during which time bleeding spots can be detected. The flow then changes automatically to the dripping function to suppress tip burning and prevent damage to the surrounding tissues from heat and current leakage. Repeated pressing of the foot switch initiates the jet irrigation function (continuous high flow rates), allowing irrigation of hematomas and removal of excess debris.

Isotonic mannitol and the prevention of local heat generation and tissue adherence to bipolar diathermy forceps tips during electrical coagulation

The authors observed temperature levels of saline and mannitol on the tips of bipolar diathermy forceps during application of power to the forceps and compared the effects of irrigation with saline and isotonic mannitol on electrical coagulation of vessels during neurosurgical operations. There was a marked rise in the temperature of saline corresponding to increased output power of the coagulator; there was no rise in the temperature of the mannitol. Irrigation with isotonic mannitol during surgery resulted in a considerable reduction of adherence of burned tissue and blood clots to forceps tips during coagulation of both arteries and veins compared with that which occurred during irrigation with saline. These results demonstrate that irrigation with an isotonic mannitol surpasses that with conventional ionic fluids, such as a saline, for prevention of both tissue adherence to bipolar diathermy forceps and removal of heat generated during electrical coagulation.

バイポーラによる電気凝固時の局所温度変化ならびにイリゲーションの効果

バイポーラによる電気凝固時の局所熱発生ならびにイリゲーション効果をサーモグラフィーを用いて検討した.局所温度は凝固出力に応じて上昇したが,組織の接触面の大きさや浸潤度によりばらつきを認めた.高温領域はバイポーラ先端部の間に限局し,3.5〜4mm外側では正常温度に低下していた.生理食塩水によるイリゲーションの冷却効果は凝固出力により異なった.すなわち低出力凝固では冷却効果を認めたが,中等度以上の出力ではイリゲーション液に通電するため溶液が沸騰し,逆に高温領域が拡大した.一方,非イオン性溶液のマンニトールでは高出力凝固時にも沸騰せず安定した冷却効果を認め,さらにバイポーラの癒着も生理食塩水と比較して少なかった.