Electrocautery Tip Research Articles

Tissue response to different incision tools in animal model.

The aim of this study is to compare the repair of incisions performed with microdissection electrocautery tip, conventional electrocautery tip, high potency diode laser, and conventional scalpel blade in a in vivo model. Different incisions were performed in adults Holtzman rats using the four types of instruments: microdissection electrocautery tip, conventional electrocautery tip, high potency diode laser, and conventional scalpel blade, in different periods of healing process. Thirty rats were divided into 5 groups, according to the period of euthanasia-24h, 48h, 72h, 7days, and 14days. All animals received four incisions, each by a different method. Quantitative histological and histomorphometric analyses were performed using hematoxylin and eosin (HE) and Picrosirius Red staining. Inflammatory profile and tissue repair presented small statistically significance differences comparing conventional scalpel blade and microdissection tip; moreover, both presented quantitatively superior to the others. It is believed that the microdissection tip can perform a dynamic incision just as a common scalpel blade, but more effective. Furthermore, it can promote a better hemostatic control of the surgical field that is comparable to conventional electrocautery tip without affecting tissue repair.

Monopolar electrocautery tip vs plasma ablation in tonsillotomy: A randomized case-control study comparing outcomes in pediatric population

BackgroundThe objective of this study was to compare the low-priced monopolar electrocautery to the high-priced, worldwide used, plasma ablation in tonsillotomy among children aged between three and twelve years, suffering from obstructive breathing disorders (OBD), with respect to post-operative pain, bleeding and related morbidities. MethodsA randomized case-control study was conducted in the Eye and Ear Hospital International- Lebanon. 103 children aged between three and twelve years suffering from OBD secondary to tonsillar hypertrophy were randomly assigned into two groups. Post-operative pain was evaluated using age-adequate validated scales: “FLACC-R” (Face, Legs, Activity, Cry, Consolability-Revised) for children aged less than five years, and “Wong Baker faces” for older children. Additional post-operative outcomes were evaluated using Pain-PROM (Patient reported Pain-Related Outcome Measures) and TAHSI (Tonsil and Adenoid Health Status Instrument) scales. ResultsSignificantly, higher rates of patients who underwent tonsillotomy via plasma ablation technique used analgesics and had severe pain compared to the monopolar electrocautery group. A longer operative duration was significantly associated with higher pain scores, and the plasma ablation technique yielded significantly higher operative mean durations. 10 days post-operatively, a significantly higher percentage of children reported an overall high pain severity and more than expected overall pain when using the plasma ablation technique compared to the monopolar electrocautery one. Overall bleeding rates were similar. No difference was reported one month post-operatively. ConclusionWhen compared to plasma ablation, monopolar electrocautery, can provide the same efficiency in relieving OBD in healthy children, with equal overall bleeding rates, but significantly lower cost, operating time, pain scores and need for analgesics.

Navigating the COVID-19 Pandemic: Lessons From Global Surgery.

Many hospitals in HIC rely on just-in-time inventory management, which can be an effective method to cut down on costs, as it calls for minimal reserves of healthcare supplies However, the widespread use of such strategies, which are reliant on consistent and tightly controlled supply chains, have made HIC vulnerable to PPE and supply shortages should demand sharply increase, as has been seen with the COVID-19 pandemic In some HIC hospitals, healthcare workers facing PPE shortages have already had to adopt common practices from LMIC, such as using bin liners instead of gowns and wearing reusable cloth masks HIC providers have also implemented evidence based adaptations, such as creating reusable elastomeric respirators, the development of open source ventilators, and reprocessing N95 masks using the hydrogen peroxide vapor sterilization technique Learning how LMIC providers manage resource limitations through global surgery collaborations can give surgeons working in HIC valuable perspective that has become increasingly relevant during the COVID-19 pandemic The rapid expansion of social media has facilitated such collaborations, and is a valuable tool for networking, mentorship, and information sharing Additionally, the rapid sharing of research findings via social media is enhancing our ability as a global health community to respond to this pandemic in a strong evidence based manner However, it is essential that social media be used responsibly, and that precautions are taken to prevent the spread of misinformation The most vulnerable populations, often linked to the underlying social determinants of health such as poverty, food security, literacy, sex, and racial and ethnic factors, are most at risk of adverse outcomes during these health and social shocks There is already data demonstrating that racial and ethnic minorities in the US and UK are at increased risk of death from COVID-19 Difficulty in accessing care for emergent conditions exists at baseline for these populations, and extensive backlogs for essential operations are commonplace, especially in LMIC This is likely only to get worse during the current crisis and underscores the importance of our professional commitment to health equity - regardless of geography New estimates of the "collateral damage" caused by the pandemic are very concerning and also illustrate the urgent need to mitigate this impact through local and global coordinated action

Contamination Rate of Burnt Necrotic Tissue after Electrocoagulation in Total Knee Arthroplasty.

BackgroundPeriprosthetic joint infection (PJI) is one of the commonly found catastrophic complications after total knee arthroplasty (TKA). Preoperative antibiotic prophylaxis, proper skin cleansing, shortened operative time, and sterility of surgical field and equipment are essential to minimize the risk of PJI. Although bacterial contamination of electrocautery tips has been reported, contamination of residual product of electrocoagulation, burnt necrotic tissue (BNT), is not well known. Therefore, we aimed to assess the contamination rate of BNT and association between contaminated BNT and PJI, and risk factors.MethodsBNTs from 183 patients who had undergone unilateral primary TKA at our institution were retrospectively analyzed. In each patient, three to five specimens of BNT were routinely collected in the operative field of primary TKA. Collecting time was defined as the duration from start of using the electrocautery device to the first collection of BNT.ResultsCulture was positive in eight of 183 patients (4.4%; contaminated BNT group), and the most commonly isolated organism was coagulase-negative Staphylococcus (62.5%). The average operative time was 103.1 ± 44.2 minutes in the contaminated BNT group and 79.0 ± 16.7 minutes in the non-contaminated BNT group (p = 0.17), and collecting time was 48.0 ± 44.3 minutes and 29.7 ± 17.0 minutes (p = 0.28), respectively. None of the patients with contaminated BNT developed PJI, whereas four patients with culture-negative BNT developed PJI within 2 postoperative years.ConclusionsBNT in surgical field can become a reservoir of contaminating bacteria. However, contamination of BNT was not associated with PJI. Therefore, routine removal of all BNTs may be unnecessary.

Microdermal Implants Show No Effect on Surrounding Tissue During Surgery With Electrocautery

BackgroundMicrodermal implants are an increasingly popular form of body jewelry. The potential for electrical conduction burn at the site of metal jewelry left in situ during electrosurgery has prompted surgical societies to recommend routine removal before surgery. To date, however, there is a lack of evidence to support this practice. We assessed in vivo thermal effect and tissue damage around implants during and after electrocautery. Materials and methodsStainless steel microdermal anchors were surgically implanted into four swine. After allowing for initial healing, negative controls were excised and evaluated. An electrocautery grounding pad was placed 2 cm caudal to the implant. Continuous electrocautery (coagulation/30 W) for 30 s was applied to the skin 2 cm cranial to the implant. Surface skin temperature was recorded during electrocautery using thermal imaging. Tissue damage was assessed by gross examination and histologic evaluation. The same procedure was then performed to the contralateral nonimplanted side as a sham control. ResultsElectrocoagulation raised skin temperature around the electrocautery tip 27.7°C (Tmax 64.8°C). Skin temperature around the dermal implant rose 1.58°C (Tmax 38.6°C) compared with 2.03°C (Tmax 39.2°C) in the nonimplanted control skin (P = 0.627). Skin temperatures at implanted and control sites showed no statistical difference at any recorded time interval. Histologic review of excised tissue samples showed no evidence of thermal injury. ConclusionsMetallic implants appear to have no effect on skin temperature during the use of electrocautery even when in close proximity to both the electrocautery pen and return pad. Aggressive steps to remove microdermal implants before surgery may be unnecessary.

Transient Heat Transfer in Dental Implants for Thermal Necrosis-Aided Implant Removal: A 3D Finite Element Analysis.

Removal of osseointegrated but otherwise failed (mechanical failure, mispositioning, esthetics, etc) dental implants is a traumatic process resulting in loss of healthy bone and complicating the treatment process. The traumatic effects of implant removal can be reduced by weakening the implant-bone attachment. Thermal necrosis-aided implant removal has been proposed as a minimally invasive method toward this end. In this method, an electrocautery tip is contacted to the implant to increase the temperature to 47°C and generate a limited and controlled thermal necrosis at the bone-implant interface. So far, no controlled studies have been performed to investigate the optimal clinical parameters for this method. In this study, we aimed to investigate, using finite element analysis method, the optimal settings to achieve intentional thermal necrosis on 3 implant systems, at 5 W and 40 W device power and with different size tips. The temperature increase of the implants at 40 W power was very sudden (< 0.5 seconds) and as the bone reached 47°C, the implants were at unacceptable temperatures. At 5 W power, temperature increase of the implants happened at manageable durations (< 1 second). Moreover, the temperature increase was even slower with larger implants and larger tip sizes. Therefore, low power settings must be used for thermal necrosis-aided implant removal. Also, the size of the implant and the tip must be taken into consideration in deciding the duration of contact with the electrocautery tip and the implant.

Creating a Microdissection Cautery Tip Using Disposable Needle.

The use of electrocautery is universal in modern day surgery. Through decades electrocautery has reformed from larger electrodes to smaller ones. The latest modification is the micro-dissection cautery with a fine electrode tip. We have modified the electrocautery tip to replicate the usage of micro dissection-cautery using readily available, low cost disposable needle. The idea is to replicate the benefits of micro-dissection needle with a low cost construct which can be learned easily, used widely to provide optimum surgical results to the wider sections of the society. A video demonstration for creation of the micro-dissection cautery construct is also demonstrated.

High bacterial contamination rate of electrocautery tips during total hip and knee arthroplasty.

The aim of the study was to quantify the bacterial contamination rate of electrocautery tips during primary total joint replacement (TJR), as well as during aseptic and septic revision TJR. A total of 150 electrocautery tips were collected between April and July 2017. TJR surgeries were divided into three groups: (1) primary, (2) aseptic and (3) septic revisions. In each group, a total of 50 electrocautery tips were collected. A monopolar electrocautery with a reusable stainless-steel blade tip was used in all cases. The rate of bacterial contamination was determined for all groups. Correlation of exposure time and type of surgery was analyzed. The overall bacterial contamination rate was 14.7% (95% CI 9.4 to 21.4%). The highest contamination rate occurred in the septic revision group (30.0%; 95% CI 17.9 to 44.6%), followed by the primary cases group (10.0%; 95% CI 3.3 to 21.8%) and the aseptic revision group (4.0%; 95% CI 0.5 to 13.7%). Exposure time did not affect the bacterial contamination rate. In 12 out of 15 (80%) contaminations identified in the septic group, we found the same causative microorganism of the prosthetic joint infection on the electrocautery tip. The bacterial contamination of the electrocautery tips is relatively high, especially during septic hip revision arthroplasty. Electrocautery tips should be changed after debridement of infected tissue.

Comparing the outcomes of incisions made by colorado microdissection needle, electrosurgery tip, and surgical blade during periodontal surgery: A randomized controlled trial.

Context:Electrosurgery offers many unique advantages such as hemostasis and precise tissue cutting; however, there are a number of disadvantages including thermal injury and delayed wound healing.Aims:The aim of the present study was to compare the outcomes of incisions made by Colorado® microdissection needle, electrosurgery tip, and surgical blade during periodontal surgery.Settings and Design:Twenty-two individuals participated in this study. Three quadrants in each individual were randomly assigned into each of the following experimental groups: Colorado® microdissection needle (CMD), electrosurgery tip (EC) and surgical blade (BP), in which, incisions were given with Colorado® microdissection needle, straight electrocautery tip, and a scalpel blade, respectively.Materials and Methods:Blood loss (BL) was measured immediately after surgery, and changes in interdental papilla dimensions were recorded at baseline, 7, 30, 120, and 180 days after surgery. Measures of periodontal disease were recorded at baseline, 120, and 180 days after surgery. Postoperative pain and wound healing were recorded at 1, 7, and 15 days after surgery.Results:The use of CMD for periodontal surgery showed better results over EC in all parameters. CMD resulted in lesser bleeding and less postoperative pain and attained similar results to that of BP in clinical parameters of periodontal disease.Conclusions:Colorado® microdissection needle may be a better choice for incisions as it seems to show less tissue damage than cautery and offers tissue healing comparable to scalpel blade.

Bacterial Contamination in Tips of Electrocautery Devices During Total Hip Arthroplasty

Surgical equipment can become contaminated during surgery. It is unknown if electrocautery tips can become contaminated in clean orthopedic procedures despite the produced heat. Therefore, we conducted a prospective study to address this concern. The tips from 25 primary and 25 aseptic revision THAs were collected and an additional 5 sterile tips served as negative controls. Aerobic and anaerobic cultures were incubated for a minimum of 3days. There were 3 positive cultures (6%); one in primary THA (4%) with Lactobacillus and Enterococcus faecalis; two among revisions (8%), one with E. faecalis and another one with alpha hemolytic streptococci and coagulase negative Staphylococcus. The mean exposure time of the contaminated tips was 132.3minutes. Patients were followed for 90days postoperatively and none of them developed surgical site infection. This is the first study to demonstrate that electrosurgical devices can become contaminated during THA in laminar flow equipped operating rooms.

Quicker yet safe: skeletonization of 1640 internal mammary arteries with harmonic technology in 965 patients

Skeletonization of the internal mammary artery (IMA) facilitates arterial grafting and has been shown to reduce deep sternal infection but is more time-consuming and tedious than pedicle harvest. We wished to determine if use of harmonic technology (HT) facilitates skeletonization of the IMA and is as safe as the conventional technique of skeletonization. In a consecutive series of 1057 patients with isolated coronary artery bypass graft (CABG) surgery from 2003 to 2013, adverse events and recorded harvest times were compared between harmonic (965 patients) and non-harmonic patients (86 patients). HT was used to harvest 1640 IMAs in 965 (91%) of 1057 consecutive CABG patients and skeletonization with the traditional technique (use of an electrocautery tip as a dissector) was used to harvest 147 IMAs in 86 patients. Six patients had no IMA harvested with this surgery (4 patients had an IMA used from a previous CABG, 1 had no disease of the left anterior descending coronary artery and 1 patient was in cardiogenic shock precluding IMA use). Excluding patients with single-vessel disease, 730/987 (74%) of patients received bilateral IMAs. Demographics of patients with and without harmonic skeletonization, respectively, were the following: mean age: 64.7 vs 67.7 years; diabetes: 33 vs 34%; women: 21 vs 26% and median European System for Cardiac Operative Risk Evaluation: 2.9 vs 3.2. The mean harvest time for 77 non-harmonic skeletonized mammary arteries (49 surgeries) was 32.2 min (95% confidence interval (CI): 30.1, 34.3), for harmonic skeletonized arteries after 450 surgeries was 28.4 min, (95% CI: 27.8, 29.1) and in the last 100 IMAs harvested for the isolated harmonic device use/mammary was 15.4 min (95% CI: 14.0, 16.7). Major adverse events for patients with and without harmonic skeletonization, respectively, were: reoperation for bleeding: 2.7 vs 3.5% (difference = 0.8%, 95% CI: -3.2, 4.8); damaged mammaries: 0.4 vs 0.7% (difference = 0.3%, 95% CI: -1.0, 1.7); deep sternal infection: 1.6 vs 1.2% (difference = -0.4%, 95% CI: -2.8, 2.0) and perioperative infarction: 1.7 vs 2.3% (difference = 0.7%, 95% CI: -2.6, 4.0). In this largest series to date of harmonic IMA skeletonization, this technique results in rare damage, is quicker and with a comparable adverse event rate compared with the non-harmonic method.

Modified microdissection electrocautery needle.

Electrocautery is routinely used in surgical procedures. The commercially available microdissection electrocautery needles are costly. To overcome this disadvantage, we have modified monopolar electrocautery tip to function as well as commercially available systems.

Tonsillectomy

Tonsillectomy

Manual resurfacing and trichloroacetic acid for the treatment of patients with widespread actinic damage. Clinical and histologic observations.

A facial resurfacing regimen combining manual abrasion of the skin and 25% trichloroacetic acid has been reported to produce excellent results, but the histologic depth of injury produced by this technique has not been studied. To describe our experience with this technique treating patients with extensive actinic damage and to determine the histologic depth of injury produced. We treated 40 patients using manual resurfacing and trichloroacetic acid, primarily for widespread actinic keratoses. Resurfacing tools included silicone carbide sandpaper, drywall screen, electrocautery tip cleaners, abrasive pads, scalpel blades, and curettes. Four patients underwent sequential biopsies to evaluate the depth of wounding using this technique. Manual resurfacing combined with trichloroacetic acid consistently produced excellent cosmetic results and nearly complete eradication of actinic keratoses. Histologically, treated areas showed replacement of the dermal elastotic band by newly formed collagen, a significantly deeper level of wounding than the Jessner's/35% trichloroacetic acid peel. There was no evidence for foreign body granulomas clinically or histologically as a result of the abrasive materials. The deeper level of this peel explains the improved cosmetic outcome and greater eradication of actinic keratoses. This treatment is particularly well suited for patients with extensive photodamage and widespread actinic keratoses.

Advantages of Electrocautery

To the Editor.— Bennett and Kraffert, 1 in their article, and Sebben, 2 in his editorial, are to be congratulated for addressing a topic that affects any surgeon who uses electrosurgery in the practice of dermatology. Both bacterial and viral contamination have been shown to occur with use of high-frequency electrosurgical electrode tips. 1-4 The dermatologic surgeon needs to consider utilization of the less frequently used modality of electrocautery. While most training programs provide instruction in the use of highfrequency electrosurgical currents and the effects of electrofulguration, electrodesiccation, and electrocoagulation caused by their heating properties, little attention is directed to that of electrocautery. Because the electrocautery tip is regulated by a rheostat to produce a glowing red- to white-hot tip, the electrode is sterile due to the high temperature. 2 With electrocautery, the contamination risks associated with most forms of electrosurgery electrode tips would not be a consideration if the

A simple method for preventing misplaced electrocauterization.

A small segment of universally available and inexpensive rubber catheter can be easily fitted to insulate electrocautery tips. This technique can prevent numerous thermal injuries and potential litigation arising from accidently burning adjacent tissues. The routine use of this modification in the operating room can save time, anxiety, and potential litigation by preventing misplaced cauterization.

The effect of technique on histology of arthroscopic partial meniscectomy with electrosurgery

Fifty-one patients had arthroscopic partial meniscectomies with electrosurgery between 1982 and 1985. Two patients who had undergone prior meniscectomies with electrosurgery had biopsies of the old excision site at repeat arthroscopy, necessitated by new injuries. Three different combinations of electrocautery tips and either a standard electrocautery generator or a new electrocautery generator specifically designed for arthroscopic electrosurgery were used in different combinations. Depth of damage as defined by the Trichrome stain was measured by a micrometer. A rating summary of the quality of resection technique was also performed. Overall, the newly developed electrocautery generator and the newly developed electrocautery tips were not beneficial in reducing the depth of damage. The average depth of damage was .29 mm. Forty-seven percent of patients showed no histologic evidence of damage from the electrosurgical resection. The two individuals with repeat biopsies showed normal histology. Arthroscopic partial meniscectomy with electrosurgery causes a very thin layer of tissue damage. This appears to resolve with time. Recently developed instruments specifically designed for arthroscopic electrosurgery do not appear to decrease the depth of damage.