Electrosurgical Treatment Research Articles

The effectiveness of electrosurgical treatment of drug-resistant keratitis

The effectiveness of electrosurgical treatment of drug-resistant keratitis

Optical Emission Spectroscopy for the Real-Time Identification of Malignant Breast Tissue

Breast conserving resection with free margins is the gold standard treatment for early breast cancer recommended by guidelines worldwide. Therefore, reliable discrimination between normal and malignant tissue at the resection margins is essential. In this study, normal and abnormal tissue samples from breast cancer patients were characterized ex vivo by optical emission spectroscopy (OES) based on ionized atoms and molecules generated during electrosurgical treatment. The aim of the study was to determine spectroscopic features which are typical for healthy and neoplastic breast tissue allowing for future real-time tissue differentiation and margin assessment during breast cancer surgery. A total of 972 spectra generated by electrosurgical sparking on normal and abnormal tissue were used for support vector classifier (SVC) training. Specific spectroscopic features were selected for the classification of tissues in the included breast cancer patients. The average classification accuracy for all patients was 96.9%. Normal and abnormal breast tissue could be differentiated with a mean sensitivity of 94.8%, a specificity of 99.0%, a positive predictive value (PPV) of 99.1% and a negative predictive value (NPV) of 96.1%. For 66.6% patients all classifications reached 100%. Based on this convincing data, a future clinical application of OES-based tissue differentiation in breast cancer surgery seems to be feasible.

Evaluating a novel 3D printed model for simulating Large Loop Excision of the Transformation Zone (LLETZ).

BackgroundElectrosurgical excisions are common procedures for treating cervical dysplasia and are often seen as minor surgeries. Yet, thorough training of this intervention is required, as there are considerable consequences of inadequate resections, e.g. preterm birth, the risk of recurrence, injuries and many more. Unfortunately, there is a lack of sufficiently validated possibilities of simulating electrosurgeries, which focus on high fidelity and patient safety.MethodsA novel 3D printed simulator for examination and electrosurgical treatment of dysplastic areas of the cervix was compared with a conventional simulator. Sixty medical students experienced a seminar about cervical dysplasia. Group A underwent the seminar with the conventional and Group B with the novel simulator. After a theoretical introduction, the students were randomly assigned by picking a ticket from a box and went on to perform the hands-on training with their respective simulator. Each student first obtained colposcopic examination training. Then he or she performed five electrosurgical excisions (each). This was assessed with a validated score, to visualize their learning curve. Furthermore, adequate and inadequate resections and contacts between electrosurgical loop and vagina or speculum were counted. Both groups also assessed the seminar and their simulator with 18 questions (Likert-scales, 1–10, 1 = strongly agree / very good, 10 = strongly disagree / very bad). Group B additionally assessed the novel simulator with four questions (similar Likert-scales, 1–10).ResultsNine of 18 questions showed statistically significant differences favoring Group B (p < 0.05). Group B also achieved more adequate R0-resections and less contacts between electrosurgical loop and vagina or speculum. The learning curves of the performed resections favored the novel simulator of Group B without statistically significant differences. The four questions focusing on certain aspects of the novel simulator indicate high appreciation of the students with a mean score of 1.6 points.ConclusionThe presented novel simulator shows several advantages compared to the existing model. Thus, novice gynecologists can be supported with a higher quality of simulation to improve their training and thereby patient safety.Supplementary InformationThe online version contains supplementary material available at 10.1186/s41205-022-00143-x.

Morphological changes in eyes after suprachoroidal high-frequency electrosurgical treatment of the retina

A variety of methods and approaches are used for the surgical treatment of retinal detachment, among which high-frequency electrocoagulation through the suprachoroidal access has attracted the attention of researchers. The research question concerned the selection of the optimal mode of electrocoagulation with the help of a monopolar instrument of the original design, during which a strong chorioretinal adhesion occurs in a short period of time after surgical intervention, there is no need for tamponade, and the destruction of cells of chorioretinal structures is minimized, which is associated with the temperature factor of electrocoagulation. The study was conducted on 52 rabbits (104 eyes), which were divided into 4 groups: Group I – exposure voltage 10–12 V, frequency 66 kHz, current strength 0.1 A (16 animals, 32 eyes); Group II – exposure voltage 12–14 V, other parameters are identical (16 animals, 32 eyes); Group III – exposure voltage 14–16 V, other parameters are identical (16 animals, 32 eyes); Group IV– 4 intact rabbits, 8 eyes (control). The animals were euthanized, the eyes were enucleated. Fragments with areas after electrocoagulation were fixed on a device of the original design, which measured the strength of the chorioretinal adhesion on an electronic jewelry scale by pulling a thread tied to the sample until the sample ruptured. The tissues of the chorioretinal complex were also studied by light microscopy after staining histological sections with hematoxylin-eosin. According to indicators of chorioretinal junction strength, the optimal exposure voltage was 10–12 V. Destruction of cells of the chorioretinal complex at this voltage did not differ from destruction using voltages of 12–14 V and 14–16 V, but the strength of chorioretinal junction was the greatest after 1 hour. 1 week and 2 weeks after surgery. Keywords: high-frequency electrocoagulation, chorioretinal surgery, retinal detachment, strength of chorioretinal adhesion.

New possibilities of complex ttreatment of cervical ectropion

Introduction. Ectropion of the cervix (EC) is a condition when there is a cicatricial deformity of the uterine cervix (as a result of traumatic injuries) with visualization of the ectopic columnar epithelium on the vaginal part of it. The ectopia is currently classified as a variant of the normal histophysiological state of the cervix. This article discusses the features of the course and methods of treatment of complicated EC.Objective of the study is: to develop and evaluate the effectiveness of a new method of complex treatment of CE.Material and methods. In an open prospective study, 133 patients with CE (groups 1 and 2) and 56 healthy women (group 3) has taken part. In group 1 (n = 83), we have used a method for treating CE developed by us, which included two stages: stage I – elimination of microbial and viral pathogen in combination with immunomodulatory therapy, II – electrosurgical treatment (Leep biopsy) and treatment of the cervix with Galavit (100 mg of dry matter) dissolved in 5 ml of Miramistin (Patent for invention RU 2568768 C1). In group 2 (n = 50), surgical treatment of CE has been preceded by vaginal sanitation, empirical antibacterial and antiviral therapy. Diagnostic measures, in addition to standards, have included: determination of interleukins IL-1β, IL-6, IL-8, IL-10 in the discharge of the cervical canal, ultrasound diagnostics with Doppler measurements in the vessels of the central zone of the cervix. Statistica 7.0, SPSS 17 packages have been used for statistical processing.Results and discussion. Before the start of treatment, patients in groups 1 and 2 have been found to have a combination of CE with cervicitis (100%), ASCUS cytological picture (more than 60%), abnormal colposcopic signs (100%), imbalance of the local immune system with a predominance of Th1 cytokines (the content of IL-8 increased 2.6 times; IL-1b – 13 times; IL-6 – 20 times, and IL-10 – in 1.7 times) against the background of increased vascularization and cervical perfusion. The reparative process after Leep biopsy in group 1 has ended by the end of 3 weeks in 65.6% of patients, in group 2 – in 25.5%, after 5 weeks – in 100% and 57.4%, respectively, after 8 – in group 2, 91.5%. The average period of epithelialization of a wound on the cervix in group 1 was 27.4 ± 4.3 days, in group 2 – 39.5 ± 5.6 days (p = 0.01). After 2 years, the recurrence of cervical pathology has been recorded only in group 2 (34.0%).Conclusion. The use of the developed method of two-stage complex therapy for CE increases the effectiveness of treatment, prevents complications after Leep biopsy, accelerates epithelialization by 30.6% and avoids recurrence of the disease.

Cervicovaginal Microbiome after Cervical Intraepithelial Neoplasia Treatment. A Protocol for Systematic Review and Meta-Analysis.

(1) Background: The microbiome consists of microorganisms from various kingdoms with numerous physical and chemical properties Lactobacillus species constitute the highest percentage of healthy cervical and vaginal microbiota. Dysbiosis may cause adverse outcomes, e.g., bacterial vaginosis, pelvic inflammatory disease and pregnancy complications. The cervicovaginal microbiome might contribute to the development of a persistent HPV infection—the main risk factor of cervical cancer—and influence progression to malignancy The aim is to perform a systematic review of current literature and a meta-analysis regarding microbiome changes after cervical intraepithelial neoplasia treatment. (2) Methods: We will search PubMed, Scopus, Google Scholar and Embase Database and trace citations in the reference sections. Randomized and non-randomized controlled studies, case–control and cohort studies published between January 2000 and May 2021 will be included in the study protocol. The following keywords will be used: ‘microbiome’, ‘vaginal microbiome’, ‘cervical microbiome’, ‘cervical neoplasia treatment’, ’conization’, ‘electroconization’, and ‘electrosurgical treatment’. Statistical analyses will be performed using RevMan 5.4. (3) Results: The results will be published as a peer-reviewed article. (4) Conclusions: The study will show which forms of intraepithelial neoplasia treatment change the cervicovaginal microbiome. Finding the best form of treatment by studying the cervicovaginal microbiome after various forms of treatment is essential. Patients would benefit not only from the treatment of the initial disease but also the management of dysbiosis, which might underlie other pathologies.

Characterization of smoke generated during the use of surgical knife in laparotomy surgeries

ABSTRACTThe staff in hospitals is the high-risk group affected by indoor air pollution for operational reasons. However, there is a lack of relevant information and research on surgical smoke in Taiwan. This study analyses the substance of the smoke and develops relative strategies to prevent harm from the working place. This study aims to evaluate the surgical smoke generated during laparotomy and laparoscopic operation. The relationship between smoke and the risk of health-care workers was also discussed in order to set suitable solutions for smoke collection and emission. The study measured surgical smoke of 30 cases in operating rooms in three different hospitals, smoke was collected at different timings and different areas during the operation using a low-flow sampler. The concentration and accumulation number of size 0.3 μm suspended particles were the highest among all size of particles in different detection areas and timing. The concentration number of 0.3 μm and 0.5 μm particles reached the maximum after 10 min of electrosurgical treatment; however, the concentration number of 5 μm particles began to decrease after 5–15 min of the treatment. Besides, the cumulative particle numbers of 0.3 μm and 0.5 μm in laparoscopic operation were higher than those of laparotomy after 10 min of the treatment. This study suggests that surgical smoke prevention should use smoke evacuator; health-care workers should also wear a highly efficient tight seal-fit mask in the operating room to avoid damage to their health and cause chronic diseases.Implications: Indoor air pollution in medical institutions is a topic of less concern, and the health of healthcare workers is threatened by surgical smoke that generated during operations. This study measured and analyzed the harmful substances in the surgical smoke in the operating rooms of hospitals, and put forward the corresponding suggestions. In April 2018, legislators in Taiwan also convened a seminar on “Respiratory protection for operating room personnel in medical institutions”. The seminar applied the findings of this study and adopted the recommendations to improve related equipment and strategies in future plans.

An Electrical Circuit for Biological Tissue Simulation in Electrosurgery Models

In this article, an electrical equivalent circuit for simulation of the response of various tissues of the human body to electrosurgical treatment is proposed. The circuit can be used to optimize the output characteristics of electrosurgical devices.

Ассоциации уровня интерферона и клинических признаков различных типов вируса папилломы человека

Objective: to determine the compliance of the serum interferon level (IFN) with the clinical signs of the female reproductive system diseases in the presence of various types of human papillomavirus (HPV). Materials and methods. In total 250 women aged 23–37 years were divided into two groups. The main group I comprised patients with clinical manifestations of human papillomavirus infection (PVI). The control group was divided into two subgroups: group IIA included women who had HPV-positive PCR without clinical signs of PVI, in group IIB were enrolled clinically healthy women with HPV-negative PCR results. Digene HPV 6,11,16,18,26,31,33,35,39,44,45,51,52,53,56,58,59,68,69,73,82 test with viral load was performed; as well as examination for bacteria, chlamydia, myco- and ureaplasma. The IFN level in blood serum was detected in all patients. Results. In group I, the identified HPV types were responsible for the dysplastic processes of the genital organs. Viral load less than 3 Lg was observed in 28 (56.0%) patients of group I and 18 (36.0%) of group IIA, from 3 Lg to 5 Lg – in 67 (44.6%) patients of group I and 4 (8.0%) of group IIA. In group I, the level of 2–4 Lg was associated with high-grade dysplastic changes in the genital organs and skin of the perineal area, which require electrosurgical treatment. In the control subgroup with a higher level of serum interferon, clinical manifestations of PVI were not diagnosed. Conclusions. The HPV types 6, 11, 16, 18, 26, 31, 33, 35, 39, 44, 45, 51, 52, 53, 56, 58, 59, 68, 69, 73, 82 are associated with dysplastic diseases of the cervix, vagina, external genitalia; the prognosis of the disease and severity of dysplastic processes is connected with the viral load of 3 Lg to 5 Lg, as well as the IFN serum level. These tests may be recommended to predict the disease development and use in the comprehensive pregravid preparation.

Природные механизмы иммунитета в процессе элиминации вирусной инфекции

The objective: optimization of treatment of clinical symptoms and prevention of relapse infetsii virus (HSV, HPV) using immunomodulatory therapy alloferon. Patients and methods. The study included 50 patients aged 20 to 42 years with clinical manifestations of HPV in the form of warts of vulva, vagina, cervix, cervical dysplasia. Patients were divided into two groups according to the treatment received – the main group received Allokin-Alpha 1ml subcutaneous 6 injections, the comparison group – a-2b interferon 3 million 10 injections. Results. The group of patients treated with Allokin-аlfa, showed better clinical performance treatment of genital kondilomas lesions, decrease in the number of lesions in 6–12 days after initiation of therapy, decrease in the degree of dysplastic changes in the cervix, and the absence of relapse (in the control group 32% of patients had a relapse). No side effects as a result of Allokin-alpha has not been registered, while 76% of patients receiving a-interferon-2b expressed flu-like symptoms were observed, requiring additional purpose of detoxification drugs. Test results: in the main group had the elimination of HPV in 92% of cases, 78% in the control group; herpes – elimination of 96% of the cases in the main group and 75% in the comparison group. Conclusion The medicine Allokin-alpha is highly effective in the treatment of HPV and HSV infection, demonstrating good results of therapy, no relapse of infection. The recommended regimen – 6 injections of the drug prior to the electrosurgical treatment. Key words: human papillomavirus infection, herpes, Allokin-alpha, a-interferon-2b.

Low prevalence of oral and nasal human papillomavirus in employees performing CO2-laser evaporation of genital warts or loop electrode excision procedure of cervical dysplasia.

Risk of human papillomavirus (HPV) transmission during laser vaporisation of genital warts or loop electrode excision procedure is controversial. An oral rinse, a nasal swabs, history of HPV related diseases and data on HPV exposure were collected from 287 employees at departments of dermato-venerology and gynaecology in Denmark. A mucosal HPV type was found among 5.8% of employees with experience of laser treatment of genital warts as compared to 1.7% of those with no experience (p = 0.12). HPV prevalence was not higher in employees participating in electrosurgical treatment or cryotherapy of genital warts, or loop electrode excision procedure compared with those who did not. HPV 6 or 11 were not detected in any samples. Hand warts after the age of 24 years was more common among dermatology than among non-dermatology personnel (18% vs. 8.0%, p = 0.03). Mucosal HPV types are infrequent in the oral and nasal cavity of health care personnel, however, employees at departments of dermato-venereology are at risk of acquiring hand warts.

Idiopathic linear leukoplakia of gingiva: A rare case report

White lesions of the oral cavity are not uncommon though majority of them are benign. This case report documents a rare case of idiopathic linear leukoplakia of gingiva with no apparent etiology. Initial examination revealed a non-scrapable linear white lesion on the marginal and papillary gingiva of upper right teeth region. Incisional biopsy was taken for pathologic evaluation. Patient was treated with routine oral hygiene procedures and excision of the lesions. The histopathological results demonstrated hyperparakeratinized/orthokeratinized hyperplastic oral epithelium with orthokeratin-filled clefts and with no dysplasia. Clinical results demonstrated no recurrence after electrosurgical intervention. This paper reports a rare case of idiopathic linear leukoplakia of gingiva which was non-dysplastic in nature. Electrosurgical treatment proved to be successful compared to surgical technique as there was no recurrence even after two years of follow-up.

Randomised trial of excision vs. ablation for electrosurgical treatment of mild (r-AFS 1–2) endometriosis

Randomised trial of excision vs. ablation for electrosurgical treatment of mild (r-AFS 1–2) endometriosis

Grundlagen radiochirurgischer Systeme und ihre Anwendungen in der Arthroskopie

Electrosurgical devices are being used in each medical subdiscipline,and, only recently, they have found widespread distribution in the field of arthroscopic surgery, as well. This development is mainly due to the construction of small and relatively cheap devices that work in a bipolar mode at high frequency. A local plasma field is being built up between the electrodes at the tip of the probe which has enough energy to allow the disintegration of molecules within the treated tissue. The local current flow helps to minimize the numerous disadvantages of monopolar or Laser-based systems. Nevertheless, there is considerable discrepancy between the wide spectrum of clinical use on the one hand and the knowledge of mid- or even long-term biological effects on the treated tissue on the other. So far, clinical and experimental studies exist for the frequent indications of chondroplasty and capsular or ligamental shrinkage. But, still, there is no agreement upon these indications. Studies have shown a considerable number of dead chondrocytes or fibroblasts within a depth of several millimeters within the tissue of the joint capsule or the articular cartilage after electrosurgical treatment. But especially these cells are thought to be essential for the maintenance of the tissue. While the results of other studies seem to be less critical, some authors propose not to use electrosurgery in arthroscopy at all, until further studies prove the safety of these devises. Unfortunately, there is no reliable feedback system for the temperature increase within the treated tissue or other important parameters. The use of these instruments affords a high degree of experience from a skilled arthroscopic surgeon.

Disease Persistence in Patients with Cervical Intraepithelial Neoplasia Undergoing Electrosurgical Conization

Objective. Cone margin status has been reported to be the most important predictor of residual disease in patients with cervical intraepithelial neoplasia (CIN) undergoing electrosurgical excisional treatment. The primary aim of this study of patients treated with electrosurgical conization was to evaluate the association of cone margin status and other clinical and pathologic factors with the probability of residual disease.Methods. The study population comprised 699 patients with at least one follow-up visit within 12 months of conization. Residual disease was defined as a histology diagnosis of CIN within 3 years of conization. Multivariate associations were evaluated with multiple logistic regression analysis.Results. Attendance to follow-up was 97% for the second visit and 34% for the third visit. Residual disease was detected in a total of 38 patients (5.4%). The detection rate was 3.3% at the first visit, 2.1% at the second visit, and 0.4% at the third visit. An increased probability of residual disease was associated with a referral Pap smear reported as high-grade squamous intraepithelial neoplasia and carcinoma (odds ratio, 2.9; reference category, low-grade squamous intraepithelial neoplasia). A decreased probability was associated with a squamocolumnar junction entirely visible at the first follow-up visit (odds ratio, 0.2; reference category, squamocolumnar junction not visible). Patient age, time period, lesion size, lesion site, grade of CIN, cone width, cone depth, and margin status had no influence.Conclusions. The determinants of residual disease in this study differed from those generally reported so far. Factors associated with effectiveness of electrosurgical treatment of CIN need further research.

Treatment-dependent and treatment-independent pregnancy in women with minimal and mild endometriosis

In an attempt to evaluate the efficacy of electrosurgical treatment of endometriosis by laparoscopy, we compared the reproductive performance of women with minimal and mild endometriosis who were treated electrosurgically and who were treated expectantly. The probability of conception in the treated group was higher than in the nontreated group. It suggests that laparoscopic electrocoagulation of minimal and mild endometriosis improves PR. Because of the relatively small number of patients and the nonrandomized nature of this study, the conditions required for an ethical randomized trials in a larger group of patients are warranted.

Electrosurgical treatment of rhinophyma

Thirteen patients with moderate to severe rhinophyma were treated with electrosurgery. All patients achieved cosmetic improvement with minimal postoperative complications. Six of 13 patients noted an improvement in nasal breathing after treatment. Patients with a predominantly lobular rhinophyma achieved the best overall results whereas younger patients with generalized nasal hypertrophy were at the highest risk for scarring. This low-cost treatment was associated with few complications and gave excellent cosmetic results. A new clinical classification of rhinophyma has been developed on the basis of the patients in this series.

The use of instant developing film (Polachrome) for making 35-mm slides and prints

gastrointestinal tract. One patient had an esophageal stricture and the other had a postbulbar duodenal stricture. They used a coagulation current applied through a straight needle. Unlike the treatment of achalasia and strictures, the electrosurgical treatment of esophageal rings usually does not require cutting into the muscular layers since most of the rings consist only of mucosal and submucosal elements. The procedure is further facilitated by the distinct right angle between the thin diaphragm of the ring and the esophageal wall which aids in judging the proper depth of the electrosurgical incision. An advantage of the endoscopic electrosurgical approach over other mechanical nonsurgical approaches (bougienage, endoscopic rupture, and pneumatic dilation) is that precisely directed treatment of the ring (incision) can be made under direct visualization. Since the ring is actually being incised rather than stretched, the elasticity of the ring will not interfere with efficacy. The necessary equipment is widely available from commercial sources. Clearly, expertise in electrosurgical procedures is a prerequisite. Longterm results in larger numbers of patients are needed to further evaluate this procedure. It may become a useful modality in the treatment of lower esophageal rings for which bougienage has been impossible or ineffective.

Endoscopic electrosurgical treatment for strictures of the gastrointestinal tract

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Giant-cell tumour-like changes in the maxilla

The authors have analysed 194 cases of giant-cell tumourlike changes of the jaws observed in the hospital over a period of 25 years. On the basis of histological examination and clinical as well as radiological assessment of these cases, diagnostic criteria of this granuloma have been proposed. Neoplastic giant-cell tumours are excessively rare in the jaws. The method of choice in treatment of reparative granulomas is moderately radical operation with removal of the lesion to the margins of healthy tissue or electrosurgical treatment. After non-radical operation reparative granulomas show a tendency to local recurrence.