Electrosurgical Treatment Research Articles

Electrosurgical treatment of experimental bleeding canine gastric ulcers: Development and testing of a computer control and a better electrode

Systematic evaluation of the efficacy and safety of endoscopic electrocoagulation of gastrointestinal bleeding has been thwarted by the inability to quantify or control energy delivered to tissue. An analogue computer has been developed which can be inserted in the circuit between a commercial electrosurgical generator and the active electrode. It can record the actual energy delivered to the tissue at any arbitrary generator setting. Additionally, it can deliver a predetermined amount of energy by continuously adjusting the voltage of the generator to compensate for changes in the tissue impedance during electrocoagulation (power leveling). A special electrode has been devised to assure the reproducibility of the area of tissue contact. By using a force gauge at laparotomy with a predetermined energy of 20 joules, the effect of electrode pressure on the depth of injury was measured. Light pressure (1.3 newtons per cm2) injured a mean of 36% and moderate pressure (6.4 newtons per cm32) a mean of 87% of gastric wall thickness. Electrocoagulation applied in the clinical manner, or predetermined by power leveling, stopped all bleeding from experimental gastric ulcers with the same amount of energy for each method. Similarly, chronic studies of the depth of injury with each method of electrocoagulation showed no difference. Furthermore, the whole thickness of the gastric wall was injured in 4% of ulcers treated, and there was no significant difference between the two methods of applying the electrocoagulation. Thus, despite our ability to control energy delivered during monopolar electrocoagulation of experimental gastric ulcers, the depth of injury to the gastric wall was unpredictable and, at times, excessive. Further studies of other types of electrocoagulation are needed and will be facilitated by the availability of this computer-controlled electrosurgical generator.

Surgical gems: Electrosurgical treatment of rhinophyma.

Surgical gems: Electrosurgical treatment of rhinophyma.

Satellitenförmige Rezidive bei teleangiektatischem Granulom

Following the normal electrosurgical treatment of a granuloma pyogenicum of the chin, a 55-year-old male responded with repeated relapses in the form of multiple nodules. Inspite of their alarming macroscopic aspect, such multiple satellite recurrences are not malignant. The etiology remains obscure.

Some effects of diathermy currents on eye tissue.

Most surgical procedures for the treatment of retinal detachment employ the use of high-frequency currents, conveyed to the site by a needle electrode. The local heating produced by the passage of these currents stimulates an adhesive choroiditis.¹The surgeon has little idea of the amount of current generated by his machine, nor does he measure the current that passes into the tissue. Needles of different diameter, different length, and different active surface are used. It is not surprising that the results of treatment are variable and that sometimes side-effects follow electrosurgical treatment.²It is imperative to determine and to quantify the current characteristics which will produce the desired therapeutic effect without causing unnecessary injury to the tissue. This study was undertaken to determine the extent to which these requirements can be met, with use of equipment commonly employed in this type of surgery. The current most frequently used

Submucosal saline wheal as safety factor in fulguration or rectal and sigmoidal polypi.

SURGICAL textbooks emphasize the need for care in the electrosurgical treatment of adenomatous polypi of the upper rectum and sigmoid colon, particularly when the lesion is on the anterior rectal wall or above the peritoneal reflection. In these areas, through-and-through coagulation of the colonic wall may lead to (1) injury to the vagina, in the female, or to the seminal vesicles or bladder, in the male; (2) delayed hemorrhage, when separation of too deep a slough uncovers a blood vessel of large size; (3) intestinal obstruction due to adhesion of a loop of small bowel to serosal exudate over a coagulated area, 1 or (4) peritonitis, when the necrotic area borders on peritoneum. The true incidence of such complications is not known, and it is reasonable to assume that the occasional fatality, with the unfavorable stigma it attaches to the operating surgeon, is not always reported in the literature. In

Surgery of rectal diseases by electrothermic methods: Based on 1,100 cases

1. 1. A brief résumé of the electrosurgical treatment of rectal diseases has been presented. 2. 2. Over 1,100 cases have been treated by methods described. 3. 3. Compared with other methods the following advantages are claimed: 3.1. (a) Under suitable conditions, most patients may be treated in the office. 3.2. (b) There are no complications, such as serious infection, fissure, fistula, ulcer, abscess, stricture or incontinence. 3.3. (c) There is no blood loss. 3.4. (d) Secondary hemorrhage is rare. 3.5. (e) Recurrence is extremely rare. 3.6. (f) Convalescence is much shorter and much more comfortable than with other methods.

Puerperal cervix

1. 1. Cervical injury of some degree occurs in the majority of vaginal deliveries. 2. 2. If not healed in eight weeks these injuries favor the future development of chronic cervicitis, endocervicitis and hypertrophy. 3. 3. These common cervical lesions are a frequent source of serious pelvic disease. 4. 4. Under suitable conditions immediate repair of childbirth cervical injuries tends to prevent the more serious common lesions of the cervix. 5. 5. At the eighth week of the puerperium cervical lacerations, erosions and endocervicitis may be corrected in the office by electrosurgical treatment. Electrosurgical coagulation is the method of choice. 6. 6. Too extensive destruction of tissue with carbonization and cauterization tends to heal with excess fibrous tissue, leading to stenosis. 7. 7. Healing follows electrocoagulation without excess fibrosis. The surface is covered with normal squamous epithelium. Subsequent labors show no cervical dystocia.

THE IMMUNOLOGIC ASPECT OF ELECTROSURGERY IN RHINOLARYNGOLOGY

In 1932 I 1 described a reaction, specific in nature, which occurs with each electrosurgical treatment of an infected focus. Subsequent observations have brought to light a rational explanation for the immunity which follows electrocoagulation. In order that a scientific appraisal of this so-called autogenous vaccine may be made, an analysis of the reaction in 100 patients on whom electrosurgical tonsillectomy was performed has been undertaken. The throat of each patient was swabbed and the predominant organism isolated by smear and culture at the initial treatment. A measured dose of electrocoagulation, desiccation and fulguration was given each patient at each weekly sitting. The time at which the reaction occurred, its duration, type and severity, whether local or general in scope, were noted and recorded in each case. It has been apparent for some time that patients responded with a marked degree of variation in the

Electrosurgical Treatment of Hemorrhoids

Electrosurgical Treatment of Hemorrhoids