Monopolar Electrocautery Research Articles

Periprosthetic Femoral Condyle Fracture After Total Knee Arthroplasty and Saline-coupled Bipolar Sealing Technology

Saline-cooled bipolar radiofrequency technology has emerged as an effective method to reduce bleeding during total knee arthroplasty (TKA). No significant osseous complications have been previously reported, and animal studies have revealed no difference in bone healing, strength, or osteonecrosis compared to conventional monopolar electrocautery. This article presents 4 cases of early postoperative periprosthetic femoral condyle fractures after extensive use of saline-cooled bipolar radiofrequency requiring revision TKA. Preoperative, intraoperative, and postoperative details from 4 patients who underwent early TKA revision for periprosthetic femoral condyle fractures were retrospectively reviewed. The senior author (M.M.) had not experienced similar condyle fractures postoperatively in over 2,500 primary TKAs performed over 2 decades. The cases described here were performed between July 2009 and November 2009, shortly after increasing the usage of saline-cooled bipolar radiofrequency on the synovium overlying the femoral condyles for hemostasis. No other change in surgical technique or implant that occurred during this time was observed. The senior author has significantly decreased his use of saline-cooled bipolar radiofrequency and has seen no recurrence of these complications.

Electromagnetic interference in a cardiac pacemaker during cauterization with the coagulating, not cutting mode

Electromagnetic interference in pacemakers has almost always been reported in association with the cutting mode of monopolar electrocautery and rarely in association with the coagulation mode. We report a case of electrocautery-induced electromagnetic interference with a DDDR pacemaker (dual-chamber paced, dual-chamber sensed, dual response to sensing, and rate modulated) in the coagulating and not cutting mode during a spine procedure. We also discuss the factors affecting intraoperative electromagnetic interference. A 74-year-old man experienced intraoperative electromagnetic interference that resulted in asystole caused by surgical electrocautery in the coagulation mode while the electrodispersive pad was placed at different locations and distances from the operating site (This electromagnetic interference did not occur during the use of the cutting mode). However, because of careful management, the outcome was favorable. Clinicians should be aware that the coagulation mode of electrocautery can cause electromagnetic interference and hemodynamic instability. Heightened vigilance and preparedness can ensure a favorable outcome.

Safety of Electronic Home Monitoring Devices in the Operating Room

Due to increasing financial burden on the penal systems to keep offenders in the prisons, there have been increasing uses of electronic home monitoring devices to place “less risky” offenders under house arrest. These devices on several occasions have malfunctioned and caused electrical harm to wearers in cases of power surges and lightning strikes. Due to its relative novelty, there is no consensus or guidelines in the literature on how to manage patients with electronic home monitoring devices in surgical cases using monopolar electrocautery which can deliver charges that could potentially cause harm or malfunction of the monitoring system. Recently, we encountered a patient who needed bilateral cranioplasty procedures but had been placed on house arrest unbeknownst to us. During the surgery, we packed several gauzes in between the patient and the device and placed the electrocautery pad on the contralateral leg with power set at 20 MHz. The surgery was performed without any adverse outcome and the patient did well after surgery.

Comparative use of CO2 laser, diode laser and monopolar electrocautery for resection of the soft palate in dogs with brachycephalic airway obstructive syndrome

Clinical results, complications and the outcome of using either a carbon dioxide (CO2) laser, diode laser or electrocautery (ELEC) for resection of the soft palate with an extended palatoplasty technique...

Tissue welding tonsillectomy provides an enhanced recovery compared to that after monopolar electrocautery technique in adults: a prospective randomized clinical trial

We have compared tonsillectomy (TE) with tissue welding (TW) technology using a specially designed forceps versus conventional monopolar electrocautery to evaluate whether this new technology may improve recovery after TE. This was a single-blind, randomized clinical trial with two parallel groups. Sixty healthy adult day-surgery patients were allocated into the TW-TE group (n = 31) and the monopolar electrocautery-TE group (n = 29). We recorded intraoperative events and short- and long-term recovery for 2 weeks postoperatively. The patients and study nurses evaluating patients during recovery were blinded to the operation method used. All patients in the TW-TE group completed the study as per protocol, but in the monopolar electrocautery-TE group, there was one drop-out in the hospital and another after discharge. There was no difference in the perioperative parameters and early recovery between the two groups. After discharge, recovery was significantly faster in the TW group than in the monopolar group: (1) the duration of postoperative pain was 2 days shorter, and (2) activities of normal daily living were less affected, and (3) the need for hospital contacts after discharge, and (4) the incidence of postoperative bleeding was less in the TW group than that in the monopolar group. No patients in the TW group developed secondary bleeding versus three patients in the monopolar group requiring electrocautery to control bleeding. In conclusion; our results indicate that, TW technique may provide reduced pain, faster recovery, and fewer complications compared to electrocautery TE.

Postoperative Complications of Powered Intracapsular Tonsillectomy and Monopolar Electrocautery Tonsillectomy in Teens versus Adults

This study was performed to determine whether teens have different rates of posttonsillectomy hemorrhage, admission for dehydration, or recurrent tonsillitis compared to adults. Specifically, these parameters were compared within two groups: patients who underwent powered intracapsular tonsillectomy (PIT) and those who underwent monopolar electrocautery tonsillectomy (MET). In a retrospective review of 579 patients at least 12 years of age from January 2000 to July 2006 in a tertiary referral center, outcome measures of reoperation for hemorrhage, readmission or emergency room visit for dehydration, and postoperative tonsillitis were compared for 200 patients 12 to 19 years of age and 379 patients more than 19 years of age. These outcome measures in teens were compared to those in adults who had tonsillectomy by the same technique (101 teens who underwent PIT compared to 117 adults who underwent PIT, and 99 teens who underwent MET compared to 262 adults who underwent MET). Outcome measures were also compared within the PIT and MET groups based on the indication for surgery (chronic tonsillitis, tonsillar hypertrophy, or both). In comparing teens to adults who underwent the same technique (PIT versus PIT, or MET versus MET), no statistically significant differences existed in the incidence of hemorrhage, dehydration, or postoperative tonsillitis. Greater hemorrhage rates for adults who underwent MET compared to teens, however, almost met statistical significance (p = 0.053). Analyzing complication rates by indication within the PIT and MET groups exclusively revealed higher rates of hemorrhage in adults who underwent the MET technique for the indication of chronic tonsillitis. Within the PIT comparison, no significant differences were found on the basis of indication for surgery. Teenage patients who undergo tonsillectomy should be considered unique as far as complication rates are concerned. Comparison of technique-specific complication rates between adults and teens showed no significant differences in either the PIT or MET groups, although adults who underwent MET had greater hemorrhage rates that almost met significance (p = 0.053). Adults who were undergoing tonsillectomy for chronic tonsillitis were more likely than teens to encounter postoperative hemorrhage if they underwent the MET technique.

Inferior nasal turbinate wound healing after submucosal radiofrequency tissue ablation and monopolar electrocautery: Histologic study in a sheep model

To study differences in inferior nasal turbinate (INT) mucosal and submucosal wound-healing histology after radiofrequency tissue ablation (RTA) and monopolar electrocautery (MEC). Randomized controlled trial. Experimental study in sheep. Using hematoxylin- and eosin-stained sections, stromal fibrosis, submucosal interstitial space volume (ISV), mucosal epithelial cell necrosis, submucosal inflammation, and vascularization in inferior turbinate samples were compared after RTA and MEC. Twelve turbinate samples were studied for each technique after 1, 3, and 8 weeks postoperatively (four samples at each time point) and there were five samples of controls. A 4-point semiquantitative histologic grading scale (0 = absence, 1 = mild, 2 = medium, 3 = pronounced) was used to assess changes. Comparisons were performed using the Mann-Whitney test and the Kruskal-Wallis one-way analysis of variance (ANOVA). At postoperative week 8, the RTA group had more extensive fibrosis (P = .061) and ISV reduction (P = .127), less epithelial cell necrosis (P = .131), and significantly less submucosal inflammation (P = .036) and vascularization (P = .011) compared with the MEC group. Epithelial cell necrosis and submucosal inflammation at week 8 did not differ significantly between RTA and control group (P = 1.000 and P = .356, respectively). A significant decrease in submucosal layer vascularization in RTA-treated INTs has been observed (P = .003 compared with controls). RTA is more effective (although not significantly) and less invasive than MEC for INT volume reduction. Tissue damage and wound healing were dominated by inflammation and associated epithelial cell necrosis in MEC and by a disturbance in the INT submucosal microcirculation in RTA in the studied sheep model.

Determination of optimal monopolar coagulation settings for upper GI bleeding in a pig model

Monopolar electrocautery has had a limited role in the endoscopic therapy of nonvariceal upper GI bleeding because of the lack of specifically designed endoscopic instruments and limited data on how to use this technology for endoscopic applications. To determine the optimal power settings and durations of endoscopic monopolar electrocautery for nonvariceal gastric bleeding. Twelve pigs underwent creation of cautery lesions by using a novel monopolar electrocautery device designed for endoscopic hemostasis control. The efficacy as measured by the depth of cautery and safety of monopolar electrocoagulation were evaluated in acute and survival phases. Monopolar electrocautery was applied to the stomach with power settings of 25, 50, and 75 W for durations of 2 to 5 seconds. The extent of cautery injury was assessed histologically by a blinded pathologist. An optimal cautery effect was achieved with 50 W of power and durations of cautery of 2 and 3 seconds. For 25 W, durations of cautery of 4 and 5 seconds resulted in good but often superficial cautery effect. For 75 W, durations of cautery of 2 and 3 seconds resulted in good cautery effect, but with marginal safety. The visual diameter of monopolar cautery lesions correlated with the histological depth of the cautery lesions. No adverse effects were observed. Study conducted in a nonbleeding pig stomach model; thus, results may not apply to control of GI bleeding in patients. Based on a nonbleeding pig model, we suggest that the initial settings for monopolar soft coagulation in clinical use should be 50 W for 2 to 3 seconds.

The Effect of Nonperitonization and Laparoscopic Lymphadenectomy for Minimizing the Incidence of Lymphocyst Formation After Radical Hysterectomy for Cervical Cancer

To determine the clinical effect of nonperitonization and laparoscopic lymphadenectomy using bipolar electrocautery after radical hysterectomy for cervical cancer compared with peritonization and open lymphadenectomy using monopolar electrocautery. This was a retrospective study of 180 patients who underwent a radical hysterectomy and pelvic lymph node dissection (PLND) for cervical cancer from August 1998 to August 2007. The patients were composed of the Peritonization + Laparotomy group (group A; n = 98, 196 PLND) and the Nonperitonization + Laparoscopy group (group B; n = 82, 164 PLND). Group B left the peritoneum in front of the PLND open. Two closed-suction drains were placed at each side of the PLND. Group B statistically showed a lesser total amount of lymphatic drainage (P = 0.001), shorter duration of inserted drains (P < 0.001), and shorter length of hospital stay (P < 0.001), compared with group A. The formation of lymphocysts occurred in 30 patients (41 lymphocysts) of group A and 5 patients (5 lymphocysts) of group B. Lymphocyst formation of group B had a statistically lower incidence than that of group A (P < 0.001). Lymphocyst formation was associated with an increase in the total amount of lymphatic drainage in group A (P = 0.090) and group B (P = 0.041) and a pathologic type of adenocarcinoma in group B (P = 0.016). Surgical experiences were not correlated with lymphocyst formation. The omission of peritonization and laparoscopic lymphadenectomy using bipolar electrocautery in early-stage cervical cancer were more effective than peritonization and open lymphadenectomy using monopolar electrocautery in minimizing the incidence of lymphocyst formation.

Natural orifice transgastric endoscopic wedge hepatic resection in an experimental model using an intuitively controlled master and slave transluminal endoscopic robot (MASTER)

The lack of triangulation of standard endoscopic devices limits the degree of freedom for surgical maneuvers during natural orifice transluminal endoscopic surgery (NOTES). This study explored the feasibility of adapting an intuitively controlled master and slave transluminal endoscopic robot (MASTER) the authors developed to facilitate wedge hepatic resection in NOTES. The MASTER consists of a master controller, a telesurgical workstation, and a slave manipulator that holds two end-effectors: a grasper, and a monopolar electrocautery hook. The master controller is attached to the wrist and fingers of the operator and connected to the manipulator by electrical and wire cables. Movements of the operator are detected and converted into control signals driving the slave manipulator via a tendon-sheath power transmission mechanism allowing nine degrees of freedom. Using this system, wedge hepatic resection was performed through the transgastric route on two female pigs under general anesthesia. Entry into the peritoneal cavity was via a 10-mm incision made on the anterior wall of the stomach by the electrocautery hook. Wedge hepatic resection was performed using the robotic grasper and hook. Hemostasis was achieved with the electrocautery hook. After the procedure, the resected liver tissue was retrieved through the mouth using the grasper. Using the MASTER, transgastric wedge hepatic resection was successfully performed on two pigs with no laparoscopic assistance. The entire procedure took 9.4 min (range, 8.5-10.2 min), with 7.1 min (range, 6-8.2 min) spent on excision of the liver tissue. The robotics-controlled device was able to grasp, retract, and excise the liver specimen successfully in the desired plane. This study demonstrated for the first time that the MASTER could effectively mitigate the technical constraints normally encountered in NOTES procedures. With it, the triangulation of surgical tools and the manipulation of tissue became easy, and wedge hepatic resection could be accomplished successfully without the need for assistance using laparoscopic instruments.

Use of the PlasmaJet® System in Patients Undergoing Abdominal Lipectomy Following Massive Weight Loss: A Randomized Controlled Trial

Abdominoplasty has become a popular body-contouring procedure among patients with deformity resulting from massive weight loss. We present the results of a randomized controlled trial comparing the PlasmaJet® System (PJS) and conventional monopolar electrocautery for the treatment of the dissection surfaces in patients undergoing corrective abdominoplasty following massive weight loss. Sixty consecutive patients were randomized to undergo abdominoplasty either with conventional monopolar electrosurgery or PJS. The two groups were comparable regarding demographics, associated conditions, smoking habits, type and number of previous bariatric procedures, amount of lost weight, as well as previous abdominal scars. The primary end point was the rate of procedure-related postoperative complications and secondary end points were the time of wound drainage, total accumulated fluid drainage volume, the duration of hospital stay, and patients' satisfaction. There were significantly less postoperative complications in the PJS group, namely wound infection (p < 0.05). There was no difference in the total amount of fluid output from the abdominal drains but the latter were retrieved 1day before on average in the PJS group, and patients in the PJS group were discharged on average 1day before patients in the control group. Overall, better cosmetic results were obtained in the PJS group (p < 0.05). Patients undergoing abdominoplasty with the PJS showed a lower rate of postoperative complications (p < 0.05), were discharged on average 1day before patients in the control group and had better cosmetic results (p < 0.01).

Dissection by ultrasonic energy versus monopolar electrosurgical energy in laparoscopic cholecystectomy.

Laparoscopic cholecystectomy is the gold standard for management of symptomatic gallstones. Electrocautery remains the main energy form used during laparoscopic dissection. However, due to its risks, search is continuous for safer and more efficient forms of energy. This review assesses the effects of dissection using ultrasonic energy compared with monopolar electrocautery during laparoscopic cholecystectomy. A literature search of the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE, and EMBASE was performed. Studies included were trials that prospectively randomized adult patients with symptomatic gallstone disease to either ultrasonic or monopolar electrocautery dissection during laparoscopic cholecystectomy. Data were collected regarding the characteristics and methodological quality of each trial. Outcome measures included operating time, gallbladder perforation rate, bleeding, bile leak, conversion rate, length of hospital stay and sick leave, postoperative pain and nausea scores, and influence on systemic immune and inflammatory responses. For metaanalysis, the statistical package RevMan version 4.2 was used. For continuous data, Weighted Mean Difference (WMD) was calculated with 95% confidence interval (CI) using the fixed effects model. For Categorical data, the Odds Ratio (OR) was calculated with 95% confidence interval using fixed effects model. Seven trials were included in this review, with a total number of 695 patients randomized to 2 dissection methods: 340 in the electrocautery group and 355 in the ultrasonic group. No mortality was recorded in any of the trials. With ultrasonic dissection, operating time is significantly shorter in elective surgery (WMD -8.19, 95% CI -10.36 to -6.02, P<0.0001), acute cholecystitis (WMD -17, 95% CI -28.68 to -5.32, P=0.004), complicated cases (WMD -15, 95% CI -28.15 to -1.85, P=0.03), or if surgery was performed by trainee surgeons who had performed <10 procedures (P=0.043). Gallbladder perforation risk with bile leak or stone loss is lower (OR 0.27, 95% CI 0.17 to 0.42, P<0.0001 and OR 0.13, 95% CI 0.04 to 0.47, P=0.002 respectively), particularly in the subgroup of complicated cases (OR 0.24 95% CI 0.09 to 0.61, P=0.003). Mean durations of hospital stay and sick leave were shorter with ultrasonic dissection (WMD -0.3, 95% CI -0.51 to -0.09, P=0.005 and WMD -3.8, 95% CI -6.21 to -1.39, P=0.002 respectively), with a smaller mean number of patients who stayed overnight in the hospital (OR 0.18, 95% CI 0.03 to 0.89, P=0.04). Postoperative abdominal pain scores at 1, 4, and 24 hours were significantly lower with ultrasonic dissection as were postoperative nausea scores at 2, 4, and 24 hours. Based on a few trials with relatively small patient samples, this review does not attempt to advocate the use of a single-dissection technology but rather to elucidate results that could be used in future trials and analyses. It demonstrates, with statistical significance, a shorter operating time, hospital stay and sick leave, lower gallbladder perforation risk especially in complicated cases, and lower pain and nausea scores at different postoperative time points. However, many of these potential benefits are subjective, and prone to selection, and expectation bias because most included trials are unblinded. Also the clinical significance of these statistical results has yet to be proved. The main disadvantages are the difficulty in Harmonic scalpel handling, and cost. Appropriate training programs may be implemented to overcome the first disadvantage. Cost remains the main universal issue with current ultrasonic devices, which outweighs the potential clinical benefits (if any), indicating the need for further cost-benefit analysis.

Comparison of radiofrequency and monopolar electrocautery tonsillectomy

To compare the efficacy and safety of radiofrequency and monopolar electrocautery tonsillectomy, regarding operation duration and tonsillectomy morbidity, including post-operative pain and haemorrhage and tonsillar fossa healing, in patients with recurrent chronic tonsillitis. A prospective, randomised, double-blind, controlled clinical study. Fifty patients aged over 10 years who required tonsillectomy were randomly assigned to have one tonsil removed by radiofrequency and the other by monopolar electrocautery. Operation duration, post-operative haemorrhage, post-operative pain and tonsillar fossa wound healing were compared. The mean +/- standard deviation of the operation duration required for the radiofrequency method was significantly longer than that for monopolar electrocautery: 8.1 +/- 1.6 minutes vs 7.3 +/- 1.5 minutes, respectively (p = 0.034). Post-operative haemorrhage was observed in only three patients (13.6 per cent). Inter-group analysis showed no significant differences in post-operative pain scores for the radiofrequency vs monopolar electrocautery methods (3.7 +/- 1.6 vs 3.3 +/- 1.4, respectively; p < 0.126). Inter-group analysis showed that tonsillar fossa wound healing scores evaluated on the fifth, 10th and 14th post-operative days were significantly higher in the radiofrequency group compared with the monopolar electrocautery group (p < 0.001). The present study results indicated that monopolar electrocautery tonsillectomy was superior to radiofrequency tonsillectomy in terms of post-operative tonsillar fossa wound healing; however, both techniques were comparable in terms of post-operative pain.

Difficult‐to‐Control Bleeding

A 12-year-old girl presented for excision of a nevus sebaceous of the scalp. The surgery was complicated by unexpected difficult-to-control bleeding in the operating room. Numerous attempts to obtain hemostasis were unsuccessful including the use of local anesthetic containing epinephrine, direct pressure, wall suction, monopolar electrocautery using different tip sizes, sponge sticks, and Gelfoam. Finally bleeding was contained using a suction-electocautery unit frequently used by otolaryngology. This article reviews the usual causes of unexpected bleeding in the pediatric population and both familiar and unfamiliar methods to control operative bleeding.

Optimizing Monopolar Coagulation Therapy for Non-Variceal Upper Gastrointestinal Bleeding

Purpose: Despite current endoscopic therapeutic modalities, the mortality for non-variceal upper gastrointestinal (GI) bleeding remains at 5 to 10%. Monopolar electrocautery is a proven technology for hemorrhage control in the operating room; however its use in non-variceal upper GI bleeding has been limited by unavailability of appropriate endoscopic devices and the lack of experience with this treatment modality. This study was designed to determine the optimal performance characteristics of an endoscopic monopolar electrocautery device for the upper GI tract. Methods: Female domestic pigs underwent upper endoscopy with inspection of the esophagus and stomach, followed by creation of cautery lesions using a monopolar electrocautery device designed for endoscopic hemostasis control (Coagrasper, Olympus Inc.). Various power settings and durations of coagulation were applied to the greater curve of the stomach. A total of 12 cautery lesions were created in a systematic grid with 2 cm between each lesion. The cautery energy level was tested at 25, 50 and 75 Watts (W), and durations for each of energy level of 2, 3, 4 and 5 seconds using the ESG-100 electrosurgery generator (Olympus Inc.). The extent of cautery was assessed histologically by a pathologist blinded to power settings and treatment durations. The safety of prolonged durations of monopolar coagulation was also evaluated. Results: Four pigs with mean body weight of 58 ± 15 kg were used. The mean diameter of the cautery lesion measured 4.3 ± 1.7 mm for 25W at 2 seconds, with injury reaching only the mucosa; for 25W at 3, 4 and 5 seconds, the lesions measured 4.8 ± 0.5 mm, 5.0 ± 0.0 mm and 6.0 ± 0.8 mm respectively, and the depth of injury reached muscularis mucosa. For lesions created using 50W, the cautery diameter measured 6.8 ± 1.3 mm at 2 seconds, 8.0 ± 2.0 mm at 3 seconds, 8.8 ± 2.1 mm at 4 seconds and 9.0 ± 2.9 mm at 5 seconds. At 50W, the depth of injury reached the submucosa in 50%. For lesions created using 75W, the cautery diameter measured 8.0 ± 0.8 mm at 2 seconds, 9.0 ± 1.8 mm at 3 seconds, 9.3 ± 1.3 mm at 4 seconds and 11.5 ± 2.4 mm at 5 seconds. At 75W, the depth of injury also reached the submucosa in 50%. To determine clinical safety, the duration of coagulation was prolonged to 30 seconds for 25W, 15 seconds for 50W, and 14 seconds for 75W; no acute perforations resulted. Conclusions: The optimal settings for monopolar coagulation during upper endoscopy appear to be 25 watts with durations of therapy between 3 to 5 seconds. Monopolar coagulation is an alternative modality for endoscopic management of non-variceal upper gastrointestinal bleeding.

Laparoscopic Splenectomy in Goats

To report laparoscopic splenectomy in goats. Experimental study. Healthy female goats (n=9); aged, 10-18 months; weighing, 22-30 kg. Food was withheld for 24 hours and water for 10 hours. Anesthetized right laterally recumbent goats had a laparoscopic portal and 3 instrumental portals created in the left flank. Splenic attachments were dissected with monopolar electrocautery and blunt dissection through 2 instrument portals. Exposure and isolation of splenic vessels was performed with laparoscopic "right-angle" preparation forceps. Vessels were ligated with a medium-titanium clip and 2 silk sutures and then transected between the silk sutures. The detached spleen was manipulated into a specimen retrieval bag, morcellated, and the bag retrieved through an enlarged portal. Repeat laparoscopic examination was performed at 1 month. Laparoscopic splenectomy required 70 minutes (range, 52-88 minutes) and was successful without major intraoperative and postoperative complications. Postoperatively, all goats had signs of mild abdominal discomfort. On repeat laparoscopy, with the exception of 1 goat that had a focal omental adhesion to the enlarged portal site, no other abnormalities were identified. Laparoscopic splenectomy can be accomplished in goats using 4 portals in the left flank and a combination of monopolar cautery dissection of splenic attachments, ligation of vessels using metal clips and intracorporeal ligatures, and intra-abdominal morcellation of the detached spleen in a specimen retrieval bag. Laparoscopic splenectomy is an effective and safe technique in goats.

Laparoscopic cholecystectomy in the elderly

Methods We conducted a retrospective study evaluating the medical records of 40 consecutive patients age 70 or older who underwent laparoscopic cholecystectomy at the Department of Surgical Sciences, Organ Transplantation and Advanced Technologies, Oncology Surgery Unit, University of Catania, Italy. Data included age and gender, American Society of Anaesthesiologists (ASA) score, comorbid illness, prior abdominal surgery, presentation, operative time, conversion rate and reasons for conversion, postoperative morbidity and mortality rates, pathologic diagnosis, and length of hospital stay. Patients were classified as having complicated (acute cholecystitis, biliary pancreatitis, obstructive jaundice, and cholangitis) or uncomplicated (biliary pain) gallstone disease. Ultrasonography evidence of a dilated common duct or presence of common duct stones, serum elevations in alkaline phosphatase, transaminase, or bilirubin were indications for preoperative magnetic resonance cholangiography. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) with removal of possible common duct stones was performed in the patients suspected of having choledocholithiasis. The timing for LC in patients with acute cholecystitis was 24–72 hours from admission. Patients with acute pancreatitis related to gallstone disease underwent surgery after resolution of clinical and biochemical symptoms. The supportive treatment during the acute phase consisted of intravenous infusion, antibiotics, and nasogastric suction when necessary. Early surgery was defined as laparoscopic cholecystectomy during the initial hospitalization usually within 5 days, whereas patients undergoing delayed surgery were treated conservatively, discharged, and readmitted for elective operation. Patients were included if surgery was performed primarily for symptomatic gallstone disease and excluded if cholecystectomy was performed incidentally or secondary to another procedure. Laparoscopic cholecystectomy was performed using a standard four-trocars technique. An open technique was used in all cases to introduce the subumbilical cannula as previously described by our group. Dissection of the gallbladder from the liver was accomplished using monopolar electrocautery. Intraoperative cholangiography was performed selectively to assist in defining the anatomy or intraoperative abnormalities. A closed suction drainage was used in all procedures.

Extensive tissue damage after bipolar ovarian drilling compared to monopolar electrocautery or CO2 laser

OBJECTIVE: Ovarian drilling has been used for years in polycystic ovary syndrome (PCOS), but the amount of inflicted ovarian damage is unknown. The aim of this study is to evaluate the size of tissue damage caused by the most frequently used ovarian drilling techniques. DESIGN: Experimental prospective design. MATERIALS AND METHODS: We tested the 1) carbon dioxide (CO2) laser, 2)monopolar and 3)bipolar electrocoagulation (EC) for in vitro ‘ovarian drilling’ on 6 fresh bovine ovaries per technique.Table 1Power and length of stimulation per ovarian drilling technique (based on literature)TechniquePower (Watt)Length of stimulation (seconds)Length of needle inserted (mm)CO2 laser256Not applicableMonopolar electrocoagulation30410Bipolar electrocoagulation25Variable approx. 2-5 (auto-stop function)15 Open table in a new tab After drilling the ovaries were put in formalin before preparation by the pathologist. Each ovary was analysed separately and 3 completely evaluable lesions were used to measure the tissue damage per burn per ovary. One-way ANOVA (Bonferroni Post-Hoc test) was perfomed and a P-value of < 0.05 was considered significant. RESULTS: The CO2 laser induced a superficial cone shaped scar, the mono- and bipolar EC resulted in deeply penetrating cylinder shaped burns. Bipolar EC resulted in significantly more destruction per drilling than the other techniques.Table 2Tissue damage per lesion and assumed damage after extrapolation to regular clinical applicationTechniqueMean tissue damage per burn (mm3) (+/-SD) n=6Number of punctures normally appliedEstimated total damage (mm3) (+/-SD)CO2 laser24.0 (+/-8.5)25599 (+/-213)Monopolar electrocoagulation70.0 (+/-21.4)10700 (+/-214)Bipolar electrocoagulation287.6 (+/-65.1)∗P<0.05.102876 (+/-651)∗P<0.05.∗ P<0.05. Open table in a new tab After multipling the found damage per lesion by the usually applied number of punctures (based on literature) the bipolar EC resulted again in significantly more tissue damage. CONCLUSIONS: The amount of tissue damage caused by ovarian drilling is substantial and differs highly between the methods used. In particular bipolar EC causes extensive destruction of the ovary up to almost 3cm3 and this could have implications for the long term fertility prognosis. Given the same clinical effectiveness of the various procedures it is essential to use the lowest possible dose that works, thus the first choice should be CO2 laser or monopolar EC. In conclusion, bipolar EC causes extensive ovarian tissue loss and the currently used clinical regime should not be applied.

Irrigation-coupled bipolar cautery unit: A practical, economical, and simple version

ABSTRACTHemostasis is a fundamental principle of surgery for which electrocoagulation is universally used. Bipolar electrocautery has an advantage over monopolar electrocautery in terms of the precision of the extent of tissue coagulation and the lateral extent of thermal tissue injury. However, secondary to the thermal changes induced in the tissue due to electric current passage, there is charring of tissue, which adheres to the cautery tip. This, not only decreases its effectiveness, but also, by getting avulsed while removing the cautery tip from the surgical field, causes rebleeding and more trauma to the tissue. Irrigation of the surgical field during application of cautery reduces the charring effect, thereby improving the efficiency and efficacy. Irrigation-coupled electrocautery devices are available but are costly to acquire and maintain. We describe a simple and reliable version of an irrigation-coupled cautery device, which is of immense functional utility in our experience. It decreases the amount of charring of the tissue and its adherence to the bipolar forceps tips, thereby decreasing the frustrating loss of effectiveness and also increases the life of the bipolar forceps as cleaning needs to be less frequent. By virtue of its simplicity and cost-effectiveness, it can be used in almost all hospitals and situations.

Fire/burn risk with electrosurgical devices and endoscopy fiberoptic cables

Purpose The purpose of the study was to systematically explore the fire and burn risk associated with fiberoptic cables and electrosurgical devices. Materials and methods A 300-W light source was connected to a standard gray fiberoptic light cable. The end of the cable was either rested atop or buried within a cotton towel or polypropylene drape in the presence or absence of 100% oxygen for up to 10 minutes. A monopolar electrosurgical device set at 1 W, 10 W, or 30 W was tested on a cotton towel or polypropylene drape for a period of 30 seconds. All trials were repeated. Results Resting the light cable on top of the cotton towel or polypropylene drape with or without oxygen produced no result. Burying the end of the cable within the drape produced a hole in the drape within 15 seconds both with and without oxygen. Burying the end of the cable within the cotton towel produced a yellow discoloration after 2 minutes both with and without oxygen. The monopolar electrosurgical device set at 30 W burned immediately through the polypropylene drape, producing a skin burn. All other trials with monopolar electrocautery produced no result. No flame or fire was produced in any trial. Conclusions Fiberoptic cables and electrosurgical generators represent a serious burn risk for surgical patients, with operating room drapes and towels affording only limited protection. Otolaryngologists should be keenly aware of the risks that these devices represent because our specialty uses them frequently.