Monopolar Electrocautery Research Articles

Production and systemic absorption of toxic byproducts of tissue combustion during laparoscopic cholecystectomy

Among the potential hazards of laparoscopic surgery using electrocautery is the release of chemical byproducts of incomplete tissue combustion into the pneumoperitoneum with subsequent transperitoneal absorption into the bloodstream and/or release into the operating room. The purpose of this study of patients undergoing laparoscopic cholecystectomy (LC) was twofold: (1) to assess the relationship between intraperitoneal concentration of carbon monoxide (CO) and blood levels of carboxyhemoglobin (COHb) and methemoglobin (MetHb), and (2) to assess the surgeon's inhalation of CO resulting from ambient smoke exposure. During LC with monopolar electrocautery, 21 patients were evaluated intraoperatively for intraperitoneal [CO] by sampling gas from a trocar, whereas arterial [COHb] and [MetHb] were determined perioperatively. The surgeon's venous blood was drawn pre- and postoperatively to assay [COHb] and [MetHb]. Patients completed visual analogue questionnaires 6 hours and 24 hours postoperatively to assess for adverse symptoms. Mean (± SEM) patient age and weight were 45 ± 3 years and 84 ± 4 kg, respectively. Mean duration of the operation was 69 ± 5 minutes, and electrocautery was used for 3.0 ± 0.3 minutes. Intraperitoneal [CO] rose to peak levels of 209 ± 19 ppm at 50 minutes, whereas systemic [COHb] and [MetHb] were unchanged. The surgeon's systemic [COHb] and [MetHb] did not increase postoperatively. Nausea, abdominal pain, and fatigue scores decreased significantly between 6 and 24 hours postoperatively; however, there were no correlations between these symptoms and peak intraperitoneal [CO]. Although LC using electrocautery increases intraperitoneal [CO] to “hazardous” levels, systemic [COHb] and [MetHb] are not elevated by generation of intraperitoneal smoke. The surgeon's exposure to CO by the evacuation of smoke through laparoscopic ports is negligible. Production of smoke during LC using monopolar electrocautery, therefore, does not appear to pose a threat to either the patient or the surgeon.

Production and systemic absorption of toxic byproducts of tissue combustion during laparoscopic surgery.

Among the potential hazards of laparoscopic surgery using electrocautery is the intraperitoneal release and subsequent absorption of byproducts of tissue combustion. In a porcine model of laparoscopic surgery with smoke production, our aims were to assess (1) the relationship between levels of intraperitoneal carbon monoxide (CO) and systemic carboxyhemoglobin (COHb) and methemoglobin (MetHb), and (2) intraperitoneal concentrations of other noxious gases, including hydrogen cyanide (HCN), acrylonitrile (Acr), and benzene (Bzn). Seven pigs underwent laparoscopic resection of three hepatic wedges using monopolar electrocautery in a CO2 pneumoperitoneum. Sequential arterial samples were drawn to measure [COHb] and [MetHb] perioperatively, while gaseous intraabdominal [CO], [HCN], [Acr], and [Bzn] were assayed intraoperatively. The mean +/- SEM duration of operation was 90 +/- 2 min, and electrocautery was used for 68 +/- 4 min. Intraabdominal [CO] rose from 0 to 814 +/- 200 ppm (p < 0.01) while [COHb] increased from 2.9 +/- 0.1% to 3.5 +/- 0.1% (p < 0.001). Systemic [MetHb] remained unchanged intra- and postoperatively, ranging from 0.3 to 0.7%. Intraperitoneal [HCN] rose from 0 to 5.7 +/- 0.7 ppm (p < 0.001). [Acr], however, did not change significantly from preoperative values, ranging from 0 to 1.6 +/- 1. 0 ppm, and [Bzn] was undetectable. Laparoscopic tissue combustion increases intraabdominal [CO] to "hazardous" levels leading to minimal, yet significant, elevations of [COHb]. Systemic [MetHb] and intraabdominal [HCN], [Acr], and [Bzn] are not elevated to toxic levels. Production of intraperitoneal smoke during laparoscopic electrosurgery therefore may not pose a significant threat to the patient.

Hydrolaparoscopy in the rabbit: A fine model for the development of operative fetoscopy

Our goal was to become adept at performing laparoscopic procedures within a fluid medium and at using miniature instruments in a small animal model. Adult female New Zealand rabbits underwent carbon dioxide laparoscopy while they were under general anesthesia with the use of 2 mm instruments. The abdominal cavity was filled with lactated Ringer's solution. Visualization of the intraabdominal organs and surgical procedures were performed below the fluid level. Excellent visualization of the abdominal organs below the fluid level was obtained. Several surgical tasks were accomplished, including cutting and coagulation of the uterine horns with monopolar electrocautery, creation of a defect in the mesovarium and mesometrium, extracorporeal knot tying, and intraabdominal cutting of suture material. Relatively high amounts of energy were needed during electrocautery within the liquid medium (> 25 W). Occasional fluid and gas leakage through the skin punctures was prevented with accessory clamps. Hydrolaparoscopy can be performed in the rabbit with miniature instruments. As it simulates the human intraamniotic environment, it is a useful model for the development of operative fetoscopy.

Blepharoplasty and ptosis

Recent advances in local anesthetic techniques have led to suggestions that buffered solutions for infiltration increase patient comfort. The use of an eutectic mixture of local anesthetics cream has however proved to be disappointing. The use of monopolar electrocautery, carbon dioxide lasers, and high-frequency radio wave electrosection provide the surgeon with new modes of cutting and coagulation. Lower lid blepharoplasty via a conjunctival approach may avoid many of the complications of the anterior approach. Such complications may also be minimized by careful preoperative planning and frequently the inclusion of a lateral canthopexy in the surgical procedure. The lid height after anterior and posterior levator resection can now be set more accurately with adjustable suture techniques. A new technique combining a superior tarsectomy with levator resection is described. A range of materials for brow suspension are now available. Autogenous fascia lata remains the material of choice when available.

Manual of Laparoscopic Surgery

The Manual of Laparoscopic Surgery is an English translation of a text first published in 1992. The authors accurately describe their manual in the introduction as being limited to the description of laparoscopic appendectomy, cholecystectomy, adhesiolysis, and emergency laparoscopy, topics with which we have sufficient experience and can present reliable results. The textbook is divided into two main sections: General Considerations and Specialized Procedures. In the first section, the chapter entitled Equipment depicts instruments manufactured by a single manufacturer (Wolfe). Basic laparoscopic instrumentation is covered adequately, and at the end of the chapter are several checklists of instruments for different laparoscopic operations and troubleshooting charts covering problems that may be encountered with the insufflating machine, light source, and video equipment. Each of these charts ends with the ultimate proviso, Inform technical department! The next chapter, High Frequency Electrosurgery, describes the basics of monopolar electrocautery and the use

Monopolar Electrocautery Dissection in Ophthalmic Plastic Surgery

Monopolar electrocautery in the cutting mode is a superb surgical technique in many types of oculoplastic surgery because it efficiently dissects tissue with excellent hemostasis. The purpose of this article is to define how monopolar electrocautery functions and point out specific steps of certain oculoplastic procedures in which electrocautery dissection is useful. We have found it to be a helpful adjunct in over 1,200 clinical cases. We review the problems with electrocautery reported in the literature and discuss ways to avoid them.

Laparoscopic Posterior Truncal Vagotomy and Anterior Seromyotomy: A Porcine Model

A training technique for posterior truncal vagotomy and an anterior seromyotomy in the anesthetized pig is described. The first of five procedures was performed open in a conventional method. All succeeding procedures were performed after the establishment of a pneumoperitoneum with CO2 insufflation and the placement of two 10 mm trocars and three 5-mm trocars. A 45 degree camera and monopolar electrocautery were used during the video laparoscopic procedure. After completion of the procedure, the pigs were opened to closely inspect the surgery performed. Though there are some minor anatomic differences between porcine and human anatomy, the pig is an excellent model for gaining technical experience in the performance of a posterior truncal vagotomy and anterior seromyotomy.

The Effects of Cautery on the Optic Nerve

A case history is presented of a patient who sustained visual loss and a third-nerve palsy after the application of monopolar electrocautery to the orbital apex. Because the third-nerve palsy resolved and most of the vision was regained, it is theorized that the neurological deficits were secondary to myelin damage caused by the monopolar electrocoagulator. The purpose of this article is to compare the effects of monopolar electrocoagulation, bipolar electrocoagulation, and hot-wire cautery on decompressed optic nerves of cats. Although all three forms of coagulation are capable of causing demyelination within the optic nerve when used on the nerve sheath, monopolar electrocoagulation resulted in the greatest degree of demyelination and bipolar electrocoagulation resulted in the least demyelination.

The needle knife: a valuable tool in diagnostic and therapeutic ERCP

Using monopolar electrocautery technique, we have used both an electrified guide wire and a needle-tipped sphincterotome to successfully enter the common bile duct, subsequently image it, and perform therapeutic procedures when by virtue of the patient's anatomy, or because of tumor, this had not been possible using conventional ERCP catheters. In an initial group of 45 patients using the needle-tipped sphincterotome, clinically significant complications occurred in 3 patients but were not of a serious nature. The technique was an effective method for achieving both diagnostic ERCP and therapeutic maneuvers in 43 of 45 patients. We stress that this technique should only be attempted by those with long experience in ERCP and related procedures.

Quantitation of colonic injury from argon laser, neodymium: YAG laser and monopolar electrocautery applied to flat mucosa and small sessile polyps of the canine colon

This study determined the optimum laser energy for ablation of colonic mucosal lesions and small sessile polyps in the canine colon. Neodymium (Nd):YAG laser, argon laser, and monopolar electrocautery were applied to exposed canine colonic mucosa for various application times at various power settings. At the minimum energy level necessary to ablate mucosa, the Nd:YAG laser caused greater muscularis injury than the argon laser and monopolar electrocautery. At higher energy levels, monopolar electrocautery and Nd:YAG laser caused greater muscularis injury than argon laser. Small surgically created polyps in the canine colon were ablated endoscopically with the three energy sources. Single-session complete polyp ablation occurred most frequently with Nd:YAG laser and least frequently with argon laser. The depth of tissue injury beneath polyp ablation sites was least with argon laser and greatest with Nd:YAG laser. This study suggests that the argon laser is safer than the Nd:YAG laser or monopolar electrocautery for coagulation of flat colonic mucosal lesions. Although the argon laser is safer for the coagulation of small sessile colonic polyps, it may be less effective than monopolar electrocautery or the Nd:YAG laser for the single-session fulguration of polyps greater than 5 mm in diameter.

Arrêt définitif d'un stimulateur cardiaque après utilisation du bistouri électrique

A case is reported of irreversible damage being caused to a permanent programmable pacemaker by electrocautery used in the epigastric region. The pacemaker was rapidly replaced, and the patient had no adverse effects of this accident. The use of monopolar electrocautery in patients who have one of the new generation of programmable pacemakers is very dangerous. Bipolar forceps can reduce the level of interference between electrocautery units and pacemaker electrodes. With programmable pacemakers, the generator instruction manual should be consulted before surgery, as placing a magnet on the generator may not necessarily convert it to the asynchronous mode. When the use of electrocautery is unavoidable, external cardiac pacing electrodes should be placed on the patient, with an external cardiac pacemaker ready.

Colonic mucosal dissection following electrocautery or laser polypectomy

Mucosal proctectomy and ileoanal anastomosis is being increasingly performed on patients with familial polyposis, many of whom have undergone previous subtotal colectomy followed by endoscopic surveillance and polypectomy with monopolar electrocautery (MPEC) or, more recently, argon laser (AL). Our aim was to compare the ease of mucosal dissection following polypectomy with MPEC or AL in the canine colon. At celiotomy, two groups of fifteen 5-to 7-mm sessile polyps were surgically created in the descending colon of five mongrel dogs. Six weeks later, each animal underwent flexible colonoscopy and polyp fulguration with MPEC (15 polyps) and AL (15 polyps). Fulguration was performed weekly for 2–3 weeks until all polyps had been obliterated. Ten weeks later, mucosal dissection was performed with the operating team unaware of prior treatment. Mucosal dissection was scored for dissectability (1 to 4; 1 = facile, 4 = difficult), blood loss, operating time, and number of mucosal perforations with the last three parameters normalized to 100 cm 2 of mucosa. AL and MPEC were equally effective at polyp obliteration; however, more AL-treated polyps required retreatment than MPEC-treated polyps ( P < 0.05). After AL treatment, mucosal dissection was more facile [dissectability index (mean ± SEM): 1.4 ± 0.2 vs 2.6 ± 0.2; P < 0.05] and could be performed more quickly (15.1 ± 2.4 min vs 23.6 ± 2.7 min; P < 0.01). After AL treatment, mucosal dissection could be performed with fewer mucosal holes (1.6 ± 1.0 vs 7.7 ± 1.0 holes, P < 0.007) and less blood loss (67.2 ± 19.3 cc vs 105.6 ± 24.5 cc, P < 0.03). We conclude that argon laser is as effective as MPEC in colonic polyp ablation and may allow the surgeon an easier and safer mucosal dissection at the time of subsequent mucosal proctectomy.