Soft Coagulation Research Articles

Laparoscopic Off-Clamp Unsutured Partial Nephrectomy Using Soft Coagulation for a Large Renal Angiomyolipoma After Transarterial Embolization for Rupture

Abstract Introduction: Transarterial embolization (TAE) and partial nephrectomy (PN) are the standard treatments for a symptomatic or large renal angiomyolipoma (AML).1 PN for AML has shown high success rates and fewer retreatments than TAE. Recently, indications for laparoscopic PN have been expanded to large renal tumors to preserve renal function. We report a case of large AML effectively treated by laparoscopic off-clamp unsutured PN using soft coagulation2,3 after TAE for ruptured AML. Patient and Method: The patient was a 53-year-old female with complaints of left flank pain and vomiting. After diagnosis of the spontaneous rupture of the AML (85 × 81 mm), TAE was performed in a community hospital. Since the size of the tumor had not sufficiently decreased, she was referred to our clinic for surgery. Laparoscopic off-clamp PN was performed. The tumor resection was carried out using soft coagulation with the combination of monopolar scissors and bipolar forceps, without hilum clamping. Soft coagulatio...

Efficacy of Endoscopic Hemostasis with Soft Coagulation Using Hemostatic Forceps for Upper Gastrointestinal Bleeding over a 12-year Period: 2016 ACG Presidential Poster Award

Introduction: The endoscopic submucosal dissection (ESD) technique was introduced to obtain en bloc specimens of early gastric cancer. Endoscopic high-frequency soft coagulation is used to manage visible bleeding and/or nonbleeding vessels during ESD. Upper gastrointestinal bleeding (UGIB) is the most common gastroenterological emergency, and has a considerable morbidity and mortality. This study aimed to compare the etiology and clinical outcome of nonvariceal UGIB between two periods during the last 12 years. Methods: The present retrospectively study evaluated the medical records of patients who underwent emergency endoscopic hemostasis for nonvariceal UGIB from 2003 to 2014. The patients were divided into two periods: the first period was from 2003 to 2008 and the second period was from 2009 to 2014. The study revealed the characteristics of these patients and compared the treatment outcome of endoscopic hemostasis between soft coagulation and other modalities. In addition, endoscopic hemostasis rate was compared between specialists and trainees. The specialists already had the fundamental skills and knowledge needed for ESD, and each specialist assisted more than 40 gastric ESD procedures. Results: 566 patients underwent emergency endoscopy with nonvariceal UGIB. Among the 502 out of 566 patients who underwent endoscopic hemostasis, 197 were in the first period and 305 patients were in the second period. Whereas peptic ulcer lesions were the main cause of bleeding (89.4%) during the whole study period, small and multiple ulcers in addition to duodenal ulcers significantly increased in the second period. Endoscopic hemostasis was successfully performed in 97.0% in the first period and in 95.4% in the second period with no significant difference between the periods. In the modality of hemostasis, the rate of endoscopic hemostasis with soft coagulation using the ESD technique significantly increased in the second period compared to the first period (71.1% vs.11.7%, p < 0.001). The rate of endoscopic hemostasis performed by trainees was significantly higher in the second period than in the first period (76.1% vs.56.3%, p < 0.001). Rebleeding after endoscopic hemostasis decreased in the second period (9.8%) compared to the first period (15.7%). Conclusion: This retrospective study suggested that endoscopic hemostasis with soft coagulation using the ESD technique was safe even performed by trainees and might lead to a lower rebleeding rate after endoscopic hemostasis for UGIB.

01 - Zero ischemic sutureless laparoscopic minimal margin partial nephrectomy for renal tumours with soft coagulation: Preliminary results

01 - Zero ischemic sutureless laparoscopic minimal margin partial nephrectomy for renal tumours with soft coagulation: Preliminary results

MP41-08 COMPARISON OF PERIOPERATIVE OUTCOMES WITH OR WITHOUT RENORRHAPHY IN OPEN PARTIAL NEPHRECTOMY: A PROPENSITY SCORE-MATCHED STUDY

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy I1 Apr 2016MP41-08 COMPARISON OF PERIOPERATIVE OUTCOMES WITH OR WITHOUT RENORRHAPHY IN OPEN PARTIAL NEPHRECTOMY: A PROPENSITY SCORE-MATCHED STUDY Hidekazu Tachibana, Toshio Takagi, Junpei Iizuka, Tsunenori Kondo, and Kazunari Tanabe Hidekazu TachibanaHidekazu Tachibana More articles by this author , Toshio TakagiToshio Takagi More articles by this author , Junpei IizukaJunpei Iizuka More articles by this author , Tsunenori KondoTsunenori Kondo More articles by this author , and Kazunari TanabeKazunari Tanabe More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.175AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To preserve renal function after partial nephrectomy, various renorrhaphy techniques have been presented. However, any renorrhaphy technique may damage intraparenchymal vessels and compress the renal parenchyma, which may lead to renal artery pseudoaneurysm or vascularized parenchymal volume reduction. We therefore adopted a non-renorrhaphy technique in 2012 to avoid these issues. Using propensity score matching, we compared surgical outcomes of the non-renorrhaphy and renorrhaphy techniques for open partial nephrectomy for T1a renal tumors. METHODS We retrospectively analyzed data from 159 patients with normal contralateral kidneys who underwent open partial nephrectomy for T1a renal tumors and pre- and postoperative enhanced computed tomography between 2012 and 2015. Patient variables, including age, sex, body mass index, presence of hypertension and/or diabetes mellitus, performance status, tumor size, RENAL nephrometry score, and preoperative estimated glomerular filtration rate (eGFR), were adjusted using 1:1 propensity score matching between the renorrhaphy and non-renorrhaphy groups. For the renorrhaphy technique, we coagulated the surface of the resected renal parenchyma with monopolar soft coagulation after pressing a TachoSil tissue-sealing sheet on the resected bed for 10 minutes. RESULTS We matched 43 patients per group. Operative time, estimated blood loss, cold ischemic time, and postoperative hospital stay were not significantly different between the groups. Urine leakage occurred in 9 non-renorrhaphy cases and 1 renorrhaphy case (2.3% vs. 20%, P = 0.02). Renal artery pseudoaneurysm (RAP) occurred in 6 renorrhaphy cases but in 0 non-renorrhaphy cases (13% vs. 0%, P = 0.02). Postoperative eGFR decreased significantly less in the non-renorrhaphy group than in the renorrhaphy group (-11% vs. -1.5%, P = 0.04). CONCLUSIONS Despite the risk of urine leakage, the non-renorrhaphy technique compared to the renorrhaphy technique resulted in a lower risk of RAP and better preservation of eGFR for T1a renal tumors. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e562-e563 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Hidekazu Tachibana More articles by this author Toshio Takagi More articles by this author Junpei Iizuka More articles by this author Tsunenori Kondo More articles by this author Kazunari Tanabe More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Expanding the field of cold snare polypectomy.

Expanding the field of cold snare polypectomy.

Closure method for thick pancreas stump after distal pancreatectomy: soft coagulation and polyglycolic acid felt with fibrin glue.

Pancreatic fistula (PF) remains an obstacle to safe distal pancreatectomy (DP). A thick pancreatic parenchyma is a major risk factor for PF. In this paper, we elucidate the feasibility of the new closure method using soft coagulation and polyglycolic acid felt with fibrin glue. In 2009-2013, 96 patients underwent DP with a novel closure method for pancreatic stump that utilized soft coagulation and polyglycolic acid felt with fibrin glue. We evaluated amylase levels in drainage fluid on postoperative days (POD) 1 and 3 and the incidence of postoperative PF according to International Study Group of Pancreatic Fistula (ISGPF) definitions. Drain amylase levels on POD1 and POD3 were 275 and 241 U/L, respectively, and ISGPF-defined Grade B/C PF rates were 16.7%. No clinical factors were significantly associated with PF. Average pancreatic parenchymal thicknesses were similar in PF-positive and PF-negative patients (10.4 ± 2.6 mm vs. 10.1 ± 2.2 mm, P = 0.639). There was no significant difference in the postoperative PF rate between patients with thick (≥12 mm) and thin (<12 mm) pancreas (11.1 vs. 18.8%, P = 0.544). Our novel pancreatic stump closure method appears to be simple and effective, particularly in patients with thick pancreas.

Incidental bronchial injury by soft coagulation.

Soft coagulation is a hemostat system of electrosurgical units, which automatically regulates its output voltage below 200 V, to avoid excessive output that causes carbonization of the target tissue. However, this new minimally invasive technology still has the potential risk of tissue damage during surgery. We encountered three patients with bronchial injury caused by the above system; one of whom had bronchopleural fistula. This is believed to be the first report emphasizing the adverse effects of the soft coagulation system in thoracic surgery, giving a warning to the application of this convenient device.

Assessment of Surgical Outcomes of the Non-renorrhaphy Technique in Open Partial Nephrectomy for ≥T1b Renal Tumors

To assess surgical outcomes between the non-renorrhaphy and renorrhaphy techniques in open partial nephrectomy for ≥T1b renal tumors using volumetric studies. We retrospectively analyzed the records of 91 patients with normal contralateral kidneys who underwent both open partial nephrectomy for ≥T1b renal tumors and pre- and postoperative enhanced computed tomography between 2010 and 2014. Volumetric studies to assess vascularized parenchymal volume of the operated kidney were performed within 2 months preoperatively and 6 months postoperatively. Using the non-renorrhaphy technique, we coagulated hemorrhagic areas on the surface of the renal parenchyma by monopolar soft coagulation, while a TachoSil tissue-sealing sheet was placed on the resected bed. A total of 50 patients underwent renorrhaphy and 41 patients underwent non-renorrhaphy. Patient backgrounds and R.E.N.A.L. nephrometry scores were not significantly different between the two groups. Cold ischemia time was significantly longer in the renorrhaphy than that in the non-renorrhaphy (52 vs 42 minutes, P = .0162). However, significant differences were not observed in the preservation rate of the vascularized parenchymal mass in the operated kidney (renorrhaphy, 71%; non-renorrhaphy, 70%; P = .5054) and global kidney function (renorrhaphy, 88%; non-renorrhaphy, 90%; P = .3653) between the two groups. Renal artery pseudoaneurysm occurred in 2 cases in both groups. Urinary fistula tended to occur more frequently in non-renorrhaphy (2 cases) than in renorrhaphy (5 cases), though this difference was not statistically significant (P = .237). The non-renorrhaphy technique failed to show a benefit in the preservation of vascularized parenchymal mass of the operated kidney and global renal function for ≥T1b renal tumors compared to the renorrhaphy technique.

Sa1580 Argon Plasma Coagulation Compared With snare Tip Soft Coagulation in an In-Vivo Porcine Model of Endoscopic Mucosal Resection

Endoscopic Mucosal Resection (EMR) is now a well-established and effective method for the management of sessile polyps and laterally spreading tumours (LSTs). There are few studies of adjunctive thermal therapies such as argon plasma coagulation (APC) and snare tip soft coagulation (STSC) for the ablation of marginal defect tissue. Small studies examining APC have shown that recurrence may be variably reduced, but criticisms of APC include that it is poorly controllable, that the ablation depth varies, and that it may leave patchy areas of residual mucosa explaining the recurrence that occurs despite treatment.

Comparison of hemostatic forceps with soft coagulation versus argon plasma coagulation for bleeding peptic ulcer--a randomized trial.

Endoscopic high-frequency soft coagulation is used to manage visible bleeding or nonbleeding vessels during endoscopic submucosal dissection. The aim of the present study was to compare the efficacy of hemostasis by soft coagulation (using hemostatic forceps) with argon plasma coagulation (APC), in a prospective randomized trial. From January 2013 to June 2014, 276 patients were randomly assigned into two groups: epinephrine injection plus APC (the APC group); or epinephrine injection plus soft coagulation using hemostatic forceps (the HFSC group). As the primary outcome we compared recurrent bleeding rates within 30 days after initial hemostasis in a noninferiority design. After exclusion, 75 patients in the APC group and 76 in the HFSC group were finally evaluated. In the APC group 72 patients (96 %) were successfully treated with the assigned treatment alone vs. 73 (96 %) in the HFSC group. Initial endoscopic hemostasis using a single or combined modality was achieved in all patients. Recurrent bleeding within 30 days was experienced by five patients (6.7 %) and seven patients (9.2 %) in the AFC and HFSC groups, respectively (P = 0.563), and within 7 days by three patients (4.0 %) and five patients (6.6 %), respectively (P = 0.719). We found no significant difference in the rates of adverse events (1.3 % vs. 2.6 %) or mortality (2.7 % vs. 2.6 %) between the groups. The efficacy and safety of soft coagulation using endoscopic hemostatic forceps is not inferior to APC when used to treat patients with bleeding peptic ulcers. Clinicaltrials.gov NCT02020603.

ソフト凝固における生理食塩液滴下の効果

ソフト凝固における生理食塩液滴下の効果

Sa1610 Efficacy of Hemostasis by Soft Coagulation Using Endoscopic Hemostatic Forceps in Comparison With Argon Plasma Coagulation for Acute Peptic Ulcer Bleeding: Preliminary Results of a Prospective Randomized Trial

Endoscopic high-frequency soft coagulation is available for the management of bleeding or nonbleeding visible vessels during endoscopic submucosal dissection. However, its efficacy on peptic ulcer bleeding has not been elucidated so far. The aim of this study was to evaluate the efficacy of hemostasis with soft coagulation using hemostatic forceps by comparing it with argon plasma coagulation (APC) in a prospective, randomized trial.

Microperforation of the colon: animal model in rats to reproduce mucosal thermal damage

BackgroundThe aim of the present study was to develop a rat model of colonic microperforation secondary to thermal injury for future studies to assess new treatments. MethodsTwenty-four male Sprague–Dawley rats were used in this study. Hot biopsy forceps were used for all treatments. All lesions were created in proximal left colon using the soft coagulation setting. The power setting tested was 40 W, and the durations of monopolar soft coagulation application evaluated were 2, 3, and 4 s. ResultsIn the acute phase, 48 h after thermal injury, durations of cautery of 2 and 3 s resulted in transmural necrosis, whereas with 4 s microperforation was obtained. In the late phase, 7 d after the damage, only duration of cautery of 4 s showed deep cautery effects, with signs of peritonitis. ConclusionsWe determined optimal power settings and duration of therapy in a rat model for producing electrocautery that involves transmural necrosis with microperforation.

Effect of structure of PVDF membranes on the performance of membrane distillation

A series of microporous PVDF membranes were prepared by isothermal immersionprecipitation of PVDF/TEP casting dopes in both soft and harsh coagulation baths. Morphologies of the membranes' top surfaces were found to depend strongly on the bath strength, which could be controlled by the TEP content in the bath. By changing the bath gradually from pure water to 70% TEP, the top surface evolved from a dense skin-like (asymmetric) to a totally open porous morphology (symmetric). The latter structure could similarly be obtained by precipitation of the same dope in an alcoholic bath, e.g., 1-butanol. Membrane distillation processes to desalt sodium chloride aqueous solutions were conducted using various prepared membranes and two commercial microporous membranes, PTFE (Toyo, Japan, code: J020A330R) and PVDF (GE, USA, code: YMJWSP3001). The permeation fluxes were compared and correlated with the morphologies of the tested membranes.

Clinical T1腎腫瘍に対するソフト凝固を使用した無阻血腎部分切除術の検討：マイクロ波組織凝固との比較

We have performed non-ischemic partial nephrectomy for clinical T1 renal tumors using microwave tissue coagulation (MTC group) or soft coagulation (soft coagulation group). The clinical outcomes were retrospectively compared between the two groups. A total of 36 patients were analyzed in this study (22 in the MTC group and 14 in the soft coagulation group). The anatomical characteristics of the renal tumors were assessed using the R.E.N.A.L Nephrometry Score. Renal function was assessed by the estimated glomerular filtration rate. The preoperative estimated glomerular filtration rate was 72.1 ml/min in the MTC group and 65.6 ml/min in the soft coagulation group (p = 0.05). The R.E.N.A.L Nephrometry Score was not significantly different between the two groups. Clavian grade > or = 2 postoperative complications occurred in one patient (4.5%) in the MTC group and one patient (7.1%) in the soft coagulation group. Postoperative local recurrence and distant metastasis occurred in one patient (8.3%) in the soft coagulation group and no patients in the MTC group, which was not a significant difference between the two groups. The median postoperative decrease in estimated glomerular filtration rate was 11.5% in the MTC group and 3.6% in the soft coagulation group. Postoperative renal preservation tended to be better in the soft coagulation group than in the MTC group, but this difference was not significant. The use of soft coagulation in non-ischemic partial nephrectomy for the treatment of clinical T1 renal tumors is as effective as that of MTC.

Endoscopic Hemostasis with High-frequency Soft Coagulation Using Endoscopic Hemostatic Forceps for Hemorrhagic Gastric Ulcers

Endoscopic Hemostasis with High-frequency Soft Coagulation Using Endoscopic Hemostatic Forceps for Hemorrhagic Gastric Ulcers

Intraductal endoscopic radiofrequency ablation for the treatment of hilar non-resectable malignant bile duct obstruction

To evaluate the safety and technical success of endoscopic radiofrequency ablation (RFA) for palliative treatment of malignant hilar bile duct obstruction. In this study, a recently CE and FDA-approved endoscopic RFA catheter was first tested in an ex vivo pig liver model to study the effect of electrosurgical variables on the extent of the area of induced necrosis. Subsequently, a retrospective analysis was conducted of all patients treated with endoscopic RFA for malignant biliary obstruction at our center between February 2012 and April 2013. All patients received an additional plastic stent implantation into the biliary tree following RFA. In the pig model, ablation time of 60-90 seconds using the bipolar soft coagulation mode at 8-10 watts with an effect of 8 was found to be the most feasible setting. Twelve patients (5 females, 7 males; mean age, 70 years) underwent 19 endoscopic RFA (range, 1-5) sessions. Deployment of RFA was successful in all patients. Systemic chemotherapy was administered in four patients. We observed biliary bleeding 4-6 wk after the intervention in three cases and two of these patients died: in one patient, spontaneous hemobilia occurred, whereas bleeding started during stent extraction in the other. In the third patient, bleeding was stopped by insertion of a non-covered self-expanding metal stent. Another three patients developed cholangitis during follow-up. Seven patients died during follow-up and median survival was 6.4 mo (95%CI: 0.05-12.7) from the time of the first RFA. Endoscopic RFA is an easy to perform and technically highly successful procedure. However, hemobilia possibly associated with RFA occurred in three of our patients. Therefore, larger prospective studies are needed to further evaluate the safety and efficacy of this promising new method.

Efficacy of Hemostasis for Epidural Venous Plexus and Safety for Neural Structure Using Soft Coagulation System in Spinal Surgery

A laboratory investigation using porcine model. To clarify the effectiveness of the soft coagulation system for stopping bleeding from the epidural vein using different outputs and the safety in terms of tissue damage including spinal cord injury. Problems associated with coagulation using an electrosurgical device, such as carbonization of tissue or adhesion to the electrode, have been highlighted. So called "soft coagulation" has been developed to solve these problems. Its' utility as well as the safety of the neural structure in spine surgery has never been reported. A total of 3 animals and 45 spinal segments were used. Total laminectomy was performed to expose the dural tube and epidural venous plexus. Stable bleeding was induced by a 22 G needle puncture. Soft coagulation monopolar output (SCM), soft coagulation bipolar output (SCB), and conventional bipolar output (CB) were used as the coagulators. Valid hemostasis was defined as macroscopically complete bleeding stoppage by coagulation within 3 minutes. The neurological assessment was evaluated by somatosensory evoked potential. Histologic analysis was performed to determine the area of thermal damage. Valid hemostasis ratio was 75.0% of SCM group, 68.8% of SCB group, and 30.8% of CB group. Somatosensory evoked potential monitoring revealed that spinal cord injury was observed in 4 lesions (25%) of the SCM group. Neither bipolar groups (SCB and CB) showed any changes in waveform pattern. Histologic analysis revealed that severe thermal damages were observed in the epidural space of the SCM group. The usefulness of soft coagulation is revealed in terms of bleeding stoppage from epidural vessels and reduced soft-tissue damage compared with the conventional electric device. However, assessing the potential risk of severe neural tissue damage including spinal cord injury, a bipolar soft coagulation is strongly recommended for use in spine surgery.

Editorial Comment to Soft coagulation in partial nephrectomy without renorrhaphy: Feasibility of a new technique and early outcomes

Editorial Comment to Soft coagulation in partial nephrectomy without renorrhaphy: Feasibility of a new technique and early outcomes

Soft coagulation in partial nephrectomy without renorrhaphy: Feasibility of a new technique and early outcomes

To study the feasibility of a new partial nephrectomy technique using soft coagulation without renorrhaphy. Open partial nephrectomy using soft coagulation without renorrhaphy was carried out on 39 consecutive patients with renal tumors. The renal artery was clamped in the initial 23 cases (59%), whereas 16 surgeries (41%) were carried out without clamping. The resected surface of the kidney was coagulated solely by soft coagulation without renorrhaphy. Suturing was used only when the urinary collecting system was opened. The surgical results and perioperative complications were retrospectively evaluated. The mean age of patients was 63.1 years. The mean tumor size was 28.2 mm (range 10-56 mm). The mean RENAL nephrometry score was 8.03 (range 4-10). The mean cold ischemic time (in clamped cases) was 25 min. The mean operative time was 193 min (range 113-310 min), and the mean estimated total blood loss was 172 mL (range 20-530 mL) in all cases. All operations were uneventful, and none required blood transfusion or conversion to nephrectomy. Postoperative complications, such as hemorrhage, urinary fistula formation and requirement of hemodialysis, were not observed. All patients had negative surgical margins, and were free of disease recurrence during the follow-up period (3-49 months). Overall, a remarkable decrease in renal function was not evident at the end of the follow-up period. This new technique using soft coagulation appears to be safe and feasible for partial nephrectomy.