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PubMed1998

Argon laser punctal therapy versus thermal cautery for the treatment of aqueous deficiency dry eye syndrome.

BACKGROUND: The objective of this prospective randomized study was to compare the safety and efficacy of argon laser punctal ablation and electrocautery punctal occlusion in the treatment of moderate to severe dry eye and to correlate standard clinical signs with symptoms in these patients. METHODS: From June 1996 to April 1997 we studied 32 patients (64 eyes) referred to a university-affiliated tertiary care hospital with signs or symptoms of dry eye. Moderate to severe dry eye was confirmed by means of the Schirmer 1 test, fluorescein and rose bengal staining and a visual analogue scale measure of six subjective symptoms. Patients with severe dry eye were randomly assigned to undergo argon laser ablation (17 eyes) or electrocautery occlusion (18 eyes), and were reassessed 2 weeks, 1 month and 6 months after treatment. RESULTS: Compared with baseline, the laser-treated patients had a peak improvement of 40% in surface wetting at 1 month and improvement of 33% at 6 months; the peak improvement at 6 months in the electrocautery group was 84% (p < 0.05). At 6 months the laser group had a twofold reduction in rose bengal staining, compared with a sevenfold reduction in the electrocautery group (p < 0.05). The electrocautery group had the greatest decrease in fluorescein staining at 6 months (2.8-fold vs. twofold) (p < 0.05). The laser group reported a reduction in symptoms of 31% at 1 month and 14% at 6 months; the corresponding values for the electrocautery group were 55% and 64% (p = 0.02). Posttreatment epiphora was insignificant in both groups. In patients with surface wetting of more than 5 mm at baseline, regular use of Tear-Gel resulted in both objective and subjective improvement. INTERPRETATION: Although argon laser punctal ablation is a safe method of treating aqueous tear deficiency states, with minimal side effects, both subjective and objective improvement were greater with electrocautery punctal occlusion. Intensive use of Tear-Gel offers benefit to patients with debilitating symptoms in whom aqueous tear production is not severely reduced.

Adult↗
PubMed1999

Correlation of VEGF expression by leukocytes with the growth and regression of blood vessels in the rat cornea.

PURPOSE: To determine the temporal and spatial relationships between neovascularization and basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF) mRNA and protein expression in the rat cornea after cautery with silver nitrate. METHODS: In female Sprague-Dawley rats, a silver nitrate applicator was placed on the central cornea to elicit circumferential angiogenesis, and blood vessel growth was quantified by digital image analysis of corneal flat-mounts. Total RNA or protein was extracted from whole corneas until 1 week after cautery, and bFGF and VEGF mRNA and protein levels were determined by reverse transcription-polymerase chain reaction (RT-PCR) and enzyme-linked immunosorbent assay (ELISA). To localize VEGF mRNA and protein, paraformaldehyde-fixed and paraffin-embedded histologic cross sections of corneas were examined by in situ hybridization and immunohistochemistry. Macrophages were identified by ED2 immunohistochemistry. To examine the regulation of VEGF, rats were treated with dexamethasone (0.5 mg/kg per day) and hyperoxia (70% O2). RESULTS: The neovascular response progresses in three phases: (1) a nonproliferative phase preceding vessel growth (< or = 48 hours after cautery); (2) a proliferative phase with maximal growth rate between 3 and 4 days; and (3) a regressive phase (day 7) with a decrease in vessel density accompanying the completion of vessel elongation. In corneas after cautery, bFGF mRNA expression was unchanged, and bFGF protein concentration decreaseed by 97% after 24 hours and returned to control levels by day 7. In contrast, VEGF164 and VEGF188 mRNA splice variants and protein peaked 48 hours after cautery, remained elevated 4 days after cautery, and decreased to near baseline by day 7. The peak concentration of VEGF in the cornea at 48 hours was calculated to be 720 pM, which is sufficient to evoke a functional response. In situ hybridization and immunohistochemistry showed VEGF expressed initially in neutrophils (24 - 48 hours) and subsequently in macrophages (4 days) adjacent to the cautery site. Treatment with either dexamethasone or systemic hyperoxia inhibited both neovascularization and the increase in VEGF expression. Dexamethasone inhibited 27% of cautery-induced VEGF upregulation at 24 hours and 23% at 48 hours, hyperoxia inhibited 32% at 24 hours and 43% at 48 hours, and combined treatment with both dexamethasone and hyperoxia had an additive effect (56% inhibition at 24 hours). CONCLUSIONS: VEGF production by leukocytes correlates temporally and spatially with cautery-induced angiogenesis in the rat cornea. Both inflammatory products and hypoxia appear to sufficiently increase VEGF expression near the cautery lesion to increase vascular permeability of limbal vessels and induce endothelial cell migration and proliferation.

Animals↗
PubMed1998

The effect of bipolar electrocautery on peripheral nerves.

Although bipolar cautery was designed to minimize trauma to the central nervous system, little is known about the effects of bipolar cautery on peripheral nerve tissue. This experiment was designed to study the effect of direct bipolar cautery on a peripheral nerve and the muscles innervated by that nerve. Lewis rats (n = 200) were assigned to five different groups: control, sham, and three cautery groups (duration of either 0.5, 1.0, or 1.5 seconds). The hind limb tibial nerves were isolated in the sham group and isolated and cauterized in the cautery groups. Assessments performed at 2 hours, 2 weeks, 4 weeks, and 8 weeks postoperatively included isometric contractile function studies of both a fast- and a slow-twitch muscle, muscle weights, and nerve histology/morphometry. Significant muscle weight loss and reduced muscle function were found in the cautery groups at 2, 4, and 8 weeks (p < 0.05). Histologically, the nerves of the cautery groups showed nerve damage consistent with Sunderland's type 4 nerve injury when examined at 2 weeks and showed nerve regeneration at 4 and 8 weeks. Both the fast-twitch muscle and the shorter duration cautery were associated with faster recovery relative to the slow-twitch muscles and longer duration cautery, respectively. Bipolar cautery, as administered to rat tibial nerves in this experiment, is associated with a significant injury to the nerve and loss of function of the muscles innervated by the nerve.

Animals↗
PubMed1992

Application of the cavitron ultrasonic surgical aspirator (CUSA) for gynecological laparoscopic surgery using the rabbit as an animal model.

OBJECTIVE: To study the potential application of the cavitron ultrasonic surgical aspirator (CUSA) in gynecological laparoscopic surgery using a rabbit animal model. DESIGN: Twenty-six rabbits were prospectively randomized into two groups. Laparoscopically directed standard injuries were made on the randomly assigned horn and sidewall in all animals with the CUSA. Contralateral injuries were made with a contact neodymium-yttrium aluminum garnet (Nd:YAG) laser in group 1 and with bipolar cautery in group 2. Adhesion and inflammation scores were assessed for two animals in each group at 24, 48, and 72 hours, and seven animals in each group at 14 days. SETTING: University animal research facility. MAIN OUTCOME MEASURES: Adhesion and inflammation scores were compared between animals in the CUSA versus Nd:YAG study and the CUSA versus bipolar cautery at 14 days. RESULTS: No significant difference in uterine or sidewall adhesion scores was noted between the CUSA versus Nd:YAG or the CUSA versus bipolar cautery. Bipolar cautery produced significantly less inflammation on the uterine horn compared with the CUSA (3.0 +/- 0.2 versus 5.3 +/- 0.7, P = 0.0001), but no difference in sidewall inflammation was noted between the CUSA compared with bipolar cautery. No difference in inflammation was observed between the CUSA and the Nd:YAG laser. CONCLUSIONS: The bipolar cautery appears to be preferable to the CUSA for coagulation of uterine lesions, although dissection of the uterus is not possible with bipolar cautery. The CUSA and the Nd:YAG appear to be comparable for uterine horn dissection. Because the CUSA causes similar adhesion formation and tissue inflammation at the sidewall when compared with the Nd:YAG laser and bipolar cautery and may be less likely to damage blood vessels, ureters, or other collagen-rich tissues, the CUSA may represent a promising new surgical tool for laparoscopically directed peritoneal dissection.

Animals↗
PubMed2005

Vasectomy surgical techniques in South and South East Asia.

BACKGROUND: Simple ligation of the vas with suture material and excision of a small vas segment is believed to be the most common vasectomy occlusion technique performed in low-resource settings. Ligation and excision (LE) is associated with a risk of occlusion and contraceptive failure which can be reduced by performing fascial interposition (FI) along with LE. Combining FI with intra luminal thermal cautery could be even more effective. The objective of this study was to determine the surgical vasectomy techniques currently used in five Asian countries and to evaluate the facilitating and limiting factors to introduction and assessment of FI and thermal cautery in these countries. METHODS: Between December 2003 and February 2004, 3 to 6 major vasectomy centers from Cambodia, Thailand, India, Nepal, and Bangladesh were visited and interviews with 5 to 11 key informants in each country were conducted. Vasectomy techniques performed in each center were observed. Vasectomy techniques using hand-held, battery-driven cautery devices and FI were demonstrated and performed under supervision by local providers. Information about interest and open-mindedness regarding the use of thermal cautery and/or FI was gathered. RESULTS: The use of vasectomy was marginal in Thailand and Cambodia. In India, Nepal, and Bangladesh, vasectomy was supported by national reproductive health programs. Most vasectomies were performed using the No-Scalpel Vasectomy (NSV) technique and simple LE. The addition of FI to LE, although largely known, was seldom performed. The main reasons reported were: 1) insufficient surgical skills, 2) time needed to perform the technique, and 3) technique not being mandatory according to country standards. Thermal cautery devices for vasectomy were not available in any selected countries. Pilot hands-on assessment showed that the technique could be safely and effectively performed by Asian providers. However, in addition to provision of supplies, introducing cautery with FI could be associated with the same barriers encountered when introducing FI in combination with LE. CONCLUSION: Further studies assessing the effectiveness, safety, and feasibility of implementation are needed before thermal cautery combined with FI is introduced in Asia on a large scale. Until thermal cautery is introduced in a country, vasectomy providers should practice LE with FI to maximize effectiveness of vasectomy procedure.

Bangladesh↗
PubMed1989

Adequacy of "hot biopsy" for the treatment of diminutive polyps: a prospective randomized trial.

Patients with diminutive polyps in the rectum or sigmoid colon were randomized to "hot biopsy" treatment for either 1) electrocautery for 2 s (fixed duration cautery) or 2) cautery until visible necrosis of the polyp base was evident (variable duration cautery). Sigmoidoscopy was performed 4 wk after treatment to determine the adequacy of polyp eradication. In the fixed duration cautery group, 11 of 21 polyps (52%) were eradicated, compared with 12 of 14 polyps (86%) in the variable duration cautery group (p = 0.04). When analyzed according to whether or not visible necrosis was achieved (some of the polyps in the fixed duration cautery group showed necrosis with 2 s cautery), 19 of 23 polyps (83%) were eradicated when necrosis was evident, compared to 5 of 12 (42%) without necrosis (p = 0.004). We conclude that hot biopsy treatment for diminutive polyps is significantly more effective when visible necrosis is achieved during cautery. Furthermore, even with visible necrosis, there is a 17% failure rate of polyp eradication.

Adenoma↗
PubMed2005

Does increased electrocautery during adenoidectomy lead to neck pain?

OBJECTIVES: The objective was to assess the impact of electrocautery on complications in adenoidectomy. We sought to quantify cautery-related temperature changes in prevertebral fascia that may occur during the procedure, retrospectively evaluate the incidence of cautery-related complications, and prospectively assess the role of cautery in postoperative neck pain. METHODS: Three consecutive related trials were performed. Initially, adenoidectomy was performed on 20 fresh cadavers, using a thermister to evaluate temperature changes in the prevertebral fascia after electrocautery (30 watts over a 30-second period). Next, retrospective analysis of adenoidectomy complications in 1206 children over a 5-year period was performed. Based on these findings, a prospective study of the incidence of neck pain following adenoidectomy was performed in a cohort of 276 children. Adenoidectomy technique, wattage, and duration of electrocautery were recorded for each child. Children with significant neck pain were evaluated with MRI. RESULTS: Peak thermister readings averaged 74 degrees C, for a mean change of 51.8 degrees C. Complications observed in retrospective analysis included neck pain (3), Grisel's syndrome (1), prolonged velopharyngeal insufficiency (1), retropharyngeal edema (1), and severe nasopharyngeal stenosis (1). The incidence of neck pain in the prospective study was 12% (33 pts), and was independent of adenoidectomy technique, cautery wattage, or duration of cautery use. MRIs revealed edema without abscess. CONCLUSIONS: Cautery can result in substantial temperature changes in the surgical adenoid bed. Despite this, the incidence of complications, specifically neck pain, associated with adenoidectomy is low, although underreported. Complications appear to be independent of adenoidectomy technique and cautery use.

Adenoidectomy↗
PubMed1989

Patterning during pupal commitment of the epidermis in the butterfly, Precis coenia: the role of intercellular communication.

The commitment of cells to pupal development in the larvae of holometabolous insects can be prevented by treatment with juvenile hormone (JH) or a JH mimic during a critical period early in the last larval instar. By treating larvae of different ages with a JH mimic, pupal commitment of the epidermis of the butterfly, Precis coenia, was found to occur in a strict temporal and spatial progression, which was serially homologous and occurred independently in each segment. The mechanism underlying this sequence of pupal commitment was examined by cauterizing regions of the epidermis to observe the effects of local ablation on the pattern of pupal commitment revealed by treatment with the JH mimic. Cautery of the segmental site of origin of pupal commitment, the dorsal midline, suppressed pupal commitment in the rest of the operated segment, indicating that the midline has a special effect on commitment of the rest of the segment. Cautery off the midline produced asymmetries in the pattern of pupal commitment; when placed close to the midline, such cauteries prevented pupal commitment in the region "downstream" of the cautery, suggesting that a signal (diffusible or transducible) emanates from the midline. Finally, cautery of a circle around the midline inhibited pupal commitment only outside the circle, showing that cautery could act as a barrier to the passage of a signal coming from the midline. These results suggest that inductive as well as hormonal signals are involved in the regulation of pupal commitment in the epidermis of the lepidopteran, P. coenia.

Animals↗
PubMed2003

Superiority of electrocautery over the suture method for achieving cervical cone bed hemostasis.

OBJECTIVE: To compare the efficacy of electrocautery with that of the suture method for achieving hemostasis of the cervical cone bed. METHODS: We performed a retrospective chart review of all patients who underwent cold-knife conization of the cervix over a 5-year period. Patients were categorized into two groups: the cautery group, in which the cone bed was electrocauterized with a hand-held electrocoagulation device; and the suture group, in which hemostasis was achieved by a continuous locking suture placed circumferentially around the cone bed. Outcome measures evaluated include estimated blood loss, operative time, and incidence of complications, including secondary hemorrhage, cervicitis, and cervical stenosis. Data were analyzed by Student t test, chi(2) test, linear regression, and multiple logistic regression where appropriate. RESULTS: There were 156 women in the cautery group and 35 in the suture group. The cautery group had significantly lower estimated blood loss (27 mL versus 101 mL; P <.01) and shorter operative time (34 versus 43 minutes; P <.01) than the suture group. The procedure-related complication rate was 6.4% in the cautery group, compared with 14.3% in the suture group (P = nonsignificant). A higher use of lateral sutures, vasopressors, and thrombotic agents was seen in the cautery group. However, even after adjusting for these variables, mean estimated blood loss (33 mL, P <.01) and mean operative time (34 minutes, P <.01) were significantly less in the cautery group than in the suture group. CONCLUSIONS: Cauterization of the cone bed is superior to suture as a method of achieving hemostasis, with significantly less blood loss and shorter operative time.

Adult↗
PubMed2002

Effectiveness and complications associated with 2 vasectomy occlusion techniques.

PURPOSE: We compared the effectiveness and complications associated with 2 common vasectomy occlusion techniques, namely clipping and excision of a small vas segment and thermal cautery with fascial interposition and an open testicular end. MATERIALS AND METHODS: We retrospectively reviewed the computerized records of 3,761 men who underwent initial vasectomy at a single university hospital family planning clinic and at 2 private clinics in the Quebec City, Canada area, including concurrent and historical controls. All procedures were performed by 1 surgeon, who used the scalpel-free technique to expose the vas. RESULTS: The risk of vas occlusion failure in men with at least 1 semen analysis was much greater in the clipping and excision group than in the cautery, interposition and open testicular end group (126 of 1,453 or 8.7% versus 3 of 1,165 or 0.3%, OR 37, 95% CI 12 to 116). Medical consultations for hematoma or infection were more frequent in the cautery group (28 of 1,721 cases or 1.6% versus 10 of 2,040 or 0.5%, OR 3.4, 95% CI 1.6 to 6.9). Consultations for noninfectious pain were similar for the 2 techniques (71 of 1,721 cases or 4.1% versus 72 of 2,040 or 3.5%, OR 1.2, 95% CI 0.8 to 1.6). CONCLUSIONS: Cautery and interposition with an open testicular end are much more effective than clipping and excision. The effectiveness and morbidity associated with the components of the cautery, interposition and open testicular end technique need further evaluation.

Cautery↗
PubMed2006

The expression of nuclear factor kappa B in inflammation-induced rat corneal neovascularization.

PURPOSE: To investigate the involvement of the nuclear-transfactor-kappa B (NF-kappa B) in the rat model of inflammation-induced corneal neovascularization (CNV). METHODS: The CNV model in Sprague-Dawley rats was induced by alkaline cauterization of the central cornea. The corneas were examined by a slit lamp microscope. NF-kappa B was assayed by Western blot. Vascular endothelial growth factor (VEGF) protein was evaluated by immunohistochemistry. VEGF mRNA levels were determined by reverse transcription-polymerase chain reaction (RT-PCR). RESULTS: Morphologically, the CNV was shown on the second day after cautery. In corneas after cautery, NF-kappa B protein increased 6 hours after cautery, peaked 4 days after cautery, and decreased to near baseline by day 14. VEGF protein and mRNA increased gradually in the early stage after cautery, reached the highest level on the fourth day, and then decreased to near baseline slowly after 7 days. CONCLUSIONS: The activated NF-kappa B was up-regulated in the early stage of CNV of rat induced by cauterization, which suggests it may participate in the pathogenesis of wound healing, inflammation, and neovascularization processes in the cornea.

Alkalies↗
PubMed1983

Comparative observations on effects of carbon dioxide laser-induced peripheral nerve lesions in the rat.

This study was conducted to determine any changes that might occur in the associated cell bodies and proximal nerve stumps of sciatic nerves cut with carbon dioxide laser radiation. These changes were then compared with the changes that occur when performed with cutting cautery and scalpel. Both the proximal stump and the related dorsal root ganglia were examined with light and electron microscopy. The sciatic nerve was severed in 10 rats with the carbon dioxide laser, a cutting cautery, or a scalpel. Subsequent histopathologic examinations revealed: (a) both myelin and axonal degeneration in scalpel cuts; (b) less degeneration of proximal stump myelin in laser cuts compared with cautery cuts; and (c) no abnormalities in the associated dorsal root ganglia of nerves cut with the carbon dioxide laser. It was concluded that both the carbon dioxide laser and cutting cautery result in less damage and degeneration than a scalpel when used to sever peripheral nerves. The difference between the laser and cautery lesions was more quantitative than qualitative in that both impart thermal energy to the nerve. The carbon dioxide laser resulted in the least amount of injury.

Animals↗
PubMed2004

Prospective, randomized, controlled clinical trial of a novel matrix hemostatic sealant in children undergoing adenoidectomy.

PROBLEM ADDRESSED: Floseal is a novel matrix hemostatic sealant composed of collagen-derived particles and topical bovine-derived thrombin. It is applied as a high-viscosity gel for hemostasis and has been clinically proven to control bleeding. This study is a prospective, randomized, controlled clinical trial of Floseal sealant compared to traditional suction cautery hemostasis in children undergoing adenoidectomy. METHODS AND MEASURES: Seventy patients (mean age 7.0 yrs, 45.7% male) with obstructive sleep apnea underwent traditional cold steel adenoidectomy with an adenoid curette and were then randomized to receive the hemostatic sealant (Floseal) or cautery to obtain hemostasis. Patients were crossed over to the other hemostatic technique if hemostasis was not achieved after more than 100 mL of blood loss or 15 minutes elapsed time. Objective data collected included time to hemostasis and blood loss during hemostasis. Visual analog scales (VAS) were used to record subjective data by the operating surgeon including bleeding following adenoid pack removal (0 = none, 3 = brisk) and ease of operation (1 = extremely easy, 6 = extremely difficult). Parents recorded diet on a journal and were contacted by phone at postoperative day 7 and questioned with regard to return to regular diet and use of narcotics. RESULTS: Compared to patients in the cautery group (n = 35), Floseal patients (n = 35) had significantly shorter times to hemostasis (0.6 +/- 1.3 minutes vs 9.5 +/- 5.4 minutes [mean +/- SD], P < 0.001), less blood loss (2.5 +/- 9.2 mL vs 29.4 +/- 27.1 mL, P < 0.001), less subjective bleeding (0.0 +/- 0.6 vs 2.0 +/- 0.7, [median 4-point VAS +/- SD], P < 0.001), and subjectively easier operations (2.6 +/- 1.0 vs 5.2 +/- 1.0 [mean 6-point VAS +/- SD], P < 0.001). Furthermore, Floseal patients returned to regular diet earlier (2.7 +/- 0.7 vs 4.1 +/- 0.5 days [mean +/- SD], P < 0.001) and had less use of narcotics at 7 days postoperatively (40% vs 69%, P < 0.05). Lastly, three patients in the cautery group were crossed over to the Floseal group, but no Floseal subjects were crossed over to the cautery group. The retail cost of Floseal is US 85 dollars. Operating room costs are estimated at US 12 dollars/minute. Reducing the operative length by 8.9 minutes on average produces a cost savings of US 106.80 dollars per operation. There were no complications in either experimental group including postoperative hemorrhage, hospitalization, blood transfusion, or aspiration. CONCLUSIONS: Floseal matrix hemostatic sealant is a safe, efficacious, easy, and cost-effective technique for obtaining hemostasis in children undergoing adenoidectomy. Limitations of the study include the fact that it is nonblinded, which does allow for some bias in the subjective data recorded. However, utilizing 4 different operating surgeons, 3 of whom were not affiliated with the study, minimized this. CLINICAL SIGNIFICANCE OF STUDY: This study demonstrates the safety and efficacy of a novel hemostatic sealant in children undergoing adenoidectomy. Floseal matrix hemostatic sealant can be used as a first-line hemostatic agent, and it is a good tool in the armamentarium of otolaryngologists who encounter significant bleeding following adenoidectomy.

Adenoidectomy↗
PubMed2005

Intravitreal administration of erythropoietin and preservation of retinal ganglion cells in an experimental rat model of glaucoma.

PURPOSE: The aim of this pilot study was to evaluate the potential neuroprotective effect of an intravitreal injection of erythropoietin (EPO) on retinal ganglion cell (RGC) preservation in an episcleral vessel cautery-induced rat model of glaucoma. METHODS: The animals were randomly assigned into an unoperated control group (n = 11) and three experimental groups: episcleral vessel cautery only (EVC: n = 4), episcleral vessel cautery with intravitreal normal saline injection (EVC-NS; n = 5), and episcleral vessel cautery with intravitreal EPO treatment (EVC-EPO; n = 9). The intravitreal injections were limited to 5 mul containing either normal saline alone or 200 ng of EPO in normal saline administered immediately after the cautery procedure. RGCs were labeled retrogradely by FluoroGold neuron tracer 5 to 7 days prior to the collection of eyes at day 21 and counted in whole flat-mounted retinas with fluorescence microscopy. RESULTS: Compared to the RGC counts in retinal specimens from unoperated control rats (12,619 +/- 310), the corresponding RGC counts were significantly decreased in both the EVC (9116 +/- 273; p < 0.005) and EVC-NS (9489 +/- 293; p < 0.005) groups but not significantly decreased in the EVC-EPO (11,212 +/- 414; p = 0.051) treated retinas. CONCLUSIONS: A single intravitreal 200 ng dose of EPO appears to have a protective effect on RGC viability in an in vivo rat model of glaucoma. Further experimental studies are needed to confirm these preliminary results and to optimize the appropriate dose and frequency of EPO delivery in animal models of glaucoma.

Animals↗
PubMed2004

Use of bipolar energy for transurethral resection of bladder tumors: pathologic considerations.

BACKGROUND AND PURPOSE: Bipolar electrocautery has recently been introduced as a modality for transurethral resection of bladder tumors (TURBT). The primary benefits of bipolar TURBT stem from the use of saline irrigant rather than glycine or water. TURBT should be conducted in a fashion such that the resected tissue can be used for proper grading and staging, so excessive cauterization of the tissue should be avoided. In this study, we compared the pathologic characteristics of bladder tumor specimens resected with bipolar versus standard monopolar energy to determine specimen quality. PATIENTS AND METHODS: Bipolar TURBT (Gyrus Medical Inc., Maple Grove, MN) was performed in 11 patients. Pathologic specimens were compared with the specimens from 11 patients who had previously undergone standard monopolar TURBT. Resected tissue was examined by a pathologist who recorded tumor size, grade, location, presence of muscularis propria, presence of muscle invasion, and final diagnosis. The pathologist also determined the degree of cautery artifact in each specimen. The pathologist was blinded to the form of electrocautery used and the clinical diagnosis. RESULTS: Transurethral resection with bipolar electrocautery was carried out without difficulty or complication in all cases. Similarly, there were no complications in resection by standard monopolar electrocautery. The bladder tumor chips obtained with bipolar TURBT were smaller because of the smaller size of the bipolar loop. However, this did not interfere with the pathologic assessment. There were no significant pathologic differences between specimens according to the type of cautery used. A large degree of cautery artifact was noted in the tissue of larger tumors resected using both monopolar and bipolar electrocautery. However, the incidence and degree of cautery artifact were similar in the two groups. No trends between tumor location and degree of cautery effect were noted. The pathologist had no difficulty reaching a full and proper diagnosis in all cases involving either form of electrocautery. CONCLUSIONS: Bipolar electrocautery is well suited for TURBT. Bladder tissue obtained from bipolar TURBT is of the same histologic quality as that obtained from standard monopolar TURBT and provides the urologist with a reliable and complete diagnosis.

Electrosurgery↗
PubMed2001

[Comparison of 2 lacrimal punctal occlusion methods].

PURPOSE: To study and compare two methods for canalicular occlusion: Cautery and Punctal Patch. METHOD: The study included fourty patients divided in two groups of 20 patients. The end point was 4 occluded puncti. The first group underwent deep cauterization resulting in occlusion of the full vertical aspect of the canaliculus. The second group underwent punctal patch technique for canalicular occlusion. Differential parameters were the following: time of intervention, ease of use, risks and precision. In the post operatory, discomfort, subjective and objective improvement in ocular surface as well as long term result of each technique was analysed. RESULTS: Time of intervention was longer for punctal patch compared to cautery. Both methods exhibited similar ease of use and improvement in ocular surface. Precision was high in punctal patch technique showing complete and final occlusion and no punctum needed reopening, while cautery technique presented 20% rate of reopening intervention. Postoperatory discomfort and irritation were remarkably evident with punctal technique, while minimal in cautery technique. CONCLUSION: Survival analysis after one year follow up, showed a higher rate of advantages for punctal patch technique over cautery technique.

Aged↗
PubMed1998

A prospective comparison of the costs of reusable and limited-reuse laparoscopic instruments.

OBJECTIVE: To compare the cost and performance of 2 types of laparoscopic instrumentation: reusable laparoscopic hook cautery instruments and curved scissors, or limited-reuse laparoscopic hook cautery instruments and curved scissors. DESIGN: A randomized trial. SETTING: The operating room of a tertiary care hospital. METHOD: All general surgeons performing laparoscopic procedures at the hospital were randomized to be supplied with either reusable or limited-reuse hook cautery and curved scissors. Instrument use was recorded, together with principal outcome measures. OUTCOME MEASURES: Life expectancy of the instruments, the number of cases for which they were used, the number, nature and cost of repairs, their purchase cost and surgeon satisfaction. RESULTS: Reusable hook cautery instruments were less expensive than their limited-reuse counterparts. Excellent surgeon satisfaction was reported with the use of this type of instrument. The limited-reuse curved scissors arm of the study was terminated early because of a breach in study protocol. CONCLUSIONS: Reusable hook cautery instruments were better than their limited-reuse counterparts. Rigorous attempts to compare the cost of laparoscopic instruments may be limited by their rapid evolution in design and the availability of many types of instruments on the market.

Attitude of Health Personnel↗
PubMed1992

The vas after vasectomy: comparison of cauterization methods.

A histologic study of the vas ends was carried out in 21 patients undergoing vasovasostomy. All had undergone prior vasectomy by the same surgeon, with a technique identical except for the type of cautery used to seal the vas ends. A superior sealing of the vas, as shown by fewer cases of vasitis nodosa and spermatic granuloma, followed use of the thermal cautery ("red-hot wire") than the electrosurgical cautery (23% vs 60.7% suboptimal sealing rate). The thermal cautery is a superior method of sealing the vas at vasectomy.

Cautery↗