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In vitro assessment of tissue heating near metallic medical implants by exposure to pulsed radio frequency diathermy.

A patient with bilateral implanted neurostimulators suffered significant brain tissue damage, and subsequently died, following diathermy treatment to hasten recovery from teeth extraction. Subsequent MRI examinations showed acute deterioration of the tissue near the deep brain stimulator (DBS) lead's electrodes which was attributed to excessive tissue heating induced by the diathermy treatment. Though not published in the open literature, a second incident was reported for a patient with implanted neurostimulators for the treatment of Parkinson's disease. During a diathermy treatment for severe kyphosis, the patient had a sudden change in mental status and neurological deficits. The diathermy was implicated in causing damage to the patient's brain tissue. To investigate if diathermy induced excessive heating was possible with other types of implantable lead systems, or metallic implants in general, we conducted a series of in vitro laboratory tests. We obtained a diathermy unit and also assembled a controllable laboratory exposure system. Specific absorption rate (SAR) measurements were performed using fibre optic thermometry in proximity to the implants to determine the rate of temperature rise using typical diathermy treatment power levels. Comparisons were made of the SAR measurements for a spinal cord stimulator (SCS) lead, a pacemaker lead and three types of bone prosthesis (screws, rods and a plate). Findings indicate that temperature changes of 2.54 and 4.88 degrees C s(-1) with corresponding SAR values of 9129 and 17,563 W kg(-1) near the SCS and pacemaker electrodes are significantly higher than those found in the proximity of the other metallic implants which ranged from 0.04 to 0.69 degrees C s(-1) (129 to 2471 W kg(-1)). Since the DBS leads that were implanted in the reported human incidents have one-half the electrode surface area of the tested SCS lead, these results imply that tissue heating at rates at least equal to or up to twice as much as those reported here for the SCS lead could occur for the DBS leads.

Body Temperature↗

The treatment of superficial bladder tumours under local anaesthetic using suction diathermy electrodes.

Daycase cystoscopy under local anaesthetic is commonly used in screening patients with superficial transitional cell carcinoma of the bladder. Treatment of any lesions found, however, often requires a further cystoscopy under general or regional anaesthesia. Recent reports suggest that small lesions can be diathermied without anaesthesia with only mild patient discomfort. Suction diathermy electrodes, introduced for the treatment of small superficial bladder tumours, have significant advantages over conventional methods. Firstly, most of the superficial tumour fronds can be removed painlessly by suction alone. Diathermy, the uncomfortable component of treatment, is sparingly used to treat the tumour base. Larger tumours can therefore be treated by suction diathermy, with less patient discomfort, than by standard cystodiathermy methods. Secondly, by eliminating tumour debris within the bladder during treatment and reducing tissue damage due to diathermy, suction diathermy minimizes the risk of tumour recurrence due to implantation. In this preliminary report the ease and efficacy of using suction diathermy electrodes under local anaesthesia is assessed.

Aged↗

Stapled hemorrhoidopexy vs. diathermy excision for fourth-degree hemorrhoids: a randomized, clinical trial and review of the literature.

PURPOSE: The aim of this prospective study was to compare the results of stapled hemorrhoidopexy with those of conventional diathermy excision for controlling symptoms in patients with fourth-degree hemorrhoids. METHODS: Thirty-one patients with symptomatic, prolapsed irreducible piles were randomized to either stapled hemorrhoidopexy (n = 15) or diathermy excision (n = 16). The primary outcome measure was the control of hemorrhoidal symptoms one year after operation. RESULTS: The two procedures were comparable in terms of pain relief and disappearance of bleeding. Recurrent prolapse starting from the fourth month after operation was confirmed in 8 of 15 patients in the stapled group and in none in the diathermy excision group: two-tailed Fisher's exact test P = 0.002, RR 0.33, 95 percent confidence interval 0.19-0.59). Five of these patients responded well to a later conventional diathermy hemorrhoidectomy. Persistence of itching was reported in six patients in the stapled group and in one of the diathermy excision group (P = 0.03). On the other hand, six patients in the stapled group and none in the diathermy excision group experienced tenesmus (P = 0.007). CONCLUSIONS: Stapled hemorrhoidopexy was not effective as a definitive cure for the symptoms of prolapse and itching in patients with fourth-degree hemorrhoids. Moreover, stapled hemorrhoidopexy induced the appearance of a new symptom, tenesmus, in 40 percent of the patients. Therefore conventional diathermy hemorrhoidectomy should continue to be recommended in patients with symptomatic, prolapsed, irreducible piles.

Adult↗

A prospective study comparing unilateral and bilateral laparoscopic ovarian diathermy in women with the polycystic ovary syndrome.

OBJECT: To assess the efficacy of unilateral laparoscopic ovarian diathermy in the induction of ovulation in anti-estrogen-resistant polycystic ovary syndrome (PCOS). DESIGN: A prospective randomized study was performed to compare unilateral with bilateral ovarian diathermy. SETTING: Specialist Reproductive Endocrine Unit. PATIENTS: Ten patients with anti-estrogen-resistant PCOS. INTERVENTIONS: Randomization to unilateral (4 patients) or bilateral laparoscopic ovarian diathermy (6 patients). MAIN OUTCOME MEASURES: Rate and side of ovulation and change in endocrine profiles after ovarian diathermy. RESULTS: Unilateral ovarian diathermy resulted in ovulation from both ovaries. Fifty percent of the patients responded to diathermy and those who responded had a significantly greater fall in serum LH concentrations than those who failed to respond. CONCLUSIONS: The mechanism of action of laparoscopic ovarian diathermy is via a correction of disturbed ovarian-pituitary feedback. Hypersecretion of LH appears to be the most significant endocrine disturbance in these patients.

Adult↗

Postoperative bleeding after diathermy and dissection tonsillectomy.

OBJECTIVE: To analyze the incidence and pattern of bleeding after tonsillectomy performed by either cold dissection or diathermy. DESIGN: A prospective, nonrandomized cohort study of postoperative hemorrhage after tonsillectomy. METHODS: Monthly reporting of the number of tonsillectomies and postoperative bleeds from otolaryngologists working in rural areas of Victoria, Australia over a 2.5 year period. Criteria for bleeding were either 1) repeat anesthesia and surgery because of hemorrhage (including return to theater from the recovery room), or 2) readmission to hospital because of bleeding, or 3) blood transfusion to replace blood loss. Main outcome measures were the incidence, volume, and time course of postoperative hemorrhage. RESULTS: The number of bilateral tonsillectomies with removal by cold-blunt dissection was 3,087. In this group, there were 57 (1.85%) bleeds. The number of bilateral tonsillectomies with removal by diathermy dissection was 1,557. In this group, there were 37 (2.38%) bleeds. If cold dissection is taken as the "control" and diathermy tonsillectomy as the "treatment" group, the relative risk of bleeding after diathermy tonsillectomy is 1.30 (95% confidence interval 0.88-1.93). The pattern of bleeding after each technique differs significantly over time, with more reactionary bleeds in the dissection group and more bleeds between 4 to 7 postoperative days after diathermy. When bleeding occurred, it was in excess of 500 mL in 16% of dissection cases and 43% of diathermy tonsillectomies. CONCLUSIONS: The difference in the risk of bleeding after each technique did not reach statistical significance, but the temporal pattern of hemorrhage differed, and more bleeds exceeding 500 mL were seen in the diathermy group.

Adolescent↗

The effects of different levels of heat production induced by diathermy and eccentric work on thermoregulation during exercise at a given skin temperature.

The thermal responses of two healthy male subjects have been studied at the same mean skin temperature (Tsk) during negative work, positive work and positive work in which additional heating was induced by diathermy. The results showed that for a given metabolic heat production (M) rectal (Tre) and oesophageal (Toes) temperatures were higher in negative work and positive work with diathermy than normal control experiments. In resting experiments with diathermy, Toes rose to the same level as when an equal amount of heat was produced metabolically by exercise. In negative work and positive work with diathermy sweat loss (Msw) was higher for a given M and Tsk than found for normal exercise, but in all three forms of work the relationship of Msw to total heat production (H) was identical. During positive work with and without diathermy the differences in Msw could be accounted for by using a previously developed model of relative sweating rate: %Msw = -constant + alphaTre (or Toes) + betaTsk. In negative work, removal of the difference between predicted and observed %Msw required the inclusion of a further factor into the equation based on muscle temperature. The results suggest that the core temperature in exercise rises to meet the requirements of heat dissipation mainly by stimulating Msw and establishing a heat transfer gradient from core to periphery and is not necessarily or uniquely related to M or to the rate of working. The study underlines the usefulness of negative work and diathermy as physiological tools for the further understanding of thermoregulation during exercise.

Adult↗

Transscleral diathermy: an additional tool in the management of retinal detachment due to posterior breaks in highly myopic eyes.

PURPOSE: To investigate the usefulness of transscleral diathermy for the treatment of retinal detachment due to breaks located at the posterior pole in areas of advanced chorioretinal atrophy or staphyloma in highly myopic eyes. METHODS: We reviewed the charts of seven consecutive patients who were operated on between 1984 and 1994 and for whom transscleral diathermy was used during intraocular retinal reattachment surgery to reduce posterior staphyloma. Mean refraction of the seven eyes was -24 diopters (range -16 to -35 diopters). RESULTS: After surgery, which included diathermy, the retina was reattached in six eyes (86%) that also had undergone vitrectomy and silicone oil tamponade, but remained detached in one eye (14%) that had undergone pneumopexy and diathermy; in this eye, the retina was subsequently reattached after vitrectomy and silicone oil injection. Silicone oil was removed from all seven eyes after a mean duration of 2.5 months. During a mean follow-up of 3 years, a recurrent retinal detachment developed in one eye 8 months after silicone oil removal. This retina was reattached after reinjection of silicone oil. CONCLUSIONS: In the treatment of retinal detachment in highly myopic eyes, closure of posterior holes in areas of advanced chorioretinal atrophy or staphyloma can be achieved by transscleral diathermy in conjunction with vitrectomy and temporary silicone oil tamponade. The main benefit of transscleral diathermy results from its posterior pole scleral buckling effect due to shrinkage of the sclera.

Adult↗

Scleral damage: comparison of standard and modified diathermy electrodes.

Full-thickness scleral diathermy using a standard electrode causes significant scleral damage and necrosis. Use of a modified (Jabbour's) diathermy electrode appears to cause minimal scleral damage. We evaluated the scleral changes following transscleral diathermy application using standard and modified diathermy electrodes to the peripheral retina and ciliary body. Twelve Dutch belted pigment rabbits were used in our experiment. Three eyes each were subjected to transscleral diathermy using standard and modified electrodes to produce chorioretinal scars and cyclodestruction. Eyes were examined with the slit lamp and indirect ophthalmoscope at weekly intervals for 4 weeks. Light and transmission electron microscopy was performed 1 hour after diathermy application in 4 animals and in the remaining 8 animals at 4 weeks. Chorioretinal scarring and ciliary body atrophy were successfully induced with both types of electrodes. However, scleral damage was less severe in eyes treated with the modified electrode as compared with the standard electrode.

Animals↗

Surgical treatment of atrial fibrillation with diathermy: an in vitro study.

OBJECTIVE: The utilization of diathermy (electrocautery) as an energy source in the treatment of chronic atrial fibrillation has generated positive early clinical results. Although this technology is available and affordable, it has not been well studied for this indication. The objectives of this study were: (1) to characterize atrial lesions created by diathermy, (2) to determine relationships between power setting, tissue contact time, and lesion depth and (3) to histologically compare diathermy and unipolar radiofrequency lesions. METHODS: Fresh bovine atrial tissue samples were used to create endocardial lesions using a unipolar diathermy system with a blade tip. A total of 120 lesions were created at varying power settings and tissue contact times. Subendocardial temperatures were recorded. All lesions were examined grossly, then fixed, sectioned and evaluated histologically by a blinded pathologist. Comparisons were made with saline irrigated unipolar radiofrequency lesions. RESULTS: Gross examination revealed extensive tissue destruction of the endocardial surface at the point of contact. Histological examination showed minimal penetrance of the lesions beyond the destroyed tissue margin of the endocardium. This was corroborated by the finding of minimal thermal penetration beyond the endocardium and superficial myocardium. There was a linear relationship between the power setting (15-55 watts), depth of penetrance (2-15 mm) at varying contact times (1-5s/cm). CONCLUSIONS: In this in vitro model, lesions created by diathermy were not transmural, even with high power settings and prolonged contact times. At these settings, significant tissue destruction was observed that may predispose to atrial perforation without achieving penetration. Diathermy did not constitute an effective energy source in the creation of transmural lesions for atrial fibrillation ablation.

Animals↗

Diathermy loop excision in the management of cervical intraepithelial neoplasia: diagnosis and treatment in one procedure.

OBJECTIVE: Diathermy loop excision was performed as a new diagnostic-treatment in patients with cervical cytologic diagnoses consistent with an epithelial abnormality. STUDY DESIGN: A total of 424 patients with cervical cytologic diagnoses consistent with an epithelial abnormality, but macroscopically or colposcopically not consistent with invasive carcinoma, were subjected to diathermy loop excision to diagnose and treat cervical lesions in one procedure. RESULTS: The diagnostic accuracy rate was 99%. In patients with histologically confirmed grade 3 cervical intraepithelial neoplasia, pretreatment cytologic diagnosis and subsequent histopathologic diagnosis corresponded in 73% of cases. In 91% of all patients the diathermy loop excision was sufficient for complete treatment. Cervical morphologic findings after treatment allowed adequate cytologic follow-up. There was no evidence that diathermy loop excision influenced fertility or pregnancy outcome. CONCLUSION: Diathermy loop excision is a reliable, well-tolerated, inexpensive, and efficient technique for the management of cervical intraepithelial neoplasia. This outpatient procedure is especially recommended in younger patients, because diathermy loop excision preserves the function of the cervix.

Electrocoagulation↗

Computerized bipolar diathermy with scissors and forceps in cutaneous surgery.

BACKGROUND: Bipolar diathermy coagulates tissue as effectively as monopolar with less lateral tissue injury and no risk of interference with cardiac pacemakers or joint prostheses. OBJECTIVE: To test a novel computerized bipolar diathermy machine for combined cutting and coagulation in dermatologic surgery. METHODS: A divided cable was used to deliver current from a computerized bipolar diathermy unit to both scissors and forceps. The bipolar diathermy unit senses tissue contact with the instruments and starts automatically; a built-in microcomputer measures tissue impedance and automatically terminates the current when tissue coagulation is achieved. RESULTS: The equipment has been used successfully in more than 200 patients undergoing dermatologic surgery. The advantages were a reduced operating time and a more secure hemostasis. The microprocessor controlled bipolar diathermy unit minimized any tissue adherence to the instruments during use. CONCLUSION: We recommend the use of insulated scissors and computerized bipolar diathermy for safe and efficacious coagulation and cutting in dermatologic surgery.

Dermatologic Surgical Procedures↗

Short wave diathermy for small spontaneous pneumothorax.

BACKGROUND: The treatment of small spontaneous pneumothorax can involve observation, tube thoracostomy, and surgery. This study evaluated the use of short wave diathermy as a method of accelerating the resolution of small pneumothoraces. METHODS: Twenty two patients with pneumothoraces of less than 30% by volume were randomly allocated to receive short wave diathermy for 25 minutes each day (n = 11) or observation with bed rest (n = 11). Chest radiographs were taken until the pneumothoraces resolved. RESULTS: There were no significant differences in the clinical characteristics between the two groups of patients. However, the mean (SD) rate of absorption was significantly higher with short wave diathermy than with observation (3.44 (0.94)% versus 1.57 (0.53)%, difference = 1.87, 95% confidence interval (CI) 1.19 to 2.55, p < 0.001). The time to complete reexpansion was shorter with short wave diathermy than with observation (6.86 (3.51) days versus 11.64 (3.61) days, difference = -4.78 days, 95% CI -7.95 to -1.61, p < 0.005). No evidence of damage resulting from short wave diathermy was found. CONCLUSIONS: Although further study is necessary, these results indicate that short wave diathermy may be an alternative treatment for patients with small spontaneous pneumothoraces.

Adolescent↗

Heat distribution in the lower leg from pulsed short-wave diathermy and ultrasound treatments.

OBJECTIVE: To compare tissue temperature rise and decay after 20-minute diathermy and ultrasound treatments. DESIGN AND SETTING: We inserted 3 26-gauge thermistor microprobes into the medial aspect of the anesthetized triceps surae muscle at a depth of 3 cm and spaced 5 cm apart. Eight subjects received the diathermy treatment first, followed by the ultrasound treatment. This sequence was reversed for the remaining 8 subjects. The diathermy was applied at a frequency of 27.12 MHz at the following settings: 800 bursts per second, 400-microsecond burst duration, 850-microsecond interburst interval, peak root mean square amplitude of 150 W per burst, and an average root mean square output of 48 W per burst. The ultrasound was delivered at a frequency of 1 MHz and an intensity of 1.5 W/cm(2) in the continuous mode for 20 minutes over an area of 40 times the effective radiating area. The study was performed in a ventilated research laboratory. SUBJECTS: Sixteen (11 men, 5 women) healthy subjects (mean age = 23.56 +/- 4.73 years) volunteered to participate in this study. MEASUREMENTS: We recorded baseline, final, and decay temperatures for each of the 3 sites. RESULTS: The average temperature increases over baseline temperature after pulsed short-wave diathermy were 3.02 degrees C +/- 1.02 degrees C in site 1, 4.58 degrees C +/- 0.87 degrees C in site 2, and 3.28 degrees C +/- 1.64 degrees C in site 3. The average temperature increases over baseline temperature after ultrasound were only 0.17 degrees C +/- 0.40 degrees C, 0.09 degrees C +/- 0.56 degrees C, and -0.43 degrees C +/- 0.41 degrees C in sites 1, 2, and 3, respectively. The temperature dropped only 1 degrees C in 7.65 +/- 4.96 minutes after pulsed short-wave diathermy. CONCLUSIONS: We conclude that pulsed short-wave diathermy was more effective than 1-MHz ultrasound in heating a large muscle mass and resulted in the muscles' retaining heat longer.

Journal Article↗

[Bipolar temperature controlled diathermy of the sclera for controlled refractive change of the cornea].

A bipolar scleral diathermy unit measuring tissue temperature beneath the electrodes was used in 27 autopsy eyes to induce corneal curvature changes in order to modify corneal refraction. The optimal coagulation temperature was found to be between 65 degrees and 70 degrees C. The refractive effect was influenced by the distance of the electrodes (1 mm, 2 mm, 3 mm), their location ("limbal distance") and their position in reference to the limbus ("radial", "parallel"). The highest corneal curvature changes were observed with diathermy applied directly at the limbus or 1 mm distance from the limbus. The corneal meridian corresponding to the treated sclera regularly became significantly steeper and the untreated 90 degrees meridian flatter. Limbus parallel diathermy administered directly at the limbus showed a 0.91 mm increase in the corneal curvature with a 2 mm distance or a 0.34 mm increase with a 3 mm distance of both electrodes. Placing the electrodes radially or parallel of the limbus revealed greatest changes in corneal refraction using diathermy directly at the limbus or 1 mm distant from the limbus. The refractive effect decreased as the distance from the limbus increased. Corneal astigmatism could be decreased and increased in a quasi-controlled manner. Over-lapping diathermy offered the potential of gradually changing the corneal power. Histological sections showed that scleral collagen had only a superficial coagulation effect. Scleral diathermy offers great advantages in comparison to corneal incisions for the therapy of corneal astigmatism. Further investigations are in progress.

Astigmatism↗

Randomized clinical trial of suction versus standard clearance of the diathermy plume.

BACKGROUND: Diathermy smoke contains complex hydrocarbons and organic material, and may contain viable tumour cells or viral particles. These particles measure from 0.05 to more than 25 microm, and long-term exposure to such particles may have adverse effects on health. This study investigated whether a suction clearance device reduces the amount of smoke reaching the surgeon's mask. METHODS: This was a randomized clinical trial in which subjects were randomized to standard diathermy equipment (group 1) or a diathermy smoke extraction system (group 2). All patients underwent thyroid or parathyroid surgery with standard anterior cervical collar incision and division of the strap muscles. The difference in the amount of smoke reaching the level of the operator's mask was measured by means of an aerosol monitor. RESULTS: Fifteen patients were randomized to each group. The mean amount of smoke detected at the level of the operator's mask was 0.137 mg/m(3) in group 1 and 0.012 mg/m(3) in group 2 (P < 0.001). The maximum amount detected was 2.411 and 0.255 mg/m(3) respectively (P < 0.001). There were no significant differences between the groups in terms of incision time or background particles measured before and after surgery. There was no correlation between gland weight and incision time or amount of smoke detected. CONCLUSION: Suction clearance of the diathermy plume resulted in a significant reduction in the amount of smoke reaching the level of the operator's mask. Although the risk of diathermy smoke inhalation is currently unknown, use of such a system appears advisable.

Adult↗

A randomized controlled trial of laparoscopic ovarian diathermy versus gonadotropin therapy for women with clomiphene citrate-resistant polycystic ovary syndrome.

OBJECTIVE: To compare the effectiveness of laparoscopic ovarian diathermy with gonadotropin ovulation induction for women with clomiphene citrate-resistant polycystic ovary syndrome. DESIGN: Randomized controlled trial. SETTING: A tertiary referral fertility clinic. PATIENT(S): Women with anovulatory infertility secondary to clomiphene-resistant polycystic ovary syndrome. Inclusion criteria were age of <39 years, body mass index of <35 kg/m(2), failure to ovulate with 150 mg of clomiphene citrate for 5 days in the early follicular phase, >12 months of infertility, and no other causes of infertility. INTERVENTION(S): Laparoscopic ovarian diathermy versus three cycles of urinary or recombinant gonadotropins. MAIN OUTCOME MEASURE(S): Cumulative pregnancy and miscarriage rates. RESULT(S): Cumulative pregnancy rates were 28% at 6 months for laparoscopic ovarian diathermy and 33% for three cycles of ovulation induction with gonadotropins. There were three miscarriages in each group. Women in the laparoscopic ovarian diathermy arm of the study had four additional spontaneous pregnancies 6 to 12 months after surgery. CONCLUSION(S): There was no statistically significant difference in pregnancy or miscarriage rates during the 6-month follow-up period or the three cycles. Laparoscopic ovarian diathermy is a safe and effective alternative to ovulation induction with gonadotropins.

Adult↗

Use of bipolar diathermy to prevent posterior capsule opacification(1).

PURPOSE: To determine the feasibility of using directed bipolar diathermy to eliminate or reduce the formation of new cortical lens material following phacoemulsification in a rabbit model. SETTING: Department of Research & Development, Bausch & Lomb Surgical, and Department of Ophthalmology, St. Louis University, St. Louis, Missouri, USA. METHODS: A rabbit model for posterior capsule opacification (PCO) was used. A continuous curvilinear capsulorhexis was performed followed by phacoemulsification to remove cortical lens material. In 2 experimental groups, modified bipolar instruments were used to apply diathermy to residual lens epithelial cells using an intracapsular or extracapsular method of application. Postoperative clinical examinations were at 1, 3, and 7 days and then weekly up to 60 days. Selected animals were followed for a longer period. Capsule integrity was evaluated by measuring the pressure required to rupture the capsule in similarly treated porcine eyes. RESULTS: Diathermy prevented PCO in 4 of 4 eyes in the intracapsular treatment group and 4 of 5 in the extracapsular group. Eyes remained free of new lens cortex for the life of the animal, which was as long as 18 months. New cortical material was detected after 35 days in 1 animal in the extracapsular group. Mean time for the formation of observable cortical material was 29 days +/- 5 (SD) in the control animals. Physical measurements did not detect a reduction in capsule integrity with diathermy treatment. The extracapsular treatment method resulted in fewer iris complications. CONCLUSIONS: Directed diathermy has the potential to eliminate secondary cataract formation with minimal damage to collateral tissues.

Animals↗

An experimental study on effects of monopolar diathermy on the bile ducts.

OBJECTIVE: To study the effects of monopolar diathermy on the bile ducts in pigs. DESIGN: Experimental study. SETTING: University hospital, Norway. MATERIAL: 18 pigs. INTERVENTIONS: Laparotomy, application of diathermy at standard sites along the cystic duct, the bile ducts, and a cystic duct containing a metal clip, 3 to 12 times of 5 seconds' duration at each site. Temperature was subsequently recorded at standard measurement points on the bile ducts. Twelve pigs were killed after three weeks for assessment of the bile ducts at necropsy. MAIN OUTCOME MEASUREMENTS: Increase in temperature in the bile duct walls and late changes in the bile ducts. RESULTS: Temperature increased by 4-6 degrees C during 6 of 330 diathermy applications along the cystic duct, by 4-18 degrees C in 8 of 126 applications along the common bile duct, and by 4-11 degrees C at the clip in 9 of 54 applications. There were no macroscopic or microscopic changes in the bile ducts. CONCLUSION: Monopolar diathermy induced unexpected distant increases in the temperature of the bile duct walls and at a clip on the cystic duct probably because diathermy current energy was distributed along channels of high current conductivity.

Animals↗