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Endocrine changes after laparoscopic ovarian cautery in polycystic ovarian syndrome.

Recently, laparoscopic ovarian cautery has been described as a method of ovulation induction in women with polycystic ovarian disease. In an attempt to determine the mechanism of action, serum levels of androstenedione, testosterone, luteinizing hormone, follicle-stimulating hormone, and estradiol were determined before and after the laparoscopic ovarian cautery in six women with polycystic ovarian disease who had failed to ovulate with clomiphene citrate and human chorionic gonadotropin. Six regularly cycling women undergoing laparoscopy for investigation of infertility or tubal ligation served as controls. In patients with polycystic ovarian disease but not in controls, serum androstenedione, testosterone, estradiol, and luteinizing hormone significantly decreased to nadir levels on postoperative days 3 and 4. In contrast follicle-stimulating hormone levels rose after operation. These results resemble those reported after ovarian wedge resection. Of the six treated women, five ovulated postoperatively and four conceived. Laparoscopic ovarian cautery appears to be a promising alternative treatment for patients with polycystic ovarian disease in whom initial medical management fails.

Adult↗

Feasibility study for robotic radical prostatectomy cautery-free neurovascular bundle preservation.

INTRODUCTION: Efforts continue to develop techniques that maintain the neurovascular bundles and minimize trauma for robotic laparoscopic radical prostatectomy. We evaluated the feasibility of preserving the nerve bundles without cautery or surgical clips. TECHNICAL CONSIDERATIONS: The seminal vesicles were dissected using scissors and bipolar cautery. After the rectum was mobilized, the vascular pedicles (VPs) were delineated. Laparoscopic bulldog clamps (30 mm) were placed at least 1 cm from the prostate. Using scissors, the VPs were divided right at the prostate. The neurovascular bundle was gently dissected off the prostatic capsule. After mobilizing the bundle, FloSeal was applied along its entire length. The FloSeal was then covered with a dry 1 x 4-cm sheet of Gelfoam. Once the prostate was removed, the bulldog clamps were sequentially withdrawn. The VPs were observed, and, if pulsatile bleeding was encountered, a 3-0 figure-of-eight suture was precisely placed for hemostasis. When hemostasis was complete, the anastomosis was performed. RESULTS: In 17 men, temporary vascular occlusion was applied to 27 VPs and FloSeal and Gelfoam was applied each time. In 4 cases (15%), hemostasis was inadequate because of continued arterial bleeding that was easily controlled with a superficial figure-of-eight ligature of 3.0 absorbable suture. The average estimated blood loss was 91 mL (range 75 to 150). CONCLUSIONS: Cautery-free, clip-free, nerve-sparing robotic laparoscopic radical prostatectomy is feasible using a combination of temporary occlusion of the thick posterior prostatic pedicles with bulldog clamps followed by application of FloSeal. The effect on potency needs further follow-up.

Adult↗

Tubal anastomosis following unipolar cautery.

Twenty-five of 48 women (52%) sterilized by unipolar cautery techniques conceived following tubal anastomosis, of whom 17 (36%) had a living child. The overall cumulative probability of conception at the end of follow-up as determined by life-table analysis was 76%. Increasing age, parity, and the duration of the interval from sterilization to reversal did not influence pregnancy success. A decreased pregnancy rate was associated with ampullary-isthmic anastomosis; however, a pregnancy was least likely to occur in women with shortened oviducts of less than or equal to 4 cm (P less than 0.01). A decreased pregnancy rate in cautery-sterilized patients undergoing reversal may be related to the destruction of a larger segment of the fallopian tube. Interestingly, 71% of the cautery-sterilized patients were noted to have associated tubal disease such as endometriosis and/or proximal hydrosalpinx. The influence of these findings on subsequent pregnancy success remains to be established.

Adult↗

Electro-cautery of myomas during caesarean section--two case reports.

Myomectomy is a surgical procedure not usually performed during caesarean section because associated with high risk of haemorrhage and other complications. The goal of our study is to evaluate the feasibility of myomectomy during caesarean section, the outcome, and try to establish the favourable conditions to perform a myomectomy during the same surgical event. Electro-cautery of intramural-subserous myomas was performed on two different patients. Only the myomas of little or middle size were treated. Both patients had multiple fibroids, a firm contraindication for myomectomy during caesarean section. After 10 and 13 months since myoma electro-cautery, all uterine fibroids treated were completely reabsorbed. These preliminary results regard the fibroids of middle size. It could be interesting evaluating the electro-cautery on bigger fibroids.

Adult↗

Thermal orbital injuries from disposable cauteries.

Forty rabbits divided in six groups and three brands of hot wire cautery with temperature ranging from 190 degrees C to 1035 degrees C were used in this experiment. A surgical procedure resembling a cosmetic blepharoplasty was performed on a total of 60 lower eyelids of the rabbits. The remaining eyelids were either shams or normal controls. Cautery application to orbital fat was carefully controlled, i.e., 10 or 20 seconds in single or double applications. Gross observation and microscopic examination of the biopsied specimens taken at 3 hours, 2 days, and 2 weeks after the procedures were performed. Evidence of thermal injury to the lacrimal gland and extraocular muscle damage was found. Although no evidence of thermal injury to the optic nerve was found, it was conceivable that either by a direct transfer of heat or by an indirect inflammatory and compressive effect the health of the optic nerve might be threatened. It is strongly recommended that hot wire cautery be used with extreme caution when working with orbital tissues.

Adipose Tissue↗

Electroconvergent cautery.

A new cautery system known as the electroconvergent cautery system is described. This cautery system uses a radiofrequency current of 13.56 MHz. The current is passed through an amplifier, an impedance matching system, and a loading and tuning coil into a probe. After the probe tip is touched to the tissue, the mismatch of impedance between the probe tip and the generator is minimized to almost zero, resulting in high-current density at the probe tip, which causes pinpoint heating of the tissue at the point where it is touched by the probe without spread of heat to the surrounding tissue. This heat can cut and vaporize tissue and coagulate vessels. The probe can also be used to coagulate vessels with standard surgical forceps. Because convergence of energy is used for tissue heating, a grounding pad is not needed. The system can also be used under cerebrospinal fluid or saline.

Astrocytoma↗

Local anaesthesia with a lidocaine/prilocaine cream (EMLA) for cautery of condylomata acuminata on the vulval mucosa. The effect of timing of application of the cream.

The analgesic efficacy of a lidocaine/prilocaine cream (EMLA) for the cautery of genital warts was evaluated in an open study. Fifty-two women aged 18 to 28 with at least two condylomata on the vulval mucosa took part. In a pilot study (n = 10) the time of onset of anaesthesia after the application of EMLA to the mucosa was established by pinching with a forceps. All ten patients were anaesthetized within 5-7 min and cautery was performed with no or only slight pain in 9/10 patients. In the main study EMLA was applied to the mucosa of 42 women for 10, 15 or 20 min. The anaesthesia was satisfactory for the cautery of condylomata in 92% of the patients after the application of EMLA for 10 minutes. The analgesic efficacy decreased gradually with application times of 15 min or longer (p less than 0.05). In the case of insufficient anaesthesia, an additional application of EMLA for 2-5 min enabled the operations to be completed in 7/8 patients.

Adolescent↗

Laser versus electrical cautery in the treatment of condylomata acuminata of the anus.

Thirty-eight patients with condylomata acuminata of the anus, requiring surgical therapy, had the left half of the anus treated with conventional electrical cautery, while the right half of the anus was treated with the carbon dioxide laser at the same time. Patients were questioned about the amount of pain on both sides and were studied for evidence of recurrence. The laser was associated with either more pain or the same amount of pain when compared with that of electrical cautery. Recurrences were first seen more often on the laser side. The cost of the laser treatment to the patient was higher by $50. it is concluded that the laser offers no advantage and may, indeed, be less effective than the conventional electrical cautery in the treatment of condylomata acuminata of the anus.

Anus Neoplasms↗

An investigation of bone necrosis and healing after cryosurgery, phenol cautery or packing with bone cement of defects in the dog femur.

A corticocancellous core was removed from the lateral condyle of both femurs in 26 skeletally mature dogs. The cavity was treated with cryosurgery, phenol cautery or packing with bone cement. The animals were killed after 1, 4, and 12 weeks in the phenol and cement groups, and also after 24 weeks in the cryosurgery group. The extent of the bone necrosis and healing was assessed in each group. After cryosurgery the extent of necrosis was profound in that the area of damage was 365% compared to the area of the cavity; the depth of necrosis extended between 2.5 and 14 mm, beyond the cavity wall. The effect of phenol was negligible in that only microscopic areas of superficial focal necrosis were found around the cavity wall. Bone cement produced an area of necrosis of 153% compared with the cavity, with a depth of between 1.3 and 2.8 mm. Regeneration in the region of necrosis after cryosurgery was only scanty by 4 weeks, but by 12 weeks considerable areas of regeneration were identified and complete healing was observed by 24 weeks. Regeneration of the necrotized bone produced by bone cement packing was rapid and similar to that of the control specimens. These findings suggest that cryosurgery could play a significant role as a surgical adjunct to curettage in locally aggressive benign bone tumours and in some malignancies. Phenol cautery is not regarded as an adequate treatment after curettage of bone tumours. Although the extent of necrosis was relatively small, packing with bone cement is thought to be a useful choice in benign cases.

Animals↗

Endoscopic cautery using the heater probe as an alternative to operation for massive gastroduodenal haemorrhage.

Endoscopic cautery using the heater probe has been used by the author since 1981 for treatment of acute gastroduodenal haemorrhage. The technique has been used as an alternative to immediate operation in 175 patients who had clearly demonstrated a need for intervention. All 175 had suffered recurrent haemorrhage in hospital to a blood transfusion requirement of at least 3 litres. Ulcer patients were selected by being over 60 yrs old or otherwise unfit for operation. Early experience showed that the technique was not reliable for patients bleeding from large posterior duodenal ulcers, so 35 old or sick patients with duodenal ulcer were excluded from the series. There were no exclusions with patients bleeding from lesions proximal to the pylorus, and 82% of these were successfully treated. Even with avoidance of large posterior ulcers, only 47% of duodenal ulcer patients were able to safely avoid an operation. It is concluded that heater probe cautery can replace emergency operation in most patients bleeding from gastric lesions, but it has a limited role for patients bleeding from duodenal ulcer.

Adult↗

Laparoscopic hepatectomy with the hook blade of ultrasonic coagulating shears and bipolar cautery with a saline irrigation system.

BACKGROUND: The number of patients who have undergone laparoscopic hepatectomy is small, and the operative procedure is not yet well established. METHODS: We performed laparoscopic hepatectomy in eight patients, using the hook blade of ultrasonic coagulating shears, and bipolar cautery with a saline irrigation system, with minilaparotomy. The operative time, blood loss, and postoperative hospital stay of patients with laparoscopic left lateral segmentectomy were compared with these parameters in ten patients who had had a left lateral segmentectomy with laparotomy. RESULTS: The laparoscopic hepatectomies included seven left lateral segmentectomies and one nonanatomical partial resection of the lateral segment. The mean duration of the operation in these eight patients was 181.1 +/- 44.6 min. The mean amount of blood loss was 177.6 +/- 129.1 ml. Postoperative complications consisted of two cases of bleeding. The mean postoperative hospital stay in all eight patients was 9.88 +/- 4.36 days. The mean duration of operation (185.9 +/- 46.0 min) and mean postoperative hospital stay (9.47 +/- 4.61 days) in the seven patients with laparoscopic left lateral segmentectomies were significantly shorter than these parameters (255.7 +/- 59.4 min and 24.6 +/- 8.82 days) in the ten patients who had had left lateral segmentectomies with laparotomy. The mean amount of blood loss (160.0 +/- 128.9 ml) in the laparoscopic series was less than that (318.5 +/- 192.2 days) in the patients who had had laparotomy. CONCLUSIONS: Laparoscopic hepatectomy with the ultrasonic coagulating shears and bipolar cautery with minilaparotomy was safe, and less invasive than the open procedure, for minor hepatectomy procedures such as left lateral segmentectomy.

Aged↗

Changes of bioactive luteinizing hormone after laparoscopic ovarian cautery in patients with polycystic ovarian syndrome.

The serum levels of bioactive luteinizing hormone (LH), immunoreactive LH, follicle-stimulating hormone, androstenedione (A), and testosterone (T) were determined in nine anovulatory women with polycystic ovarian syndrome (PCOS) before and after laparoscopic ovarian cautery. Eight ovulated spontaneously and three conceived after treatment. Before treatment, the mean (+/- SEM) levels of bioactive LH, immunoreactive LH, A, and T were 51.4 +/- 8.6 mIU/mL, 36.0 +/- 4.5 mIU/mL, 1.98 +/- 0.35 ng/mL, and 1.18 +/- 0.13 ng/mL, respectively, which were significantly higher than those of five control women (19.2 +/- 1.6 mIU/mL, 21.4 +/- 1.2 mIU/mL, 0.54 +/- 0.03 ng/mL, 0.28 +/- 0.03 ng/mL). After treatment, the mean levels of these hormones had significantly decreased. Decreases in the levels of these hormones by laparoscopic ovarian cautery in women with PCOS may result in both restoration of the ovulatory cycle and achievement of pregnancy.

Adult↗

Microscope and hot wire cautery management of 100 consecutive patients with acute epistaxis--a superior method to traditional packing.

The technique of microscope examination and hot wire cautery in a prospective study of 100 consecutive patients with acute epistaxis is described. The method was successful in arresting haemorrhage in 94 per cent of patients bleeding at the time of examination, and in 86 per cent, discharge home within one hour was possible. Due to improved illumination, magnification and control of the cautery instrument, nasal packing was required in only nine per cent of cases. By achieving this and by reducing the overall need for admission to 20 per cent, we recommend this method of treatment both as a successful cost saving measure, as well as advantageous to the patient.

Acute Disease↗

A randomised clinical trial of antiseptic nasal carrier cream and silver nitrate cautery in the treatment of recurrent anterior epistaxis.

Sixty-four consecutive patients with a history of recurrent epistaxis were randomly assigned in the outpatient clinic to receive treatment with either Naseptin antiseptic nasal carrier cream alone (Group A) or a combination of Naseptin cream and silver nitrate cautery (Group B). Results were available on 50 patients, 22 in Group A and 28 in Group B. Twenty patients (91%) in Group A and 25 patients (89%) in Group B demonstrated improvement in their symptoms. There was no statistically significant difference in outcome between the two treatment arms (P = 0.7569). On comparing the different age groups (under and over 16 years) in the two treatment arms, once again there was no statistically significant difference in the treatment outcome (P = 1.000). In conclusion, silver nitrate cautery offers no added advantage to the management of simple epistaxis in both children and adults.

Administration, Intranasal↗

Intraoperative flash fires associated with disposable cautery.

Three cases of intraoperative flash fires associated with the use of disposable thermal cautery units are described. As opposed to similar reports in the literature, two of the three cases were not associated with an elevated oxygen concentration at the operative site. Precautions in the use of these units or the use of mono- or bipolar cautery units are recommended.

Aged↗

Iridectomy with scleral cautery.

I have described modifications that have evolved over the years in doing iridectomy with cautery and have reviewed some of my experiences with the method. All filtering operations leave a great deal to be desired. Each technique has certain advantages and disadvantages. A great advantage of the cautery procedure is its safety and simplicity. It is as effective in lowering pressure as most other procedures. Even if the operation fails to control pressure, little harm is done to the eye, and it can be repeated. One of the great advances in management of open-angle glaucoma in recent years has been the adoption of stringent indications for surgery. Surgery should not be advised until a thorough trial of maximal medical therapy has been made. In many instances, however, the pendulum has been allowed to swing too far. When medical treatment has failed, and the patient is faced with progressive loss of vision if control of pressure is not achieved, the ophthalmic surgeon should resist the temptation to procrastinate. Surgery should be done promptly and deterioration should not be allowed to occur. Should a cataract occur, it can be removed. Endophthalmitis can be prevented or cured by antibiotic therapy. Although filtering operations leave a great deal to be desired, when effective, they will preserve a functioning optic nerve.

Cautery↗

Silver nitrate cautery in aphthous stomatitis: a randomized controlled trial.

BACKGROUND: Aphthous stomatitis is a painful, recurrent disease of the oral mucous membrane. Silver nitrate sticks have been used for a long time to provide pain relief for the duration of an aphthous ulceration, with only one application. Silver nitrate causes chemical cauterization and increases the depth of injury. OBJECTIVES: To study the effect of chemical cautery with silver nitrate in reducing pain of aphthous ulceration and to determine if this treatment shortens or prolongs healing. METHODS: In a randomized, patient-blinded, placebo-controlled study, 97 patients with painful minor oral aphthous ulceration were randomized to receive silver nitrate cautery or placebo. The severity of pain was rated on a three-category scale (severe, mild, none) and was recorded each day until the seventh day after the procedure. The lesion size was recorded at the time of the procedure and on the seventh day afterwards. In the treatment group, the ulcer was gently painted with a silver nitrate stick until it turned white. In the placebo group, the ulcer was gently painted with a placebo stick. RESULTS: In the treatment group, 33 of 47 patients (70%) evaluated and in the placebo group, four of 38 patients (11%) evaluated had reduction in severity of pain 1 day after the procedure. The difference was statistically significant (P < 0.001). On the seventh day after the procedure, the ulcers were completely re-epithelialized in 39 patients (83%) in the treatment group and in 34 patients (89%) in the placebo group. The difference was not statistically significant (P = 0.39). CONCLUSIONS: The results of our study showed that one application of silver nitrate can decrease the severity of pain in aphthous ulceration without significantly shortening or prolonging healing time. We did not observe any side-effects in our study. The effect is rapid and lasts for the duration of the lesion. The treatment is simple and cost-effective in patients with infrequent recurrences.

Administration, Oral↗

Effect of cautery with irrigation forceps on the remnant liver after hepatectomy in rats.

Monopolar cautery with irrigation forceps (CIF) was devised for use in liver resection that does not require occlusion of inflow to the remnant liver. However, a high power output is required to divide the hepatic parenchyma which boils the irrigation water. This study was performed to investigate the effects of using CIF on the hepatic parenchyma. Histologic and biochemical examination was performed in rats which had undergone hepatectomy using the CIF, irrigating bipolar (IB), Pringle's maneuver with blunt dissection (group P), or a sham operation. A greater cautery distance was obtained with the CIF than the IB. There was no significant difference in the remnant liver function after the 1st postoperative day in any of the groups. CIF is an effective instrument for anatomic or nonanatomic hepatic resection.

Animals↗