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We present a method to cauterize an actively bleeding source in anterior epistaxis. In our experience, this method is efficient, provides full control of the bleeding, and ensures precise cautery of the bleeding source with minimal usage of chemical cautery sticks.
Tonsillectomy and adenotonsillectomy are frequently performed operations. They are typically done as a day-of-surgery admission with discharge on the first postoperative day. Five hundred consecutive tonsillectomies and adenotonsillectomies performed by the authors were retrospectively reviewed to determine if these procedures could safely be performed on an outpatient basis. Primary postoperative hemorrhage was found to be rare using the suction cautery technique. Secondary hemorrhage occurred most commonly on the sixth postoperative day and the overall postoperative bleed rate was 7%. Our conclusion was that suction cautery tonsillectomy and adenotonsillectomy were safe to perform on an outpatient basis.
Trabeculectomy with cautery was performed on 31 eyes of of 25 glaucoma patients uncontrolled on maximal medical therapy. The procedure was designed to combine the effectiveness of Scheie's thermal sclerostomy with the low incidence of complications associated with trabeculectomy. There was an 81 percent success rate overall and an 83 percent success rate in blacks. Average follow-up was 25 months. The average preoperative pressure was 29 mm Hg and the average postoperative pressure was 11 mm Hg. Immediate postoperative complications were minimal. The most serious long-term problem was the acceleration of lenticular changes. The procedure is technically simple with a majority of cases being performed by house staff at a relatively early stage of training. It is believed that trabeculectomy with cautery is indicated in blacks, in far-advanced glaucoma cases, and in patients in whom a conventional trabeculectomy has failed.
Silver nitrate cautery is frequently used to control epistaxis. Although relatively free of side effects, we have encountered a case of a severe mucocutaneous reaction to silver nitrate cautery to the nose. The pathogenesis of this adverse effect is discussed.
PURPOSE: Neovascularization of the cornea occurs in numerous pathologic states causing decreased visual acuity and blindness and is a major complication of corneal allotransplantation. The purpose of this study was to investigate the effect of topical and systemic cyclosporin A (CsA) on corneal angiogenesis induced by xenotransplantation or by chemical cauterization. The subcutaneous disc angiogenesis system (DAS) also was used to study the effects of CsA on angiogenesis in a nonocular site. METHODS: Corneal angiogenesis was provoked by either xenotransplantation or chemical cautery. Rats from experiments using both of these models were subdivided into four treatment groups. Topical treatment was administered by using 4% CsA eye drops or vehicle (castor oil) four times daily for 10 days. Systemic therapy consisted of daily (5 mg/kg per day) subcutaneous injections of CsA or vehicle. In the DAS experiments, rats received CsA or vehicle systemically or intradisc. The amount of neovascularization was quantitated by digital image analysis in corneal flat preparations and sections of discs. RESULTS: Rats that received xenografts or cautery manifested less corneal neovascularization than did control animals after topical of subcutaneous CsA treatment. CsA also enhanced the survival of corneal xenografts. A difference between CsA and vehicle-treated animals in the DAS experiments was not detected. CONCLUSIONS: CsA effectively retards the growth of new vessels in the cornea after xenotransplantation or chemical cauterization and prolongs xenograft survival. However, CsA does not suppress angiogenesis in all systems, because it was ineffective in blocking vessel growth in the subcutaneous DAS.
Surgery of the floor of the mouth (FOM) using a scalpel or cautery has produced stenosis of Wharton's duct, necessitating further surgery because of painful enlargement to the gland or suspected metastasis. The laser has been proposed as an alternative method that might avoid this complication. A retrospective study comparing these excisional techniques was done at Walter Reed Army Medical Center between 1973 and 1983. Of a total of 58 lesions, 35 were T1N0M0 and 23 were T2N0M0 (two synchronous lesions being present). Of 35 lesions excised with a scalpel, 11 had an associated submandibular gland resection. Of the remaining 25, two developed secondary duct stenosis. Of 10 lesions excised with cautery, three had an associated excision of the submandibular gland. Of the remaining seven, two developed stenosis and one required subsequent excision of the gland. Of 12 lesions excised with laser, four developed stenosis and two required subsequent excision of the gland. Laser excision appears to be of no advantage in avoiding further surgery of the submandibular gland. A submandibular gland resection at the time of the original resection of T1N0 or T2N0 cancers of the FOM does not appear warranted.
Al-Qattan et al. (1989) demonstrated that for difficult infected surgical wounds the CO2 laser was a much more effective sterilising agent than a standard surgical scrub (P < 0.005). This study compares the effectiveness of a standard electrocautery unit against that of the CO2 laser for wound sterilisation. Cautery sterilisation of infected wounds was found to be significantly superior to that of the CO2 laser (P < 0.05). Infection was noted in 4% of the cautery sterilised wounds and 12% of the wounds treated with CO2 laser. Case reports are also presented to demonstrate the clinical applications and effectiveness of this technique.
BACKGROUND: Interplay between wound resistance factors and bacterial innoculum determines the risk of surgical infection. Since cautery causes more damage than the scalpel, our hypothesis is that lower numbers of bacteria are required to infect wounds made by electric cautery than to infect wounds made with a scalpel. METHODS: Abdominal fascia was incised in 375 rats by cold knife, cutting current, or coagulation current. Wounds were innoculated with increasing numbers of bacteria and histologically scored at 7 days for necrosis, inflammation, and abscess. RESULTS: Coagulation current causes more inflammation, necrosis, and abscesses than the scalpel at all bacterial levels. Electric cutting current is intermediate, causing more damage than the scalpel only after contamination reached 10(5). Above this threshold most wounds were infected in all groups. CONCLUSIONS: Electric coagulation current should be used only when the need for meticulous hemostasis outweighs the considerably increased risk of infection. Electric cutting current is less destructive but also less hemostatic; indications for its use are difficult to identify.
We have used a cautery dissection technique, initially described by Perelman, to facilitate nonanatomical pulmonary resections in certain instances in which the anatomical location of the lesion made wedge excision by standard methods difficult or impossible. With the precision cautery technique, the raw surface of the lung is left charred and allows minimum or no air leakage following the procedure. We have found this method a useful addition to existing techniques for pulmonary resection.
OBJECTIVE: To evaluate the reproductive outcome and adhesion formation after a standardized laparoscopic treatment of polycystic ovary syndrome (PCOS) in clomiphene-resistant infertile women. DESIGN: Retrospective study. SETTING: University teaching hospital. PATIENT(S): One hundred twelve clomiphene-resistant anovulatory women with PCOS. INTERVENTION(S): Laparoscopic ovarian drilling using an insulated needle cautery. MAIN OUTCOME MEASURE(S): Ovulatory rate, pregnancy rate, and adhesion formation. RESULT(S): After surgery, ovulation occurred spontaneously in 73.2% of patients. The cumulative probability of conception at 12, 18, and 24 months after surgery was 54%, 68%, and 72%, respectively. With use of Cox's proportional hazards model, the effects of age, body mass index, and duration of infertility were evaluated. These factors were not associated with the pregnancy rate. Of 15 women who underwent a second-look laparoscopy, 11 women were found to be free of adhesions. Four women had periadnexal adhesions that were filmy, minimal, and found on the ovarian surface only. CONCLUSION(S): Laparoscopic ovarian drilling is an effective alternative treatment in clomiphene-resistant anovulatory women with PCOS. The use of an insulated needle cautery is associated with a minimal amount of adhesion formation.
OBJECTIVES: To report our long-term clinical results with the use of endoureterotomy in patients undergoing renal transplant with a minimum follow-up of 23 months. METHODS: Six renal transplant patients developed persistent ureteral obstruction demonstrated by elevated serum creatinine levels, renal ultrasound, and antegrade pyelography. Stent placement and balloon dilation were performed as the initial therapy in all patients. Persistent ureteral obstruction was managed with balloon cautery endoureterotomy. Ureteral stents were removed cystoscopically 6 weeks after the procedure. RESULTS: Four men and 2 women, mean age 45 years (range 38 to 54), underwent eight procedures: six by way of an antegrade percutaneous approach and two in an endoscopic retrograde fashion. The sites of ureteral stricture were ureterovesical junction (n = 4), ureteropelvic junction (n = 1), and midureteroureteral (n = 1). Two patients required a second endoureterotomy 3 months after the first attempt. Patients were followed up for a mean of 27 months (range 23 to 34). The mean serum creatinine level for all patients at follow-up was 2.6 mg/dL (range 1.6 to 3.9), including a mean serum creatinine level of 1.8 mg/dL (range 1.6 to 1.9) for nonrejected kidneys and a mean of 3.4 mg/dL (range 2.5 to 3.9) in those found to have concurrent rejection. Overall, five (63%) of eight procedures were successful in 5 (83%) of 6 patients. No intraoperative complications occurred and no blood transfusions were required. CONCLUSIONS: Balloon cautery endoureterotomy was successful in this select group of renal transplant patients with persistent ureteral strictures after initial balloon dilation and stenting failed. This modality proved durable to 27 months of follow-up without significant complications.
A randomized prospective trial was conducted to compare the efficacy of laser cautery against sub-mucosal diathermy to the inferior turbinates in 29 patients with rhinitis. Laser diathermy was performed using an arthroscopic fitment to a CO2 laser. Subjective and objective measurement of airway obstruction were performed, using a linear analogue scale and a nasal peak inspiratory flow meter, before operation and at 3 days and 6 weeks afterwards. In both groups there was a similar and significant improvement in subjective scores at 6 weeks (SMD from 3.6 to 1.8, P less than 0.01; laser from 3.9 to 2.1, P less than 0.001), but only the laser group was significantly better at Day 3 (SMD from 3.6 to 3.5, n.s.; laser from 3.9 to 3.0, P less than 0.05). In addition, there was significantly more general subjective morbidity at Day 3 in the SMD group (P less than 0.01). The objective scores improved equally in both groups but were not significant. We conclude that laser cautery of the inferior turbinate is a superior alternative to SMD for the treatment of rhinitis.
Internal thermal sclerostomy (ITS) was performed unilaterally in 35 adult New Zealand rabbits using a pinpoint bipolar cautery probe and radio-frequency power supply, with the nonoperated eyes serving as controls. Standard trabeculectomy using a limbal-based flap was also performed on 10 additional rabbits, and served as a second bench mark for comparison with the ITS technique. Intraocular pressure (IOP) was measured in all eyes preoperatively and on postoperative days 2, 4, 6, and 8. A significant (P = .005) difference between the reduction in IOP in the ITS eyes and in the control eyes was found up to postoperative day 8; on that day the reduction in IOP was 5.2 mm Hg. IOP in the eyes undergoing standard trabeculectomy was significantly (P = .05) reduced up to postoperative day 2, and gradually decreased, to 2.5 mm Hg, on postoperative day 8. The greatest reduction in IOP (2.9 mm Hg) for these eyes also occurred on postoperative day 2. Complications of ITS included iris burn (23%), peripheral corneal edema (17%), and iritis (9%). No ruptured blebs, flat anterior chambers, hyphemas, or lens damage occurred. The potential advantages of the ITS procedure using the bipolar cautery probe include a decreased risk of cataract formation because of the curved probe design. The procedure is also technically simple to perform and requires only inexpensive and readily-available equipment.
Posterior rhinometric measurements of nasal resistance were conducted on two groups of patients with perennial rhinitis: those whose symptom of nasal stuffiness responded to a topical steroid spray and those in whom it did not. The anterior ends of the inferior turbinates in 48 patients were treated with either cryosurgery or cautery, and in half of the subjects the erectile tissue of the septum was also thermally ablated. Measurements were made before and 10-16 weeks after therapy. It is concluded from statistical comparison that there is no benefit to treating the septum, and that cryosurgery is more effective in those whose symptoms respond to topical steroids, while cautery works better in those who do not. Histology showed no change in the capacitance vessels (sinusoids) after either modality, and xylometazoline caused a marked decrease in nasal resistance, suggesting that vascular smooth muscle function was intact. Irrespective of the change in airway resistance, most subjects felt that there had been an improvement. The mechanism is discussed.
Peripheral iridectomy with cautery (Scheie operation) was carried out on 113 eyes with glaucoma. The results were so favorable and the complications so few that we believe this operation still has an important place in the surgical management of the glaucomas and is noteworthy in the light of the trend to more precise surgery of the canal of Schlemm and the trabeculae.
The filtration procedures of trephine, iridencleisis, and corneoscleral cautery are compared to show the superiority of the latter. Pathologic vertification of the three operations suggests the reason for success. Several changes in the original technique as described by Schele are suggested.
Three authors describe their individual technique for performing ETS. These are 1) a two-port approach under singlelung ventilation using a double-lumen tube and cutting the chain, 2) a two-port approach under endotracheal or mask anesthesia and clipping of the chain, and 3) a single-port approach under endotracheal or mask anesthesia and cautery of the chain. The sections are purely didactic and no attempt is made to compare or contrast the methods.
In operations in which debridement is performed over a large area (e.g., surgery for whole-body burns), it is necessary to keep the length of the operation short and the amount of blood loss as small as possible to minimize stress to the patient's body. In this study, we developed a cautery knife to which an air spray is attached for surgical procedures in which debridement is performed as treatment for burns over a large area. We have demonstrated herein that this device is very effective for reducing both blood loss and the duration of surgery as well as for simplifying the achievement of hemostasis.