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PubMed1998

Dermatologic electrosurgery in patients with implantable cardioverter-defibrillators and pacemakers.

BACKGROUND: Electrosurgery is frequently employed in the treatment of skin cancer and other dermatologic conditions in the elderly. Implantable cardioverter-defibrillators (ICDs) and pacemakers are most commonly seen in this older population. Potentially hazardous electrosurgical interference exists with the function of ICDs and pacemakers in this setting. OBJECTIVE: Our goal is to review the potential hazards of electrosurgery in patients with ICDs and pacemakers and to suggest a perioperative management plan. METHODS: Review of the medical literature on electrosurgical interference with ICDs and pacemakers was accomplished in addition to a case report of ventricular tachycardia during Mohs surgery on a patient with an ICD. RESULTS: Multiple case reports and reviews from the nonder-matologic literature demonstrate that a real hazard exists. CONCLUSION: Knowledge of the potential electrosurgical interference with ICDs and pacemakers is required to perform these procedures safely. A perioperative management plan is suggested.

Aged↗
PubMed1994

Fibreoptic bronchoscopic electrosurgery under local anaesthesia for rapid palliation in patients with central airway malignancies: a preliminary report.

BACKGROUND: Obstruction of a major airway by tumour causes serious morbidity. There is still scope for a widely applicable, simple and effective treatment to provide rapid palliation. METHODS: A fibreoptic bronchoscope prototype with an insulated inner sheath was used under local anaesthesia in 17 patients with locally advanced tracheobronchial malignancies. An insulated flexible electro-surgery probe was used to coagulate intraluminal tumour mass using standard electrosurgery equipment. RESULTS: Immediate reopening of the airway was obtained in 15 of the 17 patients. Two appeared to have extraluminal disease. Eleven patients had an obvious bronchoscopic response in whom a > 75% reopening of the normal airway diameter was achieved. Eight patients had subjective improvement of their dyspnoea, but only in four cases was there an objective improvement in physiological parameters. Haemoptysis resolved in four. There were no deaths resulting from treatment. Minor bleeding occurred in one patient and an aspiration pneumonia occurred in one. Three patients received additional treatment. CONCLUSIONS: Fibreoptic bronchoscopic electrosurgery is a simple technique for rapid palliation and immediate tumour debulking in patients with central tracheobronchial tumours. Further work is needed to compare its efficacy with other techniques.

Aged↗
PubMed1998

Electrosurgery in the head and neck.

Electrosurgery is widely used in the practice of otolaryngology-head and neck surgery. Despite its popularity, few training programs give formal education in the optimal use of electrosurgical instruments. This article reviews the history, physics, and tissue effects of these commonly used devices. Armed with this knowledge, the head and neck surgeon can take full advantage of electrosurgery's ability to dissect tissues with precision and minimal blood loss.

Electrosurgery↗
PubMed2000

The heat is on: impact of endobronchial electrosurgery on the need for Nd-YAG laser photoresection.

STUDY OBJECTIVES: Advances in bronchoscopic electrosurgery have allowed its application in the outpatient setting in patients who otherwise would have required Nd-YAG laser photoresection (LPR) in the operating room. We intended to evaluate the impact of endobronchial electrosurgery (EBES) on the need for Nd-YAG LPR on patients with symptomatic airway lesions. DESIGN: Prospective observational case series. PARTICIPANTS: One hundred eighteen evaluations for LPR were performed. Forty-seven evaluations (40%) were considered to be amendable to EBES and were treated during the initial bronchoscopy. The remaining patients underwent LPR. SETTING: Outpatient bronchoscopy suite at the Cleveland Clinic Foundation, Cleveland, OH. RESULTS: Of the 47 procedures, 42 (89%) were successful in alleviating the obstruction, thus eliminating the need for LPR. No major complications were encountered. CONCLUSION: EBES can be performed safely in the outpatient setting and is an effective procedure in treating select endobronchial lesions. EBES eliminated the need for LPR in 36% of such procedures with a potential for significant time and cost savings.

Adult↗
PubMed1976

The destructive potential of electrosurgery on the periodontium.

Three cases have been presented illustrating the complications which may arise from the use of electrosurgery. These cases provide clinical evidence of the potential for severe periodontal destruction, a potential that must be weighed carefully by any practitioner who uses an electrosurgical instrument. It is suggested that new scientific studies be initiated to establish basic principles that will eliminate the hazards that now exist in the routine use of electrosurgery.

Adult↗
PubMed1983

The effect of electrosurgery on alveolar bone.

The facial marginal alveolar bone of dogs was exposed with a full-thickness flap and touched by an activated electrosurgery electrode for periods of 0, 1, 5 and 10 seconds. Microscopic results were evaluated after periods ranging from 0 hours to 28 days. Various electrode exposure times produced similar changes in bone and periodontal ligament. The extent of the destruction was greater than that found in surgical areas not exposed to electrosurgery; healing and remodeling phases were also delayed in the electrosurgical sites.

Alveolar Process↗
PubMed2001

[Transurethral electrosurgery in the treatment of benign prostatic hyperplasia].

The article is devoted to topical problem of modern urology, one of the lines of surgical treatment of benign prostatic hyperplasia (BPH)--transurethral electrosurgery. Physical principles which are the basis of transurethral electrosurgical interventions and influence of transurethral electrosurgery on prostatic tissue are described. Methods of necessary preoperative examination of patients with BPH are presented. The most often used transurethral electrosurgical technique for destruction of hyperplastic prostatic tissue is described. The results of 5-year use of combination of transurethral electroresection and electrovaporisation in the treatment of BPH and its complications are presented. Ways of prophylaxis of possible complications are proposed.

Adult↗
PubMedDate not supplied

Pulpal therapy for primary teeth: formocresol vs electrosurgery: a clinical study.

Post-operative clinical and x-ray findings on 80 primary molars were evaluated. These molars had undergone pulpal therapy by 2 techniques: pulpotomy with formocresol and with electrosurgery. The sample was selected from children between the ages of 4 and 7. A criterion for inclusion was each child must have at least 2 primary molars with pulp exposed by caries. Experimental molars with 1 or more of the following clinical or radiographic signs and symptoms were excluded: mobility, sensitivity to percussion, the presence of fistulae, groove drainage, apical or internal resorption, fetid smell and compromised furcation. Also excluded were patients previously diagnosed with diabetes, cardiopathy and renal alterations. Initially, a dinical and radiographic examination was carried out, followed by another at 1, 3 and 6 months after application of the techniques. No significant differences were found at the end of the period. However, electrosurgery had an advantage: it was faster to apply and dispensed with the use of formocresol. Further research is suggested, using larger samples and shorter evaluation periods.

Child↗
PubMed1992

Electrosurgery in restorative dentistry: 1. Theory.

Electrosurgery techniques have been used in dentistry as an aid to soft tissue management for nearly 60 years. However, it was not until the late 1960s that the principles of electrosurgery were understood and improved equipment became available. Part 1 of this two-part series covers the theory behind using this technique. Part 2 will discuss the clinical applications.

Dentistry, Operative↗
PubMed1992

Electrosurgery in restorative Dentistry: 2. Clinical applications.

Electrosurgery techniques have been used in dentistry as an aid to soft tissue management for nearly 60 years. However, it was not until the late 1960s that the principles of electrosurgery were understood and improved equipment became available. Part 1 of the two-part series covered the theory behind using this technique. Part 2 will now discusses the clinical applications.

Dental Restoration, Permanent↗
PubMed2005

Safety technologies for laparoscopic monopolar electrosurgery; devices for managing burn risks.

The use of monopolar electrosurgery during laparoscopy has many benefits. But it also creates the risk that high-frequency leakage currents could travel from the active electrode to patient tissue, causing burns. In some cases, these burns can be serious and even lead to life-threatening complications. In this Evaluation, we review four products designed to reduce the risk of leakage-current burns during these procedures. One of the products is an active-electrode shaft with a brightly colored inner layer of insulation, making it easier to spot insulation breaks that could allow leakage currents. Two of the products use high DC voltage to detect full-thickness breaks in electrode insulation. The other product is an active-electrode shielding system that provides protection during a procedure by conducting potentially dangerous leakage current away from the patient. We rate one product Preferred and the others Acceptable. However, we don't believe that any of these technologies are essential to safe monopolar laparoscopic electrosurgery. If these technologies are used, they should be viewed only as supplemental safety measures, not as a substitute for the general safe practices required during these procedures.

Burns, Electric↗
PubMed1991

Electrosurgery for cutaneous lesions.

Electrosurgery can be used to excise tissue, coagulate blood vessels or destroy tumors. Electrosurgical techniques include cutting, coagulation, desiccation and fulguration. For skin lesions, electrosurgery offers the advantages of rapid treatment, hemostasis at the time of incision, preservation of a specimen for pathologic examination and cosmetically acceptable results.

Electrosurgery↗
PubMed1990

Electrosurgery: advantages and disadvantages.

Though electrosurgery has been with us for decades, few surgeons have received formal training in its potential uses. The erroneous belief that electrosurgery techniques increase scar formation or impair healing processes, has led surgeons to other methods to deliver energy to the living cell. A watt, is a watt, is a watt--knowing how to calculate and administer that energy is the challenge. Fig. 4. Laser technology has forced the bioelectrical engineers to develop improved electrogenerators and accessories that are easier to understand and control. The use of digital reader boards, displayed in watts rather than an arbitrary dial setting is one example. A current flow meter for bipolar forceps will now tell the surgeon when all of the tissue has been desiccated. Soon I hope the power density and wattage delivered at the electrode tip will be easily displayed for the gynecologic surgeons. Who knows, one day we may have a "laser-electrode" system to meet all of our needs.

Carbon Dioxide↗
PubMed1990

Preventing adhesions--electrosurgery: advantages and disadvantages.

Though electrosurgery has been with us for decades, few surgeons have received formal training in its potential uses. The erroneous belief that electrosurgery techniques increase scar formation or impair healing processes, has led surgeons to other methods to deliver energy to the living cell. At the cellular level, a watt, is a watt, is a watt -- knowing how to calculate and administer that energy is the challenge. Laser technology has forced the bioelectrical engineers to develop improved electrogenerators and accessories that are easier to understand and control. The use of digital reader boards, displayed in watts rather than an arbitrary dial setting is one example. A current flow meter for bipolar forceps will now tell the surgeon when all of the tissue has been desiccated. Soon I hope the power density and wattage delivered at the electrode tip will be easily displayed for the biogynecologic surgeons. Who knows, one day we may have a "laser-electrode" system to meet all of our needs.

Electrosurgery↗
PubMed1995

Unipolar electrosurgery in operative laparoscopy. Capacitance as a potential source of injury.

OBJECTIVE: To determine whether capacitive "stray" currents that can be generated during unipolar laparoscopic electrosurgery are likely to cause unintentional organ injury. STUDY DESIGN: In a controlled laboratory setting, the passage of capacitive current across the insulated portion of unipolar, 5-mm laparoscopic instruments was assessed for its ability to cause damage to biologic tissues. RESULTS: Modulated (coagulating) current output at power settings as low as 20-25 W led to apparent passage of current across the insulated portion of some laparoscopic instruments with thin insulation. This was accompanied by thermal damage to biologic tissues and instrument insulation. CONCLUSION: Our findings can explain unintentional injury during unipolar electrosurgery. The risk of such injury can be reduced by surgeon awareness, low generator output power and use of instruments with ample insulation. Thin insulation is more likely to be encountered with disposable than with multiuse instruments.

Animals↗
PubMed1997

Electrosurgery for routine pediatric penile procedures.

PURPOSE: Traditional teaching in urology has been to avoid electrosurgical devices in penile surgical procedures. In the last several years cutting current has been routinely used on the penis for making skin incisions, degloving, creating Byars flaps and destroying skin bridges. The purpose of this study was to determine the complications and final outcomes of electro-surgery. MATERIALS AND METHODS: A 5-year retrospective chart review was done to determine the complications and final outcomes of exclusively using electrical current to perform pediatric penile procedures. RESULTS: Electrosurgery was used to perform the entire surgical dissection in 346 patients, including circumcision in 124, repeat circumcision in 68, penoscrotal fusion/chordee repair in 127 and skin bridge procedures in 27. All patients had a satisfactory cosmetic result. After correction of penoscrotal fusion, separation at the scrotal suture line in 2 patients healed secondarily without sequelae. There was no hematoma, tissue necrosis or skin sloughing and all surgery was performed on an outpatient basis. CONCLUSIONS: Electrosurgery can be used safely and effectively for routine penile procedures, providing a bloodless operative field and excellent cosmetic results.

Adolescent↗
PubMed2003

Histologic characteristics of laparoscopic saline-enhanced electrosurgery of liver and splenic injuries.

BACKGROUND: Hemostasis is crucial during laparoscopic surgery. Unlike conventional electrosurgery, saline-enhanced electrosurgery (SEE) improves the electrode-to-tissue interface. This study investigated SEE as a means of achieving hemostasis in liver and splenic injuries and assessed the associated histologic changes. METHODS: Nine anesthetized pigs underwent laparoscopic liver tip and splenic wedge amputations. Injuries were treated with SEE (25-35 and 35-45 W, respectively). Animals were sacrificed postprocedure and at 1 and 4 weeks. Depth of necrosis was analyzed using a mixed model analysis of variance. RESULTS: Liver mean depth of necrosis was 5.3 mm (acute), 6.0 mm (1 week), and 5.3 mm (4 weeks) ( p = not significant). Splenic mean depth of necrosis was 7.0 mm (acute), 7.0 mm (1 week), and 2.7 mm (4 weeks). ( p < 0.01) Acute injuries demonstrated thermal coagulation necrosis that healed with well-defined bands of collagen at 1 and 4 weeks. CONCLUSIONS: SEE provides effective hemostasis and results in an acceptable depth of necrosis with satisfactory wound healing in a porcine model of solid organ injury.

Animals↗
PubMed2004

Pediatric total tonsillectomy using coblation compared to conventional electrosurgery: a prospective, controlled single-blind study.

OBJECTIVE: Postoperative recovery after tonsillectomy using Coblation excision (CES) was compared with conventional electrosurgery (ES). STUDY DESIGN AND SETTING: Patients aged 3 to 12 years from 3 clinical sites were randomly assigned and blinded to receive tonsillectomy using CES (n = 44) or ES (n = 45). RESULTS: Operative parameters did not differ between groups. Return to normal diet, activity, and pain-free status were similar, although fewer CES patients contacted the physician regarding postoperative complications (33% vs 54%; p = 0.081), experienced nausea (35% vs 62%, p = 0.013), or had localized site-specific swelling (p < 0.05) during the 2 weeks after surgery. In addition, CES children tended to discontinue prescription narcotics 1 day earlier than ES patients (7 vs 8 days, p = 0.071) and took one half as many daily doses. More CES than ES parents rated the postoperative experience as 'better than expected' (79% vs 60%, p = 0.055). CONCLUSION AND SIGNIFICANCE: Children who received CES tonsillectomy appeared to experience a better quality postoperative course, with no detriment to operative benefits of conventional electrosurgery.

Child↗