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PubMed1976

Inflammable antiseptics and theatre fires.

This paper describes an investigation designed to find out if theatre fires could be started by the antiseptic painted on the patient's skin being ignited by cautery or diathermy. It was found that hot wire cautery or diathermy generated enough heat to ignite all alcohol-based antiseptics even if these contained as little as 20 per cent alcohol. They could also cause iodine to explode in the presence of nitrous oxide, and nobecutane to explode in the presence of nitrous oxide or increased oxygen. The likelihood of these combinations causing fires is discussed, and it is recommended that when diathermy or cautery is to be used near the surface of the body, either an aqueous-based antiseptic is used or if spirit solutions are required they are carefully dried off before proceeding.

Anti-Infective Agents, Local↗
PubMed1980

Wound healing after laser surgery: an experimental study.

Healing after carbon dioxide laser incisions has been assessed in three animal experiments. Nine incisions in pig skin were found to be significantly weaker after 7 days than similar incisions made with a scalpel, but stronger than those made with a cutting diathermy. Laser excision of skin discs in pigs provided a satisfactory base to take split-skin grafts, but graft take around the edges was less complete than after scalpel excisions. Division and anasto mosis of the colon of 75 rats showed that the laser produced anastomoses that were as strong after 7 days as those produced by scalpel or diathermy division, but the laser did not produce the narrowing of the lumen that occurred with diathermy. It is concluded that if epithelial surfaces are particularly thick and slow to cut with the laser than thermal damage will impair healing, but that in general epithelial surfaces need not be avoided in laser surgery.

Animals↗
PubMed2003

Acardiac twin: a systematic review of minimally invasive treatment modalities.

This review of the literature aimed to determine pregnancy outcomes after minimally invasive treatment for occluding vascular supply to acardiac twins. A MEDLINE search was performed until 2002 using the terms 'acardiac', 'acardius', 'twin reversed arterial perfusion (TRAP) sequence' and 'chorangiopagus parasiticus' and 207 articles published in the English-language literature were identified. These articles and the corresponding cited references in English were reviewed. We identified 32 reports involving 74 cases of acardiac twin treated by minimally invasive techniques. Seventy one cases were included for analysis including 40 treated by cord occlusion and 31 by intrafetal ablation. Cord occlusion was first attempted by embolization (n = 5), cord ligation (n = 15), laser coagulation (n = 10), bipolar diathermy (n = 7) and monopolar diathermy (n = 3). Intrafetal ablation was performed by alcohol (n = 5), monopolar diathermy (n = 9), interstitial laser (n = 4) and radiofrequency (n = 13). The overall median gestational ages at treatment and delivery were 21 (range, 14-28) weeks and 36 (range, 19-42) weeks, respectively, with a median treatment-delivery interval of 13 (range, 0-25) weeks. The overall pump twin survival rate was 76% (n = 54). Intrafetal ablation was associated with later median gestational age at delivery (37 vs. 32 weeks, P = 0.04) and higher median treatment-delivery interval (16 vs. 9.5 weeks, P = 0.02) compared with cord occlusion techniques. It was also associated with a lower technical failure rate (13% vs. 35%, P = 0.03), lower rate of premature delivery or rupture of membranes before 32 weeks (23% vs. 58%, P = 0.003) and higher rate of clinical success (77% vs. 50%, P = 0.02) than cord occlusion techniques. There were no statistically significant differences in terms of outcome between the subgroups of fetoscopic- or ultrasound-guided cord occlusion techniques. This review suggests that intrafetal ablation is the treatment of choice for acardiac twins because it is simpler, safer and more effective when compared with the cord occlusion techniques.

Diseases in Twins↗
PubMed1982

[Healing of infected wounds after diathermic and scalpel cuts into the abdominal wall in rabbits (author's transl)].

The course of wound healing and the spreading of infection was investigated through a comparative procedure with 30 rabbits. We performed a laparotomy with diathermy and scalpel, afterward injecting a solution of 6 X 10(10) Staphylococcus aureus in the subcutis. The histological preparation and semiquantitative evaluation of the laparotomy wounds were performed on postoperative days 3, 7, and 14. On day 3, a clear infiltration of macrophages could already be observed in the scalpel wound, while in the diathermy wound more necrosis could be seen. On day 7, the muscle of wounds inflicted by scalpel was infiltrated with granulocytes and monocytes. In those by diathermy, the necrosis was filled with fibroblasts. On postoperative day 14, no histological difference could be seen between the two proceedings: in the subcutis, there is an abscess enveloped in a connective tissue wall; the cutis and the muscle show new scar tissue.

Abdominal Muscles↗
PubMed2005

Antegrade versus retrograde endopyelotomy for pelvi-ureteric junction (PUJ) obstruction.

OBJECTIVES: To compare complication and success rates of antegrade and retrograde endopyelotomy performed over 10 years and to define possible risk factors associated with treatment failure. METHODS: From 1994 to 2004, 61 patients underwent a total of 68 endoscopic treatments: 19 antegrade and 49 retrograde endopyelotomy procedures. Antegrade endopyelotomy was always performed using diathermy. In the first 18 procedures retrograde endopyelotomy was performed using diathermy. In the most recent 30 procedures the incision was made using holmium laser. Endoluminal ultrasound was used in 78% of retrograde endopyelotomy and in 5% of antegrade endopyelotomy. RESULTS: The retrograde endopyelotomy patients demonstrated significantly lower complication rates (12.5% vs. 42%) and shorter hospital stay (1.5 vs. 7 days) than the antegrade endopyelotomy patients. The mean follow up of the patients who remained free from disease recurrence during the study period was 46 and 24 months for the antegrade and retrograde endopyelotomy group, respectively. The overall success rate (mean time to failure) of antegrade and retrograde endopyelotomy was 56% (31 months) and 70% (17 months), respectively. There was no statistically significant increase in the overall success rate of retrograde endopyelotomy using endoluminal ultrasound per se. Stratifying retrograde endopyelotomy by the type of energy used for the incision, the overall success rate (mean time to failure) was 80% (10 months) and 53% (21 months) for Holmium laser and diathermy, respectively (p = 0.0626). CONCLUSIONS: The overall success of antegrade and retrograde endopyelotomy in this series appears to be largely a factor of lead-time bias and is similar enough to recommend retrograde endopyelotomy with holmium laser on the basis of its relative safety and shorter hospital stay.

Adolescent↗
PubMed2006

Extensibility and scanning electron microscopy evaluation of 5 pediatric anterior capsulotomy techniques in a porcine model.

PURPOSE: To compare the extensibility and scanning electron microscopy (SEM) of 5 currently used pediatric anterior capsulotomy techniques: vitrectorhexis, manual continuous curvilinear capsulorhexis (CCC), can-opener, radio frequency diathermy, and plasma blade in a porcine model. SETTING: Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS: Extensibility was determined by stretching each capsulotomy until it ruptured and measuring it by calculating the mean stretch-to-rupture circumference of each capsulotomy (20 eyes per technique) as a percentage of its baseline circumference. Edge characteristics were evaluated using SEM. RESULTS: The mean extensibility of each technique tested (vitrectorhexis 161%, CCC 185%, can opener 149%, radio frequency 145%, plasma blade 170%) was significantly different (P<.001, 1-way analysis of variance). The SEM examination found that the vitrectorhexis had a scalloped edge with the whole edge rolled over, presenting a smooth surface toward the inside of the capsulotomy; the manual CCC produced the smoothest edge, with no irregularities noted; the can-opener edge was irregular, showing each puncture of the needle had created a small arc, with occasional regions of the edge rolled over in a "hit-and-miss" fashion; the radio-frequency diathermy capsulotomy edge was ragged, rough, and irregular; and the plasma blade capsulotomy edge was rougher than the manual CCC, but there were fewer irregularities than the radio-frequency diathermy edge had. CONCLUSIONS: The manual CCC technique produced the most extensible porcine capsulotomy, followed by the plasma blade, vitrectorhexis, can-opener, and radio-frequency techniques, in a porcine model. The manual CCC technique also produced the smoothest anterior capsulotomy edge according SEM evaluation.

Animals↗
PubMed2001

A multicentre collaborative study on the use of cold scalpel and electrocautery for midline abdominal incision.

BACKGROUND: Although studies in animals demonstrated a better wound healing after abdominal incision with cold scalpel than with electrocautery, clinical experiences did not confirm these findings. The purpose of this study was to compare early and late wound complications between diathermy and scalpel in gynecologic oncologic patients undergoing midline abdominal incision. METHODS: Patients undergoing midline abdominal incision for uterine malignancies were divided into two groups according to the method used to perform the abdominal midline incision: cold scalpel and diathermy in coagulation mode. Early and late complications were compared. Logistic regressions were used for statistical analysis. RESULTS: Nine hundred sixty-four patients were included, of whom 531 were in the scalpel group and 433 in the electrocautery group. Both groups were similar with respect to demographic, operative, and postoperative characteristics. Univariate analysis revealed a higher incidence of severe wound complications in the scalpel group than in the electrocautery group (8 of 531 versus 1 of 433, P <0.05). After adjustment for confounding variables (eg, age, body mass index) no differences were found between groups. CONCLUSIONS: Scalpel and diathermy are similar in terms of early and late wound complications when used to perform midline abdominal incisions. Therefore the choice of which method to use remains only a matter of surgeon preference.

Cross-Sectional Studies↗
PubMed1987

The operative management of posterior urethral valves.

The surgical management of posterior urethral valves remains controversial. To examine the effects and results of operative treatment in boys with proven posterior urethral valves, a retrospective study was undertaken. The case records of 33 male children who presented with posterior urethral valves over a 10-year period were reviewed. Two patients died prior to definitive treatment and one died postoperatively. Following resuscitation and diagnostic procedures, the remaining patients had eradication of the posterior urethral valves by electrothermic fulguration. In 14 patients this was performed using the Innes-Williams diathermy hook under control of contrast enhanced radiography. In 16 patients the valves were fulgurated under direct cystoscopic visualization. All surviving patients had an uneventful postoperative recovery. However, of those undergoing cystoscopic fulguration, four developed symptomatic urethral strictures necessitating repeat cystoscopy and urethral dilatation. No cases developed strictures following the use of the diathermy hook. One patient from each treatment group developed dribbling. The Innes-Williams diathermy hook has been proven to be a safe, simple, and inexpensive technique. This has specific application in the neonate and small infant where cystoscopy poses technical problems because of anatomic size and where potentially traumatic urethral instrumentation should be avoided.

Child↗
PubMed2001

Effects of ball cauterization following loop excision and follow-up colposcopy.

OBJECTIVE: To investigate whether central diathermy ball cauterization after loop excision affects satisfactory colposcopy at follow-up. METHODS: One hundred one consecutive women with the squamocolumnar junction visible at the ectocervix scheduled for loop excision were assigned alternately into two groups. In group A, diathermy ball cauterization was applied to the entire crater following excision. In group B, cauterization was avoided in a 2-3-mm zone around the new os. The women were re-examined 4 months postoperatively by colposcopy and microcolpohysteroscopy with specific intention to identify the location of the squamocolumnar junction. The examiners performing colposcopy and microcolpohysteroscopy were not aware of each other's interpretation, or of the method of cauterization used. RESULTS: Follow-up colposcopy was satisfactory in 12 women in group A (24%) and 47 women in group B (92.2%) (P <.001). Forty-three women (86%) in group A and ten in group B (19.6%) had the squamocolumnar junction partly or fully located within the cervical canal (P <.001). Microcolpohysteroscopy located the squamocolumnar junction at a mean depth of 4.5 +/- 2.4 mm (+/- standard deviation [SD]) in the women in group A and 1 +/- 0.9 mm in group B (P <.001). Microcolpohysteroscopy could not be performed in 13 women in group A (26%) and one woman in group B (2%) (P <.001). CONCLUSION: Diathermy ball cauterization at the new cervical os after loop excision results in a shift of the squamocolumnar junction toward the endocervical canal, and predisposes to cervical stenosis, thereby decreasing satisfactory colposcopy rates.

Adult↗
PubMed2002

Recurrence of chocolate cysts after laparoscopic ablation.

STUDY OBJECTIVE: To estimate the recurrence rate of chocolate cysts 3 to 12 months after ablative laparoscopic surgery. The secondary outcome measure was the need for a repeat surgical procedure. DESIGN: Prospective cohort study (Canadian Task Force classification II-2). SETTING: Tertiary referral center for laparoscopic treatment of endometriosis. PATIENTS: Seventy-three consecutive women with chocolate cysts larger than 2 cm. INTERVENTION: Laparoscopy at which cyst capsules were vaporized or coagulated with the potassium-titanyl-phosphate (KTP) laser or Bicap bipolar diathermy. MEASUREMENTS AND MAIN RESULTS: There were 96 cysts (23 bilateral) in 73 women (1 patient underwent a two-stage procedure). Their mean diameter was 4.79 cm (range 2-25 cm). The median r-AFS score was 56 (range 22-128), and 55 patients (75.3%) had stage 4 disease. The KTP laser was used in 50 women (68.5%) and bipolar diathermy in 23 (31.5%). At 12 months, 5 patients (6.9%) were lost to follow-up, and 12 had a recurrent cyst. Therefore, the cyst recurrence rate/patient was 16.4% (12/73) and the rate/cyst was 12.5% (12/96). Women who had recurrences were significantly more likely to have bilateral cysts, 7/12 (58.3%), than those with single cysts, 16/61 (26.2%, p =0.032). Bicap bipolar diathermy was associated with a recurrence rate of 20.8% (5/24). The rate in women who had KTP laser ablation was 14.3% (7/49, NS). Eighteen patients had repeat operations (including on recurrent cysts). Therefore the reoperation rate was 24.6% (18/73). No major surgical complications occurred. One woman had a postoperative wound infection after a second procedure to remove an ovary with a recurrent cyst. CONCLUSION: Laparoscopic cyst fenestration followed by capsule ablation is safe and effective treatment for preventing recurrence of chocolate cysts.

Adult↗
PubMed2002

Randomized clinical trial of Ligasure versus open haemorrhoidectomy.

BACKGROUND: Postoperative pain associated with open haemorrhoidectomy remains problematic. Haemorrhoidectomy performed using bloodless bipolar diathermy--Ligasure--may have advantages over conventional open haemorrhoidectomy in terms of operating time and postoperative pain. METHODS: Thirty-four patients were randomized to undergo Ligasure (18 patients) or diathermy (16) haemorrhoidectomy. The operating time, amount of pain and postoperative analgesic requirement, postoperative complications and overall patient satisfaction were documented. RESULTS: The median duration of operation was shorter in the Ligasure haemorrhoidectomy group (5.1 versus 9.2 min; P < 0.001). There was no statistically significant difference in the postoperative pain score, but the median analgesic requirement was lower in the Ligasure group (850 versus 1600 mg tramadol; P = 0.013). Patient satisfaction was similar in both groups. CONCLUSION: Ligasure haemorrhoidectomy is quick and bloodless and, although as painful as diathermy haemorrhoidectomy, is associated with a reduced analgesic requirement.

Adult↗
PubMed2002

Increased post-tonsillectomy secondary haemorrhage with disposable instruments: an audit cycle.

The objective of the audit was to examine the increased morbidity associated with elective tonsillectomy with single-use instruments in a district general hospital in England. Retrospective audit of consecutive case notes of 145 patients who underwent tonsillectomy in a 6-week period after the introduction of single-use instruments was carried out. The main outcome measure was incidence of secondary haemorrhage. In total, 9.5% of patients required re-admission indicated by secondary haemorrhage, 4% required emergency surgery and 43% of the total group had haemostasis achieved with ties. None of these was re-admitted. Out of the total group, 57% had haemostasis achieved with single-use bipolar forceps; 16.8% of these patients were re-admitted, with 7% of this group requiring emergency surgery to control the haemorrhage. Animal tissue experiments and design analysis of the single-use bipolar diathermy highlighted the deficiencies of the initial single-use bipolar diathermy. This was replaced by a new design of single-use diathermy forceps. A second audit was performed which revealed a significant reduction in postoperative morbidity. Complications associated with the introduction of new instruments can be identified by repeated audit cycles.

Animals↗
PubMed2000

A simplified method of harvesting and dilating the radial artery achieves acceptable clinical outcomes.

BACKGROUND: The recent successful revival of the radial artery as a coronary-bypass conduit has been attributed to a minimally traumatic harvesting technique without diathermy, combined with long-term oral calcium antagonist therapy. We describe a simplified technique of harvesting the radial artery, which reduces procurement time and maintains conduit relaxation. METHODS: Radial arteries were harvested using diathermy and topical glyceryl trinitrate-verapamil dilator solution. Postoperatively, intravenous glyceryl trinitrate, but no calcium antagonist was used. The clinical results in the first 100 consecutive patients receiving radial artery grafts (RA group), procured using this technique, were compared with a group of 100 patients receiving saphenous vein conduits (SV group) immediately prior to the introduction of the radial artery at our institution. RESULTS: There were no demographic differences between the two groups, other than the SV group being slightly older. There was one intraoperative death in each group. There was no difference in the rate of peri-operative myocardial infarction or length of stay in the intensive care unit. At a median follow-up time of 16 months for the RA group, and 25 months for the SV group, the survival rates were 97 and 94%, respectively. All survivors were in the New York Heart Association class I. In the SV group, two postoperative angioplasties were performed. CONCLUSIONS: These early results suggest that this method of procuring the radial artery using diathermy, glyceryl trinitrate and no postoperative calcium antagonists, is rapid, safe and effective. The continued use of this technique is justified, while awaiting the results of long-term angiographic studies.

Aged↗
PubMed1996

The Whitaker hook in the treatment of posterior urethral valves.

OBJECTIVE: To assess the efficacy of the Whitaker diathermy hook in the treatment of posterior urethral valves (PUV). PATIENTS AND METHODS: Seventeen patients with PUV underwent primary treatment under general anaesthesia using a diathermy hook. The results were assessed by the clinical course of the patient, serial measurements of serum creatinine level and repeat cystography 6 weeks and 6 months after treatment. RESULTS: There were no complications in 12 patients and they required no further treatment of the valves. Three patients required a repeat procedure which resolved the urethral obstruction. Two patients continued to show incomplete disruption of the valves and required endoscopic treatment. Two patients developed ureteric obstruction after disruption of the valves, which was treated by supravesical diversion and later reversed with no further treatment of the valves. CONCLUSIONS: The Whitaker diathermy hook is a safe and effective instrument which has not gained its rightful place in the treatment of patients with PUV.

Creatinine↗
PubMed2001

Complicated monochorionic twin pregnancies: experience with bipolar cord coagulation.

OBJECTIVE: The purpose of the study was to evaluate our experience with ultrasound-guided bipolar diathermy forceps for cord occlusion in complicated monochorionic twin pregnancies. STUDY DESIGN: Seventeen consecutive cases were included: 9 cases were twin-to-twin transfusion syndrome; 2 cases were twin reversed arterial perfusion syndrome, and 6 cases were discordant for fetal abnormality. Bipolar diathermy was performed under local anesthetic with the use of 3-mm forceps with ultrasound guidance. RESULTS: Cord occlusion was successfully accomplished in all cases between 18 and 27 weeks' gestation. There were 2 deaths of the co-twin within 12 hours; 1 death was due to cord hemorrhage, and 1 death was unexplained. One neonatal death occurred after delivery at 27 weeks, and 1 woman with twin-to-twin transfusion syndrome elected termination of pregnancy when hydrocephaly was diagnosed 7 days after the procedure (probably related to the underlying pathologic condition). All other co-twins are alive and well, although 2 pregnancies were complicated by preterm delivery and premature rupture of membranes before 30 weeks' gestation. CONCLUSION: Bipolar diathermy is an effective procedure for cord occlusion, although it still has significant morbidity and mortality rates.

Diseases in Twins↗
PubMed1991

Photothermal, cryogenic, and diathermic effects of retinal adhesive force in vivo.

Argon laser photocoagulation, cryoretinopexy, and diathermy of moderate intensity is applied to 140 rabbit eyes. Retinal adhesive force is measured from 1 day to 6 months following the treatment, using the authors' new in vivo method. A small retinal detachment is induced within the area surrounded by the burns. At the moment when the detachment starts to expand beyond the burns, subretinal pressure is measured using a resistance servo-nulling method. Retinal adhesive force is then calculated according to Laplace's law and compared with that of untreated eyes. Both photocoagulation and diathermy enhanced adhesiveness within 24 hours to 128% and 122%, respectively, of normal levels. Cryoretinopexy reduced the retinal adhesiveness during the first week, but afterwards generated as much adhesiveness as the other two methods. Beyond 6 months, under the conditions described here by the authors, the adhesive force was stronger after diathermy (279%) than after cryoretinopexy (214%) or laser photocoagulation (220%).

Animals↗
PubMed1994

The effect of fibrin sealant haemostasis on post-operative pain in tonsillectomy.

Pain following tonsillectomy is an important problem. It is caused by the surgical trauma of excision and haemostasis. Numerous surgical and pharmacological solutions have been tried, with disappointing results. Fibrin sealant is a widely used atraumatic haemostatic agent. This study aims to determine whether tonsillectomy with fibrin sealant haemostasis results in less post-operative pain than that with the conventional technique of diathermy. Fifty consecutive adult patients undergoing tonsillectomy were prospectively studied. They were randomized to receive either fibrin sealant or diathermy haemostasis. Other pain variables were controlled. Pain was measured by a visual linear analogue scale and inter-incisor distance on both the day of operation and the first post-operative day. The patients and pain measurer were blind to the randomization. The results showed that tonsillectomy with fibrin sealant haemostasis was significantly (P < 0.05) less painful than that with diathermy on both days studied and by both methods of pain measurement.

Adolescent↗
PubMed2006

Surgical dexterity after a 'night out on the town'.

BACKGROUND: This study examines the effect of alcohol intake on surgical dexterity immediately after and the morning after alcohol intake and minimal sleep deprivation by simulating a typical night out on the town. METHODS: Five surgeons (all men, aged 31-40 years) were trained on a laparoscopic surgical simulator (minimally invasive surgical trainer-virtual reality) to reach a desired standard of performance. Three experimental settings were used: (i) a control night with no alcohol and full night's sleep; (ii) a sham night out (sleep deprived) without alcohol; and (iii) a night out with alcohol ad libitum. The parameters recorded were the average time taken to carry out a task, error rate, average diathermy time and diathermy (damage) time to main object. Comparisons between baseline readings, those in the middle of the night and those of the following morning were made by applying ANOVA methods after logarithmic transformation of the data. RESULTS: The candidates consumed, on average, 10.33 units (range, 6-15 units) of alcohol and had 0.86% (range, 0.71-1.1%) of breath alcohol levels and an average of 3.75 h (range, 3-5 h) of sleep after a typical night out. The morning-after breath alcohol levels were 0%. There was significant deterioration in performance, as measured by all indicators, immediately after alcohol consumption. The adverse effects on time taken to complete the task and total diathermy time were still apparent the morning after. The sham night out appeared to affect only 'time parameters'. No significant changes in performance were seen in the control setting. CONCLUSION: Both alcohol consumption and sleep deprivation adversely affect the ability to carry out surgical procedures. Our simulation study suggests that the adverse effects of alcohol intake persist the following morning.

Alcohol Drinking↗