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PubMed1976

Laparoscopic sterilization with electrocautery, spring-loaded clips, and Silastic bands: technical problems and early complications.

Among 2283 patients, rates of technical failure, technical difficulty, and operative and early postoperative complications were evaluated for different methods of tubal occlusion at laparoscopy: electrocoagulation (980 cases), spring-loaded clip application (991 cases), and Silastic band application (312 cases). Rates of technical failure and technical difficulty at surgery were significantly higher (P less than 0.05) for the spring-loaded clip technique than for the electrocoagulation and Silastic band techniques. Mechanical and optical difficulties with the prototype spring clip applicator were the major sources of technical difficulties. Rates of operative (1.2%) and early postoperative (1.9%) complications were not significantly different for the three techniques of tubal occlusion. It is concluded that all three study techniques appear to be practical, and large, long-term, randomized, comparative studies to determine rates of failure and subsequent gynecologic problems are necessary to determine the best method of sterilization.

Electrocoagulation↗
PubMed1992

[Laparoscopic cholecystectomy using argon bistoury].

A total of 92 patients were submitted to laparoscopic cholecystectomy during the period Autumn 1990-Spring 1991. The dissection of the gallbladder from the hepatic bed was performed in 40 patients using the Argon beam coagulator, in 25 using the monopolar electrocoagulator and in 27 using the Holmio laser beam. In average, with the Argon beam coagulator time procedure was respectively 2.7 and 5.4 minutes shorter than monopolar electrocoagulator and Holmio laser. Only one complication (pneumomediastinum) was correlated with the use of the Argon beam coagulator.

Adult↗
PubMed2005

[A woman with a vulvar swelling, a rare manifestation of the Klippel-Trenaunay-Weber syndrome].

A woman with a vulvar swelling, a rare manifestation of the Klippel-Trenaunay-Weber syndrome. - A 32-year-old woman presented with a vulvar swelling. The swelling had always been there but had increased after her last pregnancy, 5 years earlier. Because of progressive complaints, such as pain and a feeling of pressure, she now wished surgical correction. The swelling turned out to be varicosis of the right labium majus associated with the Klippel-Trenaunay-Weber syndrome. The vulvar swelling was removed by electrocoagulation. The pathological diagnosis was 'venous haemangioma'. The Klippel-Trenaunay-Weber syndrome is a congenital skin condition in which vascular angiomas, varicosis and trophic changes in the soft tissue and skeleton can arise. Vulvar involvement is rare. The abnormality can be removed surgically, for example by electrocoagulation. There is a chance of recurrence.

Adult↗
PubMed2005

Effects of laparoscopic tubal ligation on ovarian blood flow and steroidogenesis.

Changes in serum ovarian hormone and gonadotrophine levels and ovarian artery blood flow rate by Doppler ultrasonography following laparoscopic tubal sterilization were evaluated. Forty-seven cases of laparoscopic tubal sterilization by electrocoagulation were included in the study. Forty-two women who used nonhormonal contraceptive methods were randomized as a control group. Serum concentrations of estradiol, FSH, LH, progesterone and bilateral ovarian artery pulsatility indexes were measured at baseline and at three, six and 12 months. In the study group, the mean value of midluteal progesterone was significantly decreased three months postoperatively 3. and bilateral ovarian artery pulsatility indexes were increased three and six months postoperatively, compared to their preoperative values. However, there was no statistical difference between bilateral ovarian PI values calculated preoperatively and at 12 months. Laparoscopic tubal ligation by electrocoagulation may temporarily cause reduced bilateral ovarian artery flow and corpus luteum dysfunction proven by low mid-luteal progesterone levels.

Electrocoagulation↗
PubMed1991

Surgical management of complications of fiberoptic colonoscopy.

A variety of complications are associated with fiberoptic colonoscopy. Life-threatening complications such as perforation and hemorrhage may require surgical intervention. The records of all patients who underwent fiberoptic colonoscopy, with or without biopsy, polypectomy, electrocoagulation, or laser therapy at St. Luke's-Roosevelt Hospital Center were reviewed. Thirteen of 21 perforations occurred during polypectomy, laser therapy, or difficult diagnostic colonoscopy. Eight patients developed a perforation after an uneventful diagnostic colonoscopy. Three patients required operative control of hemorrhage following polypectomy and one after multipolar electrocoagulation (BICAP) therapy for a cecal arteriovenous malformation. Two patients had benign pneumoperitoneum and one a retained polyp snare. Of the 28 patients in this entire series, 26 underwent operative resection or repair. Seventeen (65%) of the latter group underwent primary resection or closure of perforation without protective fecal diversion. Only one (5.9%) septic complication occurred in this group. Twelve patients in the perforation group (57%) underwent primary resection with anastomosis or closure of perforation without fecal diversion. One (8.3%) developed a septic complication. In this entire series, four deaths (14.3%) occurred, all of which were in the perforation group. Delay in diagnosis of perforation was the main factor contributing to death. No patient died of hemorrhage, benign pneumoperitoneum, or retained polyp snare. The key to successful outcome in perforation is early diagnosis and prompt operative intervention.

Aged↗
PubMed1991

[Endoscopic surgery of bladder diverticula].

The most frequent method utilized in the treatment of bladder diverticula is by open surgery using the extravesical, transvesical or combined approach. The endoscopic techniques consisting of electrocoagulation of the diverticular mucosa alone (Orandi) or opening the diverticular neck by electroresection (Post-Vitale) constitute a therapeutic alternative not widely used to date. We have attempted to combine both techniques and, since 1985, we have treated 21 patients with bladder diverticula via the transurethral approach using the following technique: 1. The diverticular neck is opened wide by incision or electroresection. 2. Complete electrocoagulation of the diverticular mucosa. 3. Resolution of cervico-urethral obstruction by cervico-prostatic incision or electroresection of the prostate. We have achieved good results and no complications have been observed. Reduction of the diverticulum was not achieved in only one case. In our view, failure was due to the fact that treatment of the diverticulum had not been combined with prostate resection which the patient refused. The technique is described and the indications and possible complications are discussed. The results achieved by the authors indicate that this technique should be used more widely.

Cystoscopy↗
PubMed1991

[Use of a biological glue in partial pulmonary excision surgery. Results of a controlled trial in 50 patients].

A controlled study concerning the surgical use of a fibrin glue was conducted in 50 patients undergoing partial pulmonary excision. In 25 of these patients, chosen at random, hemostasis and aerostasis of the fissural, and/or intersegmentary dissection planes were achieved by electrocoagulation, in the other 25 by the application of fibrin glue. The statistical study did not show any significant difference between the two groups in terms of the surgical indication, the type of excision and the associated surgical procedures (pleurectomy and parietectomy). No significant statistical difference was observed concerning the quality of aerostasis, the post-operative drainage, the persistance of residual collection or faulty reexpansion after removal of the latter, and the necessity for repeated drainage. The same applied to the length of post-operative hospital stay. This study seems to demonstrate that the surgical application of fibrin glue on the fissural and/or intersegmentary dissection planes is feasible but, as compared to electrocoagulation, does not significantly improve the quality of the surgical results for partial pulmonary excision; however its use could reduce the duration of post-operative drainage.

Adolescent↗
PubMedDate not supplied

[The x-ray endovascular treatment of renin-dependent arterial hypertension with secondary aldosteronism in patients without vasorenal involvement].

In 20% of cases, essential hypertension is of high renin pathogenesis which is indifferent of that of renal lesions. In these patients high blood pressure is closely related to high aldosterone generation due to elevated angiotensin II levels. Adrenal blood portalization is a possible way of abolishing secondary aldosteronism and hyperreninemia in this case. With this, 90-98% aldosterone and 20-30% renin are inactivated, which served as the basis for bilateral electrocoagulation of adrenal central veins in 13 patients with permanent and malignant arterial hypertension. The renin-dependent pattern of essential hypertension was confirmed by a positive BP response to a tested captopril dose (25 mg), the vasorenal one was ruled out on the basis of the peripheral captopril test, captopril pharmacorenography. Bilateral electrocoagulation of adrenal central veins was performed during a phlebographic examination. The manipulation proved to be successful on 11 (85%) left and 9 (70%) right adrenals. Blood pressure became lower in the first day and stable on days 4-5. There was a significant decrease in blood pressure at a year follow-up, in increased aldosterone levels, plasma renin activity with unchanged adrenocorticotropic hormone concentrations. After the manipulation, 2 patients refused to take antihypertensive drugs, 11 patients received lower doses of drugs. The method for abolishing secondary aldosteronism is considered to be promising for further clinical studies. A special attention should be given to patients with diseases concomitant with essential hypertension who have no alternative to surgical treatment.

Adrenal Glands↗
PubMedDate not supplied

Pathogenesis and endoscopic treatment of the hypopharyngeal (Zenker's) diverticulum.

The authors review the literature about the pathogenesis -still unknown- of Zenker's diverticulum as well as their experience of endoscopic treatment of this disease. From 1964 till 1988, they have treated endoscopically 507 patients, 323 by electrocoagulation, 184 by CO2-laser. The endoscopic procedure is described, consisting in precise division of the tissue bridge between the oesophagus and the diverticulum by micro-endoscopic surgery under general anesthesia. In recent years, the CO2-laser was found preferable, since it may cause less tissue necrosis and consequently less fibrous scar tissue. The results were very favourable, with more than 99% of the patients satisfied. Although many patients were old and in poor condition, only one patient died two days after operation because of cardiac failure. Complications such as bleeding, emphysema, mediastinitis and stenosis were seen in 5% of the patients, but in most cases there complications were mild and conservative therapy was sufficient. Stenosis occurred in 8 patients treated by electrocoagulation and in none of the patients treated by laser. Microendoscopic surgery is a safe and efficient method of therapy for the hypopharyngeal diverticulum.

Adult↗
PubMed1990

Laparoscopic tubal sterilization. The potential for thermal bowel injury.

One of the most severe complications of laparoscopic tubal sterilization is bowel burns, although they often go undetected at the time of laparoscopy. Controversy remains over whether these injuries are caused directly by operator error or indirectly from a hot oviduct's or instrument's inadvertently touching and burning the intestine. A study was performed to determine the potential for direct or indirect bowel burns using bipolar electrocoagulation in rabbits. The results indicate that neither a hot tube nor hot (recently used) forceps could cause injuries to the serosal surface of the intestine. That was true both of immediate injury and after one to five days of recovery. It was observed that the hot uterine tube caused significant bowel adhesions by five days after the procedure. Direct electrocoagulation of the bowel using 40 W for three seconds caused a minor, noticeable blanch on the bowel that was not detectable with gross or histologic means after one day of recovery. A direct bowel injury did result when 80 W was used for three seconds; the bowel became perforated after one day. These findings indicate that it is unlikely that one can produce a bowel burn indirectly from a hot uterine tube or instrument and that only a direct insult to the bowel appears to cause an injury. However, adhesions could be a complication of the procedure and should be considered.

Animals↗
PubMed1990

Ablation of the cystic duct and the gallbladder. Experimental basis and initial clinical observations.

Bipolar radiofrequency electrocoagulation of the cystic duct by catheter can be performed safely and reproducibly using fluoroscopic control and induces endoluminal scar formation. The scar within the cystic duct forms a reliable barrier between the gallbladder and the biliary system and avoids recanalization of the cystic duct at a later date. Sclerotherapy of the isolated gallbladder with 95% ethanol and 3% STS can be performed without toxic or otherwise adverse effects and is suitable to ablate the porcine gallbladder. Initial clinical trials with this new technique on a small number of patients are promising and have demonstrated that the protocol can be applied safely to humans. The electrocoagulation technique by catheter appears suitable to ablate the human cystic duct. Follow-up evaluation of our first patients is under way and must determine whether our regimen is appropriate to ablate the human gallbladder on a long-term basis. Further development of this new approach may eventually enable definitive nonoperative treatment of cholecystolithiasis in selected patients.

Animals↗
PubMed1989

[Hemorrhagic gastroduodenal ulcer: contribution of new medical treatments].

The mortality due to upper gastrointestinal haemorrhage from ulcers has remained unchanged for several (estimated to be 6%), despite progress in surgery and intensive care, new drug treatments and, more recently, the development of endoscopic treatments. Drug treatments, although frequently used in practice always have a controversial haemostatic efficacy. Antacids have a haemostatic efficacy, but only at doses responsible for side effects. Antisecretory drugs appear to be systematically prescribed, if only to commence treatment of the peptic ulcer disease. However, their haemostatic efficacy has not been established except in the sub-group of gastric ulcers, especially in elderly subjects. According to a recent study, prostaglandins are as active as antacids. Since 1975, endoscopy is the support for haemostatic treatments, most of which are still under evaluation. Therapeutic injections, a simple and inexpensive technique, certainly represents one of the most promising methods. Different authors have proposed different solutions for injection (absolute alcohol, aetoxysclerol, adrenaline, thrombin...) with comparable haemostatic efficacy. Laser photocoagulation (Argon and Nd-YAG) is an expensive and impractical technique and a number of randomised studies indicate that the initial enthusiasm for this technique is not justified. Monopolar electrocoagulation does not constitute a real progress in contrast with bipolar electrocoagulation which significantly decreases the frequency of recurrent haemorrhages. Lastly, the efficacy of the heater probe remains to be evaluated in the light of promising studies, particularly those of Johnson in 1985. At the present time, these endoscopic haemostatic treatment should be reserved to high surgical risk patients (elderly or debilitated subjects).(ABSTRACT TRUNCATED AT 250 WORDS)

Antacids↗
PubMed1985

Laparoscopic sterilization of the bitch and queen by uterine horn occlusion.

Laparoscopic sterilization techniques, originally developed for use in women, were evaluated in the bitch and queen. In the first study (study I), the uterine horns of 6 bitches and 3 queens were occluded by electrocoagulation or plastic clips. The sites of occlusion were midway along the length of 1 cornus and at the uterotubal junction on the contralateral side. Both procedures effectively occluded the uterine horns, as evidenced by a distinctly visible separation of the reproductive tract. Laparoscopic examination 1 year after surgery revealed an enlarged, thin-walled, and fluid-filled uterine segment cranial to the midcornus occlusion sites in all animals. The contralateral horn was normal in appearance, except for the separation from the ovarian bursa. Three of the bitches developed pyometra (confined to the distended uterine segment) at 24 months, at 53 months, and at 72 months after sterilization, respectively. In a subsequent study (study II), 1 adult and 5 prepubertal bitches were sterilized by laparoscopic electrocoagulation of both uterine horns at the uterotubal junction adjacent to the ovarian bursa. Upon reexamination 1, 2, and 4 years later, the uterine horns of these females were normal in appearance, but were separated from the adjacent ovarian bursae. These females continued to be clinically healthy. Laparoscopic sterilization offers a rapid and safe alternative to ovariohysterectomy and, because of its minor invasive nature, can be performed on young, prepubertal animals. Such a procedure may have particular value as a simple, practical means of sterilizing dogs and cats on a mass basis.

Animals↗
PubMed1987

Bipolar systems--do they perform?

Recent reports of bipolar sterilization failures have questioned the compatibility of bipolar forceps used with different electrogenerators. Four different bipolar forceps were matched and mismatched with five generators and the electrocoagulation effect was studied by two physicians trained in the histologic evaluation of electrical injury. All bipolar systems, matched or mismatched, failed to coagulate the fallopian tube as completely as unipolar control--except for the matched Kleppinger system. Conversely, when mismatched with other generators the coagulation effect of the Kleppinger forceps fell far below that of other bipolar forceps--matched or mismatched. Each bipolar system should be compatible and its electrocoagulation effect studied before it is used for female sterilization.

Electrocoagulation↗
PubMed1985

Endoscopic control of upper gastrointestinal bleeding.

One important objective in managing patients with upper gastrointestinal hemorrhage is to control the bleeding until the patient's condition is stable and definitive therapy can be carried out. Endoscopic techniques are now available to attain this goal. Endoscopic sclerosis has become an accepted treatment for bleeding esophageal varices, especially in patients with Child's class B or C cirrhosis. Control of nonvariceal bleeding by endoscopic techniques is now feasible and involves laser photocoagulation and electrocoagulation. Clinical experience with endoscopic laser photocoagulation has demonstrated that it can successfully arrest bleeding in gastric and duodenal ulcers. Endoscopic electrocoagulation has been successful in stopping bleeding from Mallory-Weiss tears, acute gastric erosions, and gastric, duodenal and stomal ulcers. Use of an endoscopic heater probe, now in the development stage, to control bleeding gastric and duodenal ulcers will be an important addition.

Adult↗
PubMed1986

Endoscopic management of the bleeding ulcer. A survey.

The study was performed to evaluate the prognostic and therapeutic value of endoscopy in patients with bleeding ulcer. Before endoscopic control of ulcer bleeding was introduced 373 patients with bleeding ulcer and a median age of 67 years were studied retrospectively. Emergency surgery was required in 155 patients. The surgical mortality was 11% in 37 low risk patients, but 36% in 118 poor risk patients. There was a trend to improved outcome after introduction of diagnostic endoscopy but only in patients with hemorrhage managed conservatively. Surgical mortality remained unchanged. Ranked in order of prognostic importance, a complicating disorder, postoperative complications, overtransfusion, and absent past history of ulcer dyspepsia were identified as the most important determinants of fatal outcome. Age, onset of hemorrhage at home or in hospital, previous ulcer surgery, previous bleeds, ulcer site, and sex had comparatively less bearing on outcome. It was concluded that although surgery was efficient in preventing exsanguination, it was poorly tolerated in poor surgical risks who constituted 76% of the patients in need of emergency control of ulcer bleeding. The results indicate that the search for non-surgical methods is justified. In a pilot study, endoscopic electrocoagulation was applied to control ulcer bleeding in 60 patients. The experience from the study served as basis for a prospective study in an attempt to assess the prognostic and therapeutic potential of endoscopy in the management of bleeding ulcer and to define indications for emergency endoscopy. The histomorphologic effect of electrocoagulation employed to stop bleeding from acute gastric ulcers in rabbits suggested that intravascular occlusive fibrin thrombosis is the probable mechanism of hemostasis. In the prospective study, 539 consecutive patients admitted with hematemesis and melena underwent emergency endoscopy. Peptic ulcer, identified as the bleeding source in 51% of these patients, was the predominant lesion most liable to hemorrhage assessed as requiring emergency surgery. Black hematemesis with melena, occurring in 13% of the patients, was the best predictor of ulcer bleeding. Red hematemesis with melena (26%) was the most important predictor of major bleeding. Black hematemesis with melena was found to be as important as red hematemesis without melena (22%) in predicting major ulcer bleeding. In contrast, melena (18%) and, in particular, black hematemesis without melena (20%) were poor predictors of ulcer bleeding as well as of major bleeding.(ABSTRACT TRUNCATED AT 400 WORDS)

Electrocoagulation↗
PubMed1984

Dieulafoy's lesion.

We have presented six instances of Dieulafoy's lesion, two of which were diagnosed endoscopically preoperatively. Endoscopic electrocoagulation was used in two instances, one with success, and this may have a place in the treatment of these lesions. Oversewing alone of the lesion seems to be sufficient surgical treatment, if nonoperative measures, such as selective arterial embolization or endoscopic electrocoagulation fail or are unavailable.

Adult↗
PubMedDate not supplied

[Adrenal hormone level and collagen metabolism in the aortic wall under the effect of changes in the amygdaloid complex].

The blood catecholamine, 11-hydroxycorticosteroid and free hydroxyproline content and collagen metabolism in the rabbit aortic wall were studied under conditions of chronic electrostimulation and bilateral amygdaloid electrocoagulation. It was found that electrostimulation of the amygdaloid lateral nucleus causes changes in the adrenocorticotropin content, activating collagen metabolism and accumulation in the aortic wall. A fall of the noradrenaline, 11-hydroxycorticosteroid concentration and activation of collagen metabolism, accompanied by its accumulation in the aortic wall, are seen during the 1st month after electrocoagulation.

Adrenal Cortex Hormones↗