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We used a handheld disposable cautery for the diagnostic scraping of corneal ulcers. Sterility of the tip is obtained by activating the unit until the tip reaches a red-hot color and then allowing it to cool. The unit has a sturdy, well-defined tip, and is self-sterilizing, reusable, readily available, and simple to use.
Cautery-assisted palatal stiffening operation (CAPSO) is a recently developed single office-based procedure performed with local anesthesia for the treatment of palatal snoring. A midline strip of soft palate mucosa is removed, and the wound is allowed to heal by secondary intention. The flaccid palate is stiffened, and palatal snoring ceases. This prospective study evaluated the ability of CAPSO to treat obstructive sleep apnea syndrome (OSAS). Twenty-five consecutive patients with OSAS underwent CAPSO. Responders were defined as patients who had a reduction in apnea-hypopnea index (AHI) of 50% or more and an AHI of 10 or less after surgery. By these strict criteria, 40% of patients were considered to have responded to CAPSO. Mean AHI improved from 25.1+/-12.9 to 16.6+/-15.0 (P = 0.010). The Epworth Sleepiness Scale, a subjective measure of daytime sleepiness, improved from 12.7+/-5.6 to 8.8+/-4.6 (P<0.001). These results indicate that CAPSO is as effective as other palatal surgeries in the management of OSAS.
A case history is presented of a patient who sustained visual loss and a third-nerve palsy after the application of monopolar electrocautery to the orbital apex. Because the third-nerve palsy resolved and most of the vision was regained, it is theorized that the neurological deficits were secondary to myelin damage caused by the monopolar electrocoagulator. The purpose of this article is to compare the effects of monopolar electrocoagulation, bipolar electrocoagulation, and hot-wire cautery on decompressed optic nerves of cats. Although all three forms of coagulation are capable of causing demyelination within the optic nerve when used on the nerve sheath, monopolar electrocoagulation resulted in the greatest degree of demyelination and bipolar electrocoagulation resulted in the least demyelination.
Skin hook cautery is a useful technique in these surgical cases with special hemostatic problems. I have employed and taught this technique for 14 years, but have never seen it mentioned in any surgical publication. Many other surgeons, no doubt, are already using this method, making the skin hook an even more useful instrument. It is not recommended for routine use because extra time and machine-setting are not warranted to achieve good hemostasis in most patients.
Retinal detachment with tears can be cured by scleral buckling by synthetic material pressure retino-choroidopathy without cautery (diathermy, cryo- or photocoagulation) to tear edges on conditions: (1) To use the encircling Silastic 3-mm band (equatorial or oblique according to tear site) giving a permanent buckle. The segmental buckle may recede reopening the tear and its retino-choroidopathy effect may not be sufficient to seal the tear. (2) Not to evacuate the subretinal fluid leaving the ocular tension at end of operation a bit high [about 25 mm Hg in the first operation and 5 mm Hg (Schøtz) in the recent reoperation above the preoperative level]. The synthetic material pressure retino-choroidopathy seals the tear and lowers the ocular tension in subsequent days with beter buckling. (3) As these conditions may not be attained, it is wiser to use minimal diathermy or cryo-therapy to seal the tear.
Pyrolysis of tissue in a hypoxic environment can produce carbon monoxide. The atmosphere of the peritoneal cavity is rendered hypoxic during laparoscopic cholecystectomy by insufflation with 100% carbon dioxide. To determine whether carbon monoxide is produced by electrocautery of tissue during laparoscopic cholecystectomy, nine patients undergoing this procedure had the insufflation gas after use of electrocautery analyzed for carbon monoxide. Blood was analyzed for carboxyhemoglobin in these same patients to determine whether carbon monoxide was being absorbed in dangerous amounts. Carbon monoxide was present in the peritoneal cavity 5 min after use of electrocautery was initiated at a median concentration of 345 ppm (range 25-1600 ppm), and at the end of surgery at a concentration of 475 ppm (range 100-1900 ppm). This was well in excess of the 35 ppm upper limit for a 1-h exposure set by the Environmental Protection Agency. The carboxyhemoglobin concentrations (mean +/- SD) were the same at the beginning (1.3% +/- 0.7%), end (1.2% +/- 0.7%), and the day after surgery (1.1% +/- 0.6%). Although there was no evidence of significant absorption of carbon monoxide in these patients, care should be taken to scavenge the gases produced by cautery of tissues to avoid operating room contamination during laparoscopic surgery.
Granular cell myoblastomas of the trachea and right upper lobe bronchus were discovered incidentally during therapeutic bronchoscopy. Because of their propensity to cause airway compromise and distal atelectasis, ablation of both lesions was undertaken. This is the first reported case of bipolar cautery of GCM through a flexible fiberoptic bronchoscope. Small tumor size and lack of atelectasis permitted utilization of this technique. Long-term follow-up is necessary to compare this therapy with other nonresectional therapies.
A 61-year-old woman developed acute bilateral dacryocystitis secondary to Staphylococcus aureus 3 weeks after undergoing punctal occlusion with thermal cautery for keratoconjunctivitis sicca. The dacryocystitis resolved with intravenous antibiotics, aspiration of the lacrimal sacs, injection of sulfacetamide into the lacrimal sacs, and bilateral dacryocystorhinostomy. Preexisting bilateral nasolacrimal duct obstruction was postulated as the underlying cause. In these cases, irrigation of the lacrimal system is recommended before proceeding with punctal occlusion.
The use of a malleable curved disposable suction cautery for the control of any persistent bleeding at the conclusion of adenoidectomy in over 1000 cases has prevented any primary postoperative hemorrhages from the nasopharynx, and obviated the need for post-nasal packing.
Bleeding patterns in women sterilized by the laparoscopic route using bipolar cautery and Falope ring are compared with those in women whose husbands had been vasectomized 1 year previously. No significant association exists between the technique of sterilization used and a change in duration or amount of bleeding. Although there was an increase in the amount and duration of bleeding in some cases, there was an equivalent decrease in amount and duration of bleeding in others. There is no significant difference in bleeding patterns between women who have had laparoscopic sterilization and women whose husbands have been vasectomized.
Laparoscopic sterilization with bipolar cautery and division was found to be a safe, effective and acceptable alternative to silastic band application. The main advantages were less tubal damage, applicability in edematous tubes, ease of tackling bleeding complications. Failure occurred in 0.2% of cases and ectopic pregnancy occurred in none. There was no mortality and no cases of bowel injury. Total number of complications was 3.94%.
A bipolar cautery instrument with a tapered, blunt tip has been developed for glaucoma filtering surgery. Evaluated in 30 consecutive trabeculectomy procedures, the instrument proved suitable for all aspects of the operation. The narrow, 23-gauge shaft and tapered, blunt tip allowed gentle, pin-point coagulation of individual bleeders, as well as cauterization of tracks of tissue in a continuous motion. The unit was effective for external cauterization of conjunctival and scleral vessels, as well as for internal cauterization of anterior uveal tissue.
Tonsillectomy and adenoidectomy (T&A) is a common surgical procedure for which many different surgical techniques have been described. However, detailed information is lacking regarding complications or recovery rates for any particular procedure. A newly described technique for T&A, microbipolar dissection (MBPD) is being compared with cold knife dissection with suction cautery of bleeding vessels (CKC) in a prospective study of 200 children aged 2-16 years. Patients are randomly assigned and stratified by age-group into one of two treatment arms. Intraoperative and post-operative measures of T&A effectiveness relative to complications and patient recovery rate are being studied. The preliminary data presented here focus on the reliability of the measures and potential clinical relevance of the findings in 129 of these children, with anticipated confirmation of these tentative results after completion of the larger cohort. Thus far it appears that post-operative bleeding rates are significantly reduced, recovery rate is improved, and return to normal activities are all better in the MBPD patients. Although these data reflect small numbers of children and must be interpreted with caution, it appears that MBPD T&A holds great promise in reducing the morbidity associated with the CKC technique of T&A.
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