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PubMed2001

Comparison of tissue injury between laparosonic coagulating shears and electrosurgical scissors in the sheep model.

STUDY OBJECTIVE: To compare laparosonic coagulating shears (LCS), which use ultrasonic energy, and unipolar diathermy scissors with respect to depth of tissue injury. DESIGN: Prospective observational study (Canadian Task Force classification I). SETTING: A reproduced surgical setting. SUBJECTS: An anesthetized sheep. INTERVENTION: We laparoscopically harvested uterine horn and bowel tissue. MEASUREMENTS AND MAIN RESULTS: Tissue was transected while hemostasis was maintained. Two pathologists examined tissue independently, and each was blinded as to the instrument used for harvesting. Clinical characteristics and tissue injury created by the instruments were compared. CONCLUSION: Subjectively, LCS appeared to produce less smoke plume than diathermy scissors. It also produced greater tissue damage than unipolar electrosurgery on settings of 35 W cut and 30 W coagulate.

Animals↗

PubMed1996

Tubal patency and conception rates with three methods of laparoscopic terminal neosalpingostomy.

STUDY OBJECTIVE: To determine the best method of laparoscopic neosalpingostomy for terminal tubal obstruction with respect to postoperative tubal patency and pregnancy. DESIGN: Three-year follow-up study. SETTING: University hospital. PATIENTS: Eighty-two women. INTERVENTIONS: Clubbed fimbriae were incised with scissors and sutured after eversion in 26 patients (type 1 procedure), and incised with needle diathermy and everted by endocoagulator without suturing in 27 (type 2). In 29 women the original fimbrial shape was restored by traction with grasping forceps after making a small hole with needle diathermy, and the fimbriae were sutured after eversion (type 3). MEASUREMENT AND MAIN RESULTS: Tubal patency rates on hysterosalpingogram 2 months after the three operations were 13 (50%) of 26 patients for type 1, 23 (85.1%) of 27 patients for type 2, and 28 (96.2%) of 29 patients for type 3. Tubal patency for types 2 and 3 was significantly higher than for type 1 (p <0.01). Conception rates within 3 years for the procedures were 5 (19.2%) of 26 women for type 1, 10 (37.2%) of 27 for type 2, and 14 (48.2%) of 29 for type 3. The conception rate for type 3 was significantly higher than that for type 1 (p <0.05). Especially when the operation was performed in women with favorable prognostic conditions, the conception rate was 9 (64.3%) of 14 women for type 3 operation. CONCLUSIONS: The type 3 procedure was the most effective method of laparoscopic neosalpingostomy for terminal tubal obstruction, especially when performed in patients with favorable prognostic factors.

Adult↗

PubMed1999

Angular cheilitis after tonsillectomy.

The operation of tonsillectomy requires the oral cavity to be held open mechanically in an unconscious patient, and intra-oral instrumentation to occur. Angular cheilitis may arise as a result of this after operation. This can cause morbidity and delay the re-establishment of a normal diet. The aim of this study was to identify what factors increase the likelihood of developing this problem postoperatively. Sixty patients were randomly selected in a prospective manner. Preoperative, intraoperative and postoperative variables were recorded. The frequency of development of postoperative angular cheilitis was recorded. The prevalence of the condition was related to the prerecorded variables. Parametric analysis showed that the chance of developing angular cheilitis was directly related to the use of diathermy haemostasis (P = 0.05). Logistic regression analysis showed that the odds ratio of developing this complication if diathermy was used is 3.5 (95% confidence intervals 0.99, 12.4) and operation difficulty may also be a relevant variable. No other recorded variables were found to be significant.

Adolescent↗

PubMed2000

A comparison of the ERBE Erbotom ICC 200 generator and the Valleylab Force 2 electrosurgical generator in performing large loop excision of the transformation zone.

One drawback of the large loop excision of the transformation zone procedure (LLETZ) is the influence of electrical current on histological interpretation through thermal artefact. The ERBE Erbotom ICC 200 unit (Surgical Technology Group, Hampshire, England, UK) compared to other standard electrosurgical generators has the theoretical advantage that it automatically regulates the output according to "demand" and therefore uses the minimum amount of power to complete the procedure, which thus should cause the minimum thermal artefact. Fifty females requiring the loop procedure were randomized to treatment with either the ERBE machine or the standard Valleylab electrosurgical generator. Although there were no significant differences in the diathermy artefact measurements between the two groups, the Valleylab unit was associated with more mucosal destruction or removal (P = 0.027) and an increased number of specimens uninterpretable due to diathermy artefact. The new technology associated with the ERBE unit had clear benefits for the clinician in terms of the time of the procedure and technical problems.

Journal Article↗

PubMed1977

A newly devised cutting probe for endoscopic sphincterotomy of the ampulla of vater.

A new diathermy cutting probe for endoscopic sphincterotomy has been devised. This consisted of a standard Teflon catheter with a diathermy wire and a metal-marked long tip. Using an Olympus duodenoscope and this cutting probe, endoscopic sphincterotomy has been successfully performed in 38 out of 40 patients with common bile duct stones without any serious complications. Advantages and clinical results of this instrument are presented.

Ampulla of Vater↗

PubMed1995

Flexible endoscopic treatment of Zenker's diverticulum: a new approach.

BACKGROUND AND STUDY AIMS: In the past, a number of treatment modalities have been used for the management of a Zenker's diverticulum. These include transcervical diverticulectomy, myotomy, or laser or diathermy treatment via rigid endoscopes. Up to the present, no reports of the treatment of a Zenker's diverticulum with a flexible endoscope have been published. PATIENTS AND METHODS: In this study, we present the results of our first 20 patients (13 male; mean age 82 years) prospectively treated with a flexible endoscope applied through diathermy. All patients had significant symptoms such as dysphagia, recurrent aspiration pneumonia and/or weight loss. RESULTS: Treatment using a mean of three sessions per patient was successful, with a good symptomatic response in all subjects. There were no severe complications associated with the therapy. Four patients complained about a sore throat for a few days. During follow-up (mean 6-7 months), three patients died due to unrelated causes, and 17 remained asymptomatic. CONCLUSIONS: An important advantage is that it is possible to perform the treatment without general anesthesia, and therefore also in patients whose general health is poor. The technique can easily be performed in an interventional endoscopy unit. Our first experiences show that flexible endoscopic treatment is an effective and relatively safe method.

Aged↗

PubMed2004

The extent of ovarian damage produced by ovarian cauterisation in the human.

The object of this study was to assess the extent of ovarian damage produced by ovarian cauterisation. This was a prospective comparative study between four and eight holes using monopolar diathermy comparing the extent of damage of ovarian tissue in the human. The study was carried out in the department of obstetrics and gynaecology, Cairo University. We studied 50 patients aged 40-45 years who were scheduled for abdominal hysterectomy with bilateral salpingo-oophorectomy for benign gynaecological disease. One ovary was subjected to unipolar diathermy with four holes (group I) and the contralateral ovary involved eight holes (group II). The main outcome measured was the extent of ovarian damage produced by the cautery. The percentage area of cautery showed a median of 0.4% and a mean of 0.48% +/- 0.35 in group I, compared to a median of 1% and a mean of 1% +/- 0.31 in group II. The difference between the two groups is statistically significant (P < 0.001). The study suggests that the extent of injury to the ovary produced by cautery might be small, especially when using four holes; however, it is difficult to determine long-term host tissue response.

Adult↗

PubMed1991

Electromagnetic radiofrequency interference with Doppler equipment.

Doppler ultrasound equipments incorporate radiofrequency (RF) receivers operating at the microvolt level and are liable to interference from radiated fields and mains disturbances. The most significant interference routes are: radiation from radio broadcast, paging, communication and diathermy picked up on the transducer and patient acting as an aerial; and mains disturbances from diathermy, x-ray sets, motors and thyristor controls, etc, reaching the equipment interior. Direct mains interference can be reduced by proper design incorporating a mains filter, a low RF leakage enclosure, a ground plane, careful layout and further screening of the receiver circuits. Pick-up via the transducer occurs even if the signal leads are completely screened because an RF potential can exist between transducer and equipment enclosure due to the considerable impedance at RF of any wire or cable, typically 70 omega at 5 MHz for 2 m. This potential, reduced by about 50-60 dB, appears at the receiver input because of imperfect common mode rejection of the coupling cable. As a result, induced voltages above 100-300 microV may cause problems. It is shown that such levels can easily result from the interfering field strengths of 1 mV m-1 or more that may be experienced in a hospital environment. On the other hand, field strengths of 300 microV m-1, as generally allowed by regulatory standards at 3 m from interfering sources, should not cause much effect. Other interference can arise from modulation of a strong RF signal by mains frequency power components in the Doppler equipment and from associated computer circuits. These require careful layout to reduce electric and magnetic coupling, decoupling and filtering of power supplies and components, screening of RF circuits and particular attention to the reduction of power and computer signal currents flowing in RF signal earth paths. Finally, some initial simple acceptance tests for interference susceptibility are proposed, based on the application of 300 microV of RF signal between transducer body and equipment enclosure and 10 mV to the mains supply.

Equipment and Supplies↗

PubMed1979

The value of exercises in the treatment of low back pain.

The results of treatment with short-wave diathermy were compared with those achieved by short-wave diathermy combined with back extension or lumbar isometric flexion exercises in 43 patients with back pain. Subjects were relatively young and normally engaged in sporting activities. Marginally more patients improved amongst those receiving extension exercises. Significant reduction of pain and increase of spinal flexion occurred with each treatment and the periods taken to resume work or sport were similar in each group. Neither exercise regime appeared to have a major influence on recovery. Isometric flexion exercises did not seem to be more beneficial for those with a prominent lumbar lordosis.

Adolescent↗

PubMed1986

Nonsurgical fat removal in cosmetic blepharoplasty: a new technique.

A new technique of minimally invasive fat removal during cosmetic blepharoplasty is described. This lipolytic diathermy technique has been used successfully in more than 100 patients during the last 3 years and is compared with routine excisional fat removal. The main advantage of this technique lies in its ability to dissolve the fat without surgical excision, thus obviating the inherent complications that arise from such dissection. The technique uses a diathermy unit to cause lipolysis of the fat pockets within their intact septal compartments and can be used for both upper and lower lid herniated fat. This procedure has been found to be exceptionally efficient and predictable and adds another level of safety to cosmetic blepharoplasty.

Adipose Tissue↗

PubMed2003

Coblation tonsillectomy versus dissection tonsillectomy: postoperative hemorrhage.

OBJECTIVES/HYPOTHESIS: Coblation tonsillectomy is a recently introduced surgical technique. To measure its benefits against traditional tonsillectomy techniques, it is necessary to compare their complication rates. The study aims to identify differences in reactionary and secondary hemorrhage proportions, comparing coblation with dissection tonsillectomy. STUDY DESIGN: Prospective observational cohort study. METHODS: Rates of reactionary and delayed postoperative hemorrhage were measured, comparing 844 coblation tonsillectomies with a control group of 743 tonsillectomies performed by blunt dissection with bipolar diathermy hemostasis. RESULTS: The secondary hemorrhage rate with coblation-assisted tonsillectomy was 2.25% compared with 6.19% in the control group (P <.05). The rate of secondary hemorrhage in children following coblation tonsillectomy was 0.95% compared with 4.77% in the control group (P <.05). The difference was also significant (P <.05) in the adult population (4.40% vs. 8.81%, respectively). No difference was found in the reactionary hemorrhage proportions. CONCLUSION: In the study, coblation tonsillectomy was associated with a lesser incidence of delayed hemorrhage, more significantly in the pediatric population. The new technique using tissue coblation for tonsil dissection offers significant advantages in the postoperative period compared with dissection tonsillectomy with bipolar diathermy hemostasis. Coblation is associated with less postoperative pain and early return to daily activities. Also, there are fewer secondary infections of the tonsil bed and significantly lower rates of secondary hemorrhage with coblation. These results and the disposable nature of the coblation equipment promote coblation tonsillectomy as the authors' preferred dissection method.

Adolescent↗

PubMed1980

The use of the bipolar microcoagulator for haemostasis in tonsillectomy.

A two-part prospective trial of the use of bipolar diathermy for haemostasis in tonsillectomy was carried out. The first part of the trial showed that bipolar diathermy was as effective as conventional methods of dealing with bleeding, and has no additional undesirable effects. The second part showed that the method could substantially reduce operating time.

Child↗

PubMed1986

The stuffy nose: a comparative study of two common methods of treatment.

This study compares the efficacy of submucosal diathermy and cryotherapy in the treatment of nasal obstruction caused by engorged inferior turbinates. Subjectively they are equally effective but cryotherapy has the advantage that it can be performed under local anaesthetic and does not require hospitalization. Rhinomanometry suggests that cryotherapy causes more destruction of the submucosal vascular plexus than submucosal diathermy. Scanning electron microscopy 6 weeks postoperatively demonstrates that both treatment modalities cause widespread damage to the mucociliary epithelium.

Adolescent↗

PubMed1994

Preliminary experiences with microscopic tonsillectomy.

Experiences with a modified technique of tonsillectomy are described. The surgery is performed viewing the tonsil through the operating microscope and using the bipolar diathermy forceps for dissection and diathermy of blood vessels. In a pilot-study of 70 patients, the microscopic method was found to be an elegant technique which substantially reduced intra-operative blood loss and did not prolong surgery. Post-operative morbidity will be assessed in a further study.

Adolescent↗

PubMed1991

Laser treatment of pharyngeal pouch.

The symptoms of pharyngeal pouch become more troublesome, eventually requiring surgical treatment. Excision of the pouch and cricopharyngeal myotomy through a neck incision was the operation of choice until Dohlman described endoscopic diathermy operative treatment 30 years ago. The diathermy technique has been largely superseded by endoscopic microsurgical division of the cricopharyngeus muscle in the party wall using carbon dioxide laser. This operation is now established as a precise, accurate and safe procedure providing reliable relief of symptoms with minimal risk to the patient. Fifteen patients treated by the microsurgical laser procedure in the past 5 years are reported.

Aged↗

PubMed1997

A national survey of the complications of endometrial destruction for menstrual disorders: the MISTLETOE study. Minimally Invasive Surgical Techniques--Laser, EndoThermal or Endorescetion.

OBJECTIVES: To study the frequency of complications of endometrial resection and ablation for menstrual disturbances and the influence of the experience of the operators. DESIGN: Prospective survey with additional retrospective reporting by theatre staff. SETTING: 300 National Health Service and independent hospitals in the United Kingdom (excluding Scotland). POPULATION: 10,686 women registered by 690 doctors (1-222 cases/doctor) from April 1993 to October 1994. METHODS: Mailings were sent to relevant medical and non medical staff at every hospital to ascertain who performed the operations. These doctors were asked to complete a questionnaire detailing their previous experience. Completed patient registration forms were returned each month. Theatre contacts returned lists of cases reported in theatre registers. MAIN OUTCOME MEASURES: Perioperative, post-operative and delayed complications by method of surgery and experience of operator. RESULTS: Two directly related deaths were reported. Laser and rollerball ablations were associated with least operative and post-operative complications. Combined loop and rollerball diathermy was associated with a higher rate, but with fewer immediate operative complications than loop resection alone. Endometrial thinning agents were not associated with decreased complications. Fibroids were associated with increased operative haemorrhage. Early post-operative complication rates ranged from 0.77% to 1.51%. Six-week follow up in 82.5% of the women revealed few complications (1.25% to 4.58%). Increasing operative experience was associated with fewer uterine perforations in the loop resection alone group (chi 2 for trend, P < 0.001), but had no effect on operative haemorrhage in any group. CONCLUSIONS: These procedures were used widely in 1993 to 1994 with low morbidity and mortality. The techniques may be relatively easily learned in the apprenticeship system without compromising safety. Combined diathermy resection appears safer than loop resection alone, but laser and rollerball ablation were safest.

Adult↗

PubMed1997

Is loop excision adequate primary management of adenocarcinoma in situ of the cervix?

OBJECTIVE: To assess the efficacy of cervical loop excision as primary management of adenocarcinoma in situ. DESIGN: A two-centre retrospective study. SETTING: Birmingham and Midlands Hospital for Women and City Hospital NHS Trust. POPULATION: Nineteen women with a histological diagnosis of adenocarcinoma in situ (high grade CIGN) of the cervix made on diathermy loop excision. MAIN OUTCOME MEASURES: Presence or absence of adenocarcinoma in situ at loop specimen margins, results of cervical cytological examinations following loop excision, results of histopathological assessment of any surgical specimens taken after initial loop excision. RESULTS: Of the 19 women with confirmed adenocarcinoma in situ on loop excision, the median age was 31, and 8 (42%) were nulliparous. The median follow up of these women was 19 months. Eleven women were treated by loop excision alone and have had normal follow up to 18 months. Five women have undergone further surgical procedures, four had a hysterectomy and one had a repeat loop excision. No residual disease was found in any of these surgical specimens, confirming that loop excision was adequate primary management of the disease. Three women have had abnormal endocervical follow up cytology suggestive of residual disease. One of these three women may represent a case of residual endocervical disease. Excision margins of the loop specimen were not involved by adenocarcinoma in situ in 11 women. However, excision margin status of the loop specimen did not appear to be predictive of residual disease. CONCLUSIONS: Our small retrospective study suggests that diathermy loop excision of the cervix is adequate primary management of adenocarcinoma in situ of the cervix. Cytological and colposcopic follow up, including cytobrush endocervical cytological sampling and long term follow up, is recommended in these women.

Adenocarcinoma↗

PubMed2006

Precancerous changes in the cervix and risk of subsequent preterm birth.

OBJECTIVE: The aims of this study were (i) to examine whether women referred for assessment of precancerous changes in the cervix had higher rates of preterm birth compared with those in the general population and (ii) to compare preterm birth rates for treated and untreated women adjusting for possible confounding factors. DESIGN: Retrospective cohort design. SETTING: Teaching hospital. POPULATION: All women referred to the Royal Women's Hospital, Melbourne (1982-2000), who subsequently had a birth recorded on the Victorian Perinatal Data Collection system (n = 5548). METHODS: Record linkage of hospital dysplasia clinic records and population-based birth records. MAIN OUTCOME MEASURES: Total preterm delivery (<37 weeks of gestation) and subtypes. RESULTS: Both treated and untreated women were at a significantly increased risk for preterm birth compared with those in the general population: treated--standardised prevalence ratio (SPR) 2.0, 95% CI 1.8-2.3 and untreated--SPR 1.5, 95% CI 1.4-1.7. Within the cohort, the treated women were significantly more likely to give birth preterm (adjusted OR 1.23, 95% CI 1.01-1.51). An increased risk of preterm birth was also associated with a history of induced or spontaneous abortions, illicit drug use during pregnancy or a major maternal medical condition. Cone biopsy, loop electrosurgical excision procedure and diathermy were associated with preterm birth. After adjusting for possible confounding factors, only diathermy remained significant (adjusted OR 1.72, 95% CI 1.36-2.17). Women treated using laser ablation were not at an increased risk for preterm birth (adjusted OR 1.1, 95% CI 0.8-1.4). CONCLUSIONS: Diagnosis of precancerous changes in the cervix (regardless of the treatment) was associated with an increased risk of preterm birth. Consideration should be given to the preferential use of ablative treatments.

Adult↗