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At least 19 recordsLinked to original sources
PubMed2005

Energy sources for laparoscopic colectomy: a prospective randomized comparison of conventional electrosurgery, bipolar computer-controlled electrosurgery and ultrasonic dissection. Operative outcome and costs analysis.

The development of operative laparoscopic surgery is linked to advances in ancillary surgical instrumentation. Ultrasonic energy devices avoid the use of electricity and provide effective control of small- to medium-sized vessels. Bipolar computer-controlled electrosurgical technology eliminates the disadvantages of electrical energy, and a mechanical blade adds a cutting action. This instrument can provide effective hemostasis of large vessels up to 7 mm. Such devices significantly increase the cost of laparoscopic procedures, however, and the amount of evidence-based information on this topic is surprisingly scarce. This study compared the effectiveness of three different energy sources on the laparoscopic performance of a left colectomy. The trial included 38 nonselected patients with a disease of the colon requiring an elective segmental left-sided colon resection. Patients were preoperatively randomized into three groups. Group I had electrosurgery; vascular dissection was performed entirely with an electrosurgery generator, and vessels were controlled with clips. Group II underwent computer-controlled bipolar electrosurgery; vascular and mesocolon section was completed by using the 10-mm Ligasure device alone. In group III, 5-mm ultrasonic shears (Harmonic Scalpel) were used for bowel dissection, vascular pedicle dissection, and mesocolon transection. The mesenteric vessel pedicle was controlled with an endostapler. Demographics (age, sex, body mass index, comorbidity, previous surgery and diagnoses requiring surgery) were recorded, as were surgical details (operative time, conversion, blood loss), additional disposable instruments (number of trocars, EndoGIA charges, and clip appliers), and clinical outcome. Intraoperative economic costs were also evaluated. End points of the trial were operative time and intraoperative blood loss, and an intention-to-treat principle was followed. The three groups were well matched for demographic and pathologic features. Surgical time was significantly longer in patients operated on with conventional electrosurgery vs the Harmonic Scalpel or computed-based bipolar energy devices. This finding correlated with a significant reduction in intraoperative blood loss. Conversion to other endoscopic techniques was more frequent in Group I; however, conversion to open surgery was similar in all three groups. No intraoperative accident related to the use of the specific device was observed in any group. Immediate outcome was similar in the three groups, without differences in morbidity, mortality, or hospital stay. Analysis of operative costs showed no significant differences between the three groups. High-energy power sources specifically adapted for endoscopic surgery reduce operative time and blood loss and may be considered cost-effective when left colectomy is used as a model.

Adult↗
PubMed1996

Sharp dissection, electrosurgery, and argon-enhanced electrosurgery in porcine skin flaps.

Sharp scalpel dissection, electrosurgery, and argon-enhanced electrosurgery (argon beam coagulation) were used to elevate random pedicled skin flaps in a randomized blinded fashion with a porcine model. A total of 72 flaps on 9 pigs were examined. Flap survival was quantified, and histology was also reviewed 2 and 6 weeks after surgery. No significant difference among the three techniques was noted in terms of area or length of surviving flaps. There were also no histologic differences noted with regard to fibrosis, inflammatory infiltrate, or necrosis. We conclude that the use of electrosurgery during surgical dissection of random pedicled skin flaps is not detrimental to wound healing or tissue survival, and it provides benefits such as decreased blood loss, absence of the need for sharp instruments in the surgical field and faster operative times.

Animals↗
PubMed1982

Pulpal effects of electrosurgery involving based and unbased cervical amalgam restorations.

The pulpal effects of electrosurgery involving unrestored enamel, cementum, calcium hydroxide-copal varnish-based restorations and unbased restorations were evaluated in extracted human teeth and posterior teeth of cynomolgus monkeys. Electrosurgery for all studies was performed with a fully rectified filtered unit under conditions of normal clinical usage. Studies in extracted human teeth measured the voltage potential generated between a reference probe in apical pulp tissue and an activated electrosurgery electrode placed on enamel, cementum, based restorations, and unbased restorations. Placement of a base reduced but did not prevent passage of electrosurgical current, and no measurable potential was associated with activated electrode contact on cementum or enamel. Studies in three cynomolgus monkeys included electrosurgery of based and unbased cervical silver amalgam restorations, electrosurgery of unrestored enamel, restored teeth not subjected to electrosurgery and teeth that were neither restored nor subjected to electrosurgery. Electrosurgery of restored teeth, regardless of the presence of a base, consistently resulted in pulpal damage characterized by an altered dentin matrix, necrosis adjacent to the cavity preparation, and a transition zone between necrotic and apparently vital pulp tissue. By 8 weeks following electrosurgery, the majority of specimens showed replacement of the odontoblastic layer and adjacent pulp tissue by dense connective tissue with areas of irregular calcification.

Animals↗
PubMed2007

Histologic comparison of canine skin biopsies collected using monopolar electrosurgery, CO2 laser, radiowave radiosurgery, skin biopsy punch, and scalpel.

OBJECTIVE: To compare the histologic appearance of canine skin biopsies collected by use of a scalpel, skin biopsy punch, monopolar electrosurgery, CO2 laser, and radio wave radiosurgery in fully rectified wave form (RWRS). STUDY DESIGN: Experimental, randomized design. ANIMALS: Healthy adult grayhounds (n=4). METHODS: Skin biopsies were collected using 5 techniques. Cut margins of biopsy specimens and adjacent peripheral skin were evaluated using light microscopy to compare penetration of the dermis by tissue carbonization (char). RESULTS: No char occurred in skin specimens collected by biopsy punch and scalpel. Char penetration occurred in all specimens collected by electrosurgery, CO2 laser, and RWRS. Mean char penetration in skin biopsies collected by RWRS (0.158 mm) was significantly less than for monopolar electrosurgery (0.223 mm) and CO2 laser (0.215 mm). Mean char penetration in adjacent peripheral skin surrounding biopsies collected by RWRS (0.171 mm) was significantly less than monopolar electrosurgery (0.255 mm) but not less than CO2 laser (0.215 mm, P<.07). CONCLUSIONS: RWRS (blended waves in cut-coagulate mode) caused less lateral thermal damage to canine skin biopsies than monopolar electrosurgery and CO2 laser and less lateral thermal injury to peripheral skin than monopolar electrosurgery. CLINICAL RELEVANCE: Excision of canine skin biopsies with heat-generating devices may not allow reliable histologic interpretation, particularly when assessing margins of small biopsy specimens. RWRS may be less traumatic to canine skin than monopolar electrosurgery and CO2 laser when used to make incisions.

Animals↗
PubMed2002

Electrosurgery for tonsillectomy.

OBJECTIVE: To describe the electrophysical principles, techniques, and morbidity associated with electrosurgical tonsillectomy. STUDY DESIGN: Review. METHODS: In electrosurgery, radiofrequency energy is applied directly to tissues to generate heat. Electrosurgery devices are radiofrequency generators coupled with application handpieces. The most common electrosurgery techniques are the monopolar blade, monopolar suction, bipolar, and microscopy-assisted procedures. Several studies have compared electrosurgery with other methods for performing tonsillectomy. RESULTS: Electrosurgery has been found to be equivalent to or better than other methods used for tonsillectomy with respect to perioperative and delayed bleeding, postoperative pain, operating time, and time to return to normal activity. CONCLUSION: Several safe and effective techniques are available for tonsillectomy, including electrosurgery. The choice of method depends on the surgeon's training, comfort with the technology, experience, and impressions concerning morbidity.

Child↗
PubMed1978

Pulpal and periodontal effects of electrosurgery involving cervical metallic restorations.

The pulpal and periodontal effects of electrosurgery involving teeth restored with Class V cervical amalgams and nonrestored teeth were evaluated in three cynomolgus monkeys. Electrosurgical current was delivered for 1 second with a fully rectified unit at an output intensity consistent with normal clinical usage. Experimental conditions included electrosurgery involving restored teeth, electrosurgery involving unrestored enamel, restored teeth not subjected to electrosurgery, and teeth which were neither restored nor subjected to electrosurgery. No pulpal or periodontal tissue changes were observed in the latter three groups of teeth. Electrosurgery involving cervical restorations consistently resulted in coagulation necrosis of the pulp and extensive resorption of cementum, dentin, and interradicular bone in the furcation area of multirooted teeth. The results suggest that inadvertent contact with cervical restorations during electrosurgical procedures may endanger both the pulp and the periodontal attachment apparatus.

Animals↗
PubMedDate not supplied

Cochlear implant integrity after adenoidectomy with Coblation and monopolar electrosurgery.

PURPOSE: Conventional electrosurgical adenoidectomy has been deemed contraindicated in subjects with cochlear implants (CIs) because of risk to the CI and the auditory neurons. No published studies have evaluated the safety of electrosurgical adenoidectomy techniques with CIs. The goal of this study was to compare the impact of monopolar electrosurgery and Coblation radiofrequency bipolar electrosurgery on CI integrity. METHODS: Twelve fresh, cadaveric pigs received unilateral CIs, then the nasopharynx was treated for 15 to 30 minutes with continuous monopolar electrosurgery or Coblation. CIs were tested by the manufacturer for device integrity before and after treatment. RESULTS: Integrity was maintained in all CIs treated with either monopolar or Coblation electrosurgery. CONCLUSIONS: Although the safety of electrosurgical adenoidectomy after CI placement remains unproven, these observations suggest that judicious use of conventional monopolar and Coblation electrosurgery in adenoidectomy does not convey a serious risk to CI integrity. Theoretical considerations favor the use of Coblation over monopolar electrosurgery in CI recipients.

Adenoidectomy↗
PubMed2000

Complications and recommended practices for electrosurgery in laparoscopy.

BACKGROUND: Electrosurgery is one of the most commonly used energy systems in laparoscopic surgery. Two major categories of potential complications related to electrosurgery in laparoscopy are mechanical trauma and electrothermal injury. The latter can result from unrecognized energy transfer in the operational field or, less commonly, to unnoticed stray current outside the laparoscopic field of view. Stray current can result from insulation failure, direct coupling, or capacitive coupling. METHODS: We reviewed the literature concerning essential biophysics of electrosurgery, including electrosurgical waveform differentiation, tissue effect, and variables that determine tissue effect. The incidence of electrosurgical injuries and possible mechanisms responsible for the injuries are discussed. Different types of injuries may result in different clinical manifestations and histopathological findings. Gross and microscopic pathological check-ups of the injury sites may distinguish between different mechanisms, and thus provide further clues postoperatively. RESULTS: Several recommended practices are proposed to avoid electrosurgical injury laparoscopically. To achieve electrosurgical safety and to prevent electrosurgical injuries, the surgical team should have a good understanding of the biophysics of electrosurgery, the basis of equipment and general tissue effects, as well as the surgeon's spatial orientation and hand-eye coordination. Some intraoperative adjuvant procedures and newly developed safety devices have become available may aid to improve electrosurgical safety. CONCLUSIONS: Knowledge of the biophysics of electrosurgery and the mechanisms of electrosurgical injury is important in recognizing potential complications of electrosurgery in laparoscopy. Procedures for prevention, intraoperative adjuvant maneuvers, early recognition of the injury with in-time salvage treatment, and alertness to postoperative warning signs can help reduce such complications.

Burns, Electric↗
PubMed1987

Electrosurgery--a biological approach.

Electrosurgery has been used in dentistry for more than 50 years. Both opponents and advocates of electrosurgery have presented a variety of clinical studies in favour of their respective opinions, which are discussed in the following review. In some studies, wounds created by electrosurgical techniques were observed through the healing stages, in comparison to those following incision by a surgical blade, with no significant difference being discovered. Other studies reported that the histologic response of oral connective tissue to electrosurgery was adverse in some animal and human models. However, neither of these groups used methods that allowed documentation or control of operating variables. A critical evaluation of controlled clinical studies shows that adverse responses of (connective) tissue, epithelium, bone, cementum, and periodontal attachment are related to an excessive lateral heat production during the procedure. With electrosurgery, the clinician can control the inherent variables. Waveform, frequency, size of the electrode, time of contact and cooling periods are some of those considered to be of importance in the studies. On the basis of the research reports, clinical guidelines have been developed to give practical advice to the clinician using electrosurgery. Providing that these safeguards are adhered to, scientific evidence supports the biological compatibility of electrosurgery for intraoral surgical procedures.

Animals↗
PubMedDate not supplied

Comparison the efficacy of laparosonic coagulating shears and electrosurgery in laparoscopically assisted vaginal hysterectomy: preliminary results.

OBJECTIVE: To compare the safety and effectiveness of laparosonic coagulating shears (LCS) and electrosurgery for use in laparoscopically assisted vaginal hysterectomy (LAVH). STUDY DESIGN: In this prospective study, patients undergoing LAVH performed by one of the authors from October 1997 to January 1998 were assigned at random to the electrosurgery group (n = 20) or the LCS group (n = 20). Procedures performed with LCS or electrosurgery included coagulation and separation of infundibulopelvic or utero-ovarian round ligaments, vesico-uterine-visceral peritoneal fold dissection, and anterior and posterior colpotomy. Outcome measures were operative time, blood loss, decrease in hemoglobin values, and length of hospitalization. RESULTS: The mean operative time (90+/-22.9 min versus 80.3+/-17.1 min, P = 0.391), blood loss (308+/-167 ml versus 250+/-104 ml, P = 0.11), and hemoglobin decrease (1.57+/-0.769 mg/dl versus 1.36+/-0.886 mg/dl, P = 0.55) were slightly greater in the LCS group than in the electrosurgery group, although these differences were not statistically significant. The length of hospital stay was similar in the two groups (5 days). No patients developed serious complications related to electrosurgery or LCS. CONCLUSION: Our findings indicate that LCS is as safe and effective as electrosurgery, and may offer an alternative option for patients undergoing LAVH.

Blood Loss, Surgical↗
PubMed1978

Monitoring instrumentation. Isolated inputs, electrosurgery filtering, burns protection: what does it mean?

1. 50Hz Interference : the patient's body acts as can an antenna picking up several volts of 50 Hz noise from the power line. Differential amplifiers are the key separating the 1 mV E.C.G. signal wanted from 50Hz. Further reduction of this interference is possible with the help of high input impedance amplifiers and proper electrode techniques. 2. Isolated inputs : electrodes internal to the body give rise to potential hazards. Isolated inputs prevent dangerous currents from flowing directly through the patient to ground, should he come into contact with 50Hz AC power. Even micro-shocks caused by leakage currents as low as 50 micro-amps are prevented. These can cause ventricular fibrillation when applied directly to the heart. 3. Electrosurgery interference : electrosurgery machines generate high frequency signals with amplitudes of several hundred volts. This interference is minimized by low-pass filtering, shielding of the input circuitry and using proper monitoring and electrosurgery techniques. (Electrodes, cables, monitor and electrosurgery machine positioning). 4. Patient burns protection :isolated inputs do not protect against high frequency eleectrosurgery currents. Burns occur if the normal return path is interrupted and the current flows to ground through the monitor. Burns can be prevented by making sure that the patient is in intimate contact with the return patient plate, by using high frequency blocks (chokes) close to the E.G.C. electrodes sites and by using isolated-output electrosurgery units. 5. Monitor protection against damage from defibrillator pulses and electrosurgery currents : very sensitive input amplifiers must be able to survive up to 6,000 volt levels. 6. Battery powered monitors have a unique problem : Lack of a connection to ground. Whereas this is most often considered a safety advantage, it can be a hazard if the patient or operator becomes the link from the equipment to ground for a dangerously high current. A very expensive cabinet design could eliminate the above hazard and make the battery powered monitor the ideal operating room instrument.

Burns, Electric↗
PubMed2001

Ultrasonic energy vs monopolar electrosurgery in laparoscopic cholecystectomy: influence on the postoperative systemic immune response.

BACKGROUND: The influence of surgical operations on the systemic immune response is proportional to the degree of trauma. Ultrasonic surgery can dissect structures and divide vessels by the effect produced by vibrations in the tissues. It is believed to be less traumatic than the more commonly used monopolar electrosurgery. This randomized study compares the systemic immune response after laparoscopic cholecystectomy performed using either ultrasonic energy or monopolar electrosurgery. METHODS: Eighteen patients scheduled for elective laparoscopic cholecystectomy were randomly assigned to treatment using either a harmonic scalpel and clips or monopolar electrosurgery and clips. Postoperative inflammatory response was assessed via changes in the white blood cell count and levels of C-reactive protein. Postoperative immune function was assessed by measuring monocyte HLA-DR expression. RESULTS: Both the harmonic scalpel and the use of monopolar electrosurgery resulted in activation of the systemic immune response. No significant differences between the two groups were observed. CONCLUSION: The harmonic scalpel and monopolar electrosurgery are equally traumatic in terms of activation of the systemic immune response.

C-Reactive Protein↗
PubMed1997

Comparison of the ultrasonic scalpel to CO2 laser and electrosurgery in terms of tissue injury and adhesion formation in a rabbit model.

OBJECTIVE: To determine the relative effect of an ultrasonic scalpel on reproductive tissue compared with CO2 laser and electrosurgery. DESIGN: Prospective, randomized animal study. SETTING: University laboratory setting. ANIMALS: Sixteen New Zealand White rabbits. INTERVENTION(S): A steel scalpel, an ultrasonic scalpel, a CO2 laser, or electrosurgery were used to perform an ovarian wedge resection and to remove the distal uterine horn. A 3-cm longitudinal incision also was made in the uterine horn. MAIN OUTCOME MEASURE(S): The number of 1-second bursts of needle-tip electrosurgery required for hemostasis, the depth and degree of coagulation necrosis, degree of fibrin deposition, and postoperative adhesion formation. RESULT(S): The amount of electrosurgery needed to achieve hemostasis was less for any of the four power techniques than for the steel scalpel, with the exception of the ultrasonic scalpel at level 5 when used on the ovary. The depth (range: 0.30 to 0.38 mm) and the degree of coagulation necrosis was not different for any of the power techniques. The fibrin score was greatest for the ultrasonic scalpel at level 5 in both the ovarian tissue and the uterine tissue. There was no difference in adhesion scores for the power techniques and the steel scalpel. CONCLUSION(S): The ultrasonic scalpel at level 3 is not different from either CO2 laser or electrosurgery in terms of hemostatic properties, coagulation necrosis, or adhesion formation in the rabbit model.

Animals↗
PubMed1987

The effect of technique on histology of arthroscopic partial meniscectomy with electrosurgery.

Fifty-one patients had arthroscopic partial meniscectomies with electrosurgery between 1982 and 1985. Two patients who had undergone prior meniscectomies with electrosurgery had biopsies of the old excision site at repeat arthroscopy, necessitated by new injuries. Three different combinations of electrocautery tips and either a standard electrocautery generator or a new electrocautery generator specifically designed for arthroscopic electrosurgery were used in different combinations. Depth of damage as defined by the Trichrome stain was measured by a micrometer. A rating summary of the quality of resection technique was also performed. Overall, the newly developed electrocautery generator and the newly developed electrocautery tips were not beneficial in reducing the depth of damage. The average depth of damage was .29 mm. Forty-seven percent of patients showed no histologic evidence of damage from the electrosurgical resection. The two individuals with repeat biopsies showed normal histology. Arthroscopic partial meniscectomy with electrosurgery causes a very thin layer of tissue damage. This appears to resolve with time. Recently developed instruments specifically designed for arthroscopic electrosurgery do not appear to decrease the depth of damage.

Adolescent↗
PubMed2005

Comparison of the efficacy of the pulsed bipolar system and conventional bipolar electrosurgery in laparoscopically assisted vaginal hysterectomy.

BACKGROUND: We compared the safety and effectiveness of the pulsed bipolar system (PlasmaKinetic; Gyrus Medical, Maple Grove, MN) and conventional electrosurgery (Kleppinger bipolar forceps; Richard Wolf Instruments, Vernon Hills, IL) in laparoscopically assisted vaginal hysterectomy (LAVH). PATIENTS AND METHODS: In this prospective, nonrandomized study, 62 women with benign gynecologic diseases scheduled for LAVH were divided into two groups: one group underwent LAVH with the pulsed bipolar system and the second group underwent LAVH with conventional electrosurgery. Outcome measures for both groups were compared in terms of length of operative time, amount of blood loss, requirement of blood transfusion, and length of hospital stay. RESULTS: The mean operative time (87.6+/-28.1 minutes vs. 93.4+/-20.2 minutes, P=0.368), blood loss (196.8+/-143.7 mL vs. 253.2+/-125.8 mL, P=0.105), and blood transfusion rate (3.2% vs. 6.5%, P=1.0) were slightly greater in the conventional electrosurgery group than those in the pulsed bipolar system group, although these differences were not statistically significant. The mean length of hospital stay was similar in both groups (3 days). No patients developed serious complications related either to conventional electrosurgery or to the pulsed bipolar system. CONCLUSION: Our findings indicate that the pulsed bipolar system is as safe and effective as conventional electrosurgery, and may offer an alternative option for patients undergoing LAVH.

Adult↗