Ultrasonically activated scalpel versus monopolar electrocautery shovel in laparoscopic total mesorectal excision for rectal cancer

AIM： To investigate the feasibility and safety of monopolar electrocautery shovel （ES） in laparoscopic total mesorectal excision （TME） with anal sphincter preservation for rectal cancer in order to reduce the cost of the laparoscopic operation, and to compare ES with the ultrasonically activated scalpel （US）. METHODS： Forty patients with rectal cancer, who underwent laparoscopic TME with anal sphincter preservation from June 2005 to June 2007, were randomly divided into ultrasonic scalpel group and monopolar ES group, prospectively. White blood cells （WBC） were measured before and after operation, operative time, blood loss, pelvic volume of drainage, time of anal exhaust, visual analogue scales （VAS） and surgery-related complications were recorded. RESULTS： All the operations were successful; no one was converted to open procedure. No significant differences were observed in terms of preoperative and postoperative d I and d 3 WBC counts （P = 0.493, P = 0.375, P = 0.559）, operation time （P = 0.235）, blood loss （P = 0.296）, anal exhaust time （P = 0.431）, pelvic drainage volume and VAS in postoperative d 1 （P = 0.431, P = 0.426） and d 3 （P = 0.844, P = 0.617） between ES group and US group. The occurrence of surgery-related complications such as anastomotic leakage and wound infection was the same in the two groups.CONCLUSION： ES is a safe and feasible tool as same as US used in laparoscopic TME with anal sphincter preservation for rectal cancer on the basis of the skillful laparoscopic technique and the complete understanding of laparoscopic pelvic anatomy. Application of ES can not only reduce the operation costs but also benefit the popularization of laparoscopic operation for rectal cancer patients.

Colonic gas explosion during therapeutic colonoscopy with electrocautery

Therapeutic colonoscopy with electrocautery is widely used around the world. Adequate colonic cleansing is considered a crucial factor for the safety of this procedure. Colonic gas explosion, although rare, is one of the most frightening iatrogenic complications during colonoscopy with electrocautery. This complication is the result of an accumulation of colonic gases to explosive concentrations, but may be prevented by meticulous bowel preparation. The purpose of.this review is to discuss the indications and the types of bowel preparations for therapeutic colonoscopy, and to contribute recommendations for the adequate bowel preparation for colonoscopy with electrocautery.

Electrocautery vs non-electrocautery dilation catheters in endoscopic ultrasonography-guided pancreatic fluid collection drainage

AIM: To investigate the safety and utility of an electrocautery dilation catheter for endoscopic ultrasonography(EUS)-guided pancreatic fluid collection drainage.METHODS: A single-center, exploratory, retrospective study was conducted between August 2010 and August 2014. This study was approved by the Medical Ethics Committee of our institution. Informed, written consent was obtained from each patient prior to the procedure. The subjects included 28 consecutive patients who underwent EUS-guided transmural drainage(EUS-TD) for symptomatic pancreatic and peripancreatic fluid collections(PFCs) by fine needle aspiration using a 19-gauge needle. These patients were retrospectively divided into two groups based on the use of an electrocautery dilation catheter as a fistula dilation device; 15 patients were treated with an electrocautery dilation catheter(electrocautery group), and 13 patients were treated with a non-electrocautery dilation catheter(non-electrocautery group). We evaluated the technical and clinical successes and the adverse events associated with EUS-TD for the treatment of PFCs between the two groups.RESULTS: There were no significant differences in age, sex, type, location and diameter of PFCs between the groups. Thirteen patients(87%) in the electrocauterygroup and 10 patients(77%) in the non-electrocautery group presented with infected PFCs. The technical success rates of EUS-TD for the treatment of PFCs were 100%(15/15) and 100%(13/13) for the electrocautery and the non-electrocautery groups, respectively. The clinical success rates of EUS-TD for the treatment of PFCs were 67%(10/15) and 69%(9/13) for the electrocautery and the non-electrocautery groups, respectively(P = 0.794). The procedure time of EUS-TD for the treatment of PFCs in the electrocautery group was significantly shorter than that of the non-electrocautery group(mean ± SD: 30 ± 12 min vs 52 ± 20 min, P < 0.001). Adverse events associated with EUS-TD for the treatment of PFCs occurred in 0 patients and 1 patient for the electrocautery and the non-electrocautery groups, respectively(P = 0.942).CONCLUSION: EUS-TD using an electrocautery dilation catheter as a fistula dilation device for the treatment of symptomatic PFCs appears safe and contributes to a shorter procedure time.

Bugbee flexible electrocautery facilitates choledochoscopic biopsy,fulguration,and debulking of a high grade intraductal papillary neoplasm of the bile duct

To the Editor:Intraductal papillary neoplasm of the bile duct(IPNB)may occur in the setting of primary sclerosing cholangitis,choledochal cysts or hepatolithiasis[1].The entity may be a precursor of cancer or intrahepatic cholangiocarcinoma.Invasive carcinoma,tubular or mucinous adenocarcinoma is present in approximately 40%-80%of IPNBs[1–3].IPNB is frequently found in the resection margins of patients undergoing hepatectomy for cholangiocarcinoma[4].

Analysis of electrocautery smoke released from the tissues frequently cut in orthopedic surgeries

BACKGROUND Electrosurgical smoke could be different by the device of cutting or the type of tissue that is being cut.AIM To analyze the electrocautery smoke released from the tissues that are frequently cut in orthopedic surgeries.METHODS The released smoke from electrocautery of five different tissue types(meniscus,ligament,adipose,muscle,and synovium)of five patients who underwent total knee arthroplasty were collected and analyzed for volatile organic compounds(VOCs)and 27 candidate polycyclic aromatic hydrocarbons(n=25).Surgical smoke was produced with an electrocautery device for 4 min.RESULTS None of the 27 evaluated polycyclic aromatic hydrocarbons compounds were detectable in electrocautery smoke collected from the surgical cutting of the different tissues.The number and identity of detected VOCs were similar between the patients but not between tissue types.The number of detected VOCs was the highest in synovial tissue(n=21)and the lowest in the meniscus and adipose tissue(n=12).The number of toxic and/or carcinogenic VOCs were the most in the muscle and meniscus tissues(Toluene,Ethylbenzene,and Styrene).No toxic and/or carcinogenic VOCs were identified in the ligament and adipose tissue.CONCLUSION Meniscus and muscle tissue are associated with the highest number of toxic and/or carcinogenic VOCs.Therefore,we recommend that surgeons avoiding the electrocautery of these tissues.

Rapid Establishment of Tracheal Stenosis in Pigs Using Endotracheal Tube Cuff Overpressure and Electrocautery

To apply a new airway treatment to humans, preclinical studies in an appropriate animalmodel is needed. Canine, porcine and leporine tracheas have been employed as animal airwaystenosis models using various methods such as chemical caustic agents, laser, and electrocautery.However, existing models take a long time to develop (3- 8 weeks) and the mechanism of stenosisis different from that in humans. The aim of the present study was to establish a new and fasttracheal stenosis model in pigs using a combination of cuff overpressure intubation (COI) andelectrocautery. Fourteen pigs were divided into three groups: tracheal cautery (TC) group (n=3),COI group (n=3), and COI-TC combination group (n=8). Cuff overpressure (200/400/500 mmHg)was applied using a 9-mm endotracheal tube. Tracheal cautery (40/60 watts) was performed usinga rigid bronchoscopic electrocoagulator. After intervention, the pigs were observed for 3 weeks andbronchoscopy was performed every 7 days. When the cross-sectional area decreased by > 50%, itwas confirmed that tracheal stenosis was established. The time for tracheal stenosis was 14 days inthe TC group and 7 days in the COI-TC combination group. In the COI group, no stenosis occurred.In the COI-TC group, electrocautery (40 watts) immediately after intubation for>1 h with a cufpressure of 200 mmHg or more resulted in suficient tracheal stenosis within 7 days. Moreover, thedegree of tracheal stenosis increased in proportion to the cuff pressure and tracheal intubation time.The combined use of cuf overpressure and electrocautery helped to establish tracheal stenosis inpigs rapidly.

Postoperative Outcomes in Coblation versus Electrocautery Tonsillectomies

Purpose: To investigate whether children undergoing a tonsillectomy or adenotonsillectomy (AT) with Coblation? will experience less postoperative pain and return to a normal diet and a regular activity level sooner compared to the same procedure using electrocautery dissection. This may manifest less school and work missed by the child and caregiver, respectively. Materials and Methods: Seventy-four children between the ages 2-13 years with either obstructive sleep apnea or chronic tonsillitis were recruited at a single tertiary-care center from January 2011 to November 2012 and underwent an AT via electrocautery or Coblation?. Caregivers were given a ten-point Wong-Baker FACES pain scale and questions inquiring the degree of oral intake, activity level, and impact on both the child and caregiver in regards to missing work or school on postoperative days (POD) 0, 1, 2, 3, 5, 7, and 14. Results: Children in the Coblation? arm required less pain medications (p 0.0049) on POD 0. Subsequent results were not significantly different for any other day. Age- and gendered-controlled multivariate analysis revealed a statistically significant difference in pain medications administered (p 0.0001) but not pain scores (p 0.2115) between the two techniques, although this difference in medications is likely related to the results observed on POD 0. There was no incidence of postoperative hemorrhage in either group. Conclusions: While there was less pain medication administered and slightly improved oral intake of liquids on POD 0 for children in the Coblation? arm, there was no difference in subsequent postoperative outcome or hemorrhage rates.

显微镜支撑喉镜下改良针状电刀会厌囊肿切除术

会厌囊肿是耳鼻咽喉科常见病、多发病之一,手术切除为其主要治疗方式。我科自2009年6月~2013年12月显微镜支撑喉镜下应用改良针状电刀切除会厌囊肿156例,效果良好,现报道如下。1.1临床资料。患者男81例,女75例;年龄17~67岁,平均34岁;病史6个月~6年。主要症状咽部异物感和吞咽梗阻感。囊肿位于会厌舌面73例,会厌谷39例,舌会厌外侧襞44例。囊肿单发者97例,2个囊肿53例,≥3个6例(其中1例同时并发双侧杓会厌皱襞多发囊肿)。

The future of wireless capsule endoscopy

We outline probable and possible developments with wireless capsule endoscopy. It seems likely that capsule endoscopy will become increasingly effective in diagnostic gastrointestinal endoscopy. This will be attractive to patients especially for cancer or varices detection because capsule endoscopy is painless and is likely to have a higher take up rate compared to conventional colonoscopy and gastroscopy. Double imager capsules with increased frame rates have been used to image the esophagus for Barrett's and esophageal varices. The image quality is not bad but needs to be improved if it is to become a realistic substitute for flexible upper and lower gastrointestinal endoscopy. An increase in the frame rate, angle of view, depth of field, image numbers, duration of the procedure and improvements in illumination seem likely. Colonic, esophageal and gastric capsules will improve in quality, eroding the supremacy of flexible endoscopy, and become embedded into screening programs. Therapeutic capsules will emerge with brushing, cytology, fluid aspiration, biopsy and drug delivery capabilities. Electrocautery may also become possible. Diagnostic capsules will integrate physiological measurements with imaging and optical biopsy, and immunologic cancer recognition. Remote control movement will improve with the use of magnets and/or electrostimulation and perhaps electromechanical methods. External wireless commands will influence capsule diagnosis and therapy and will increasingly entail the use of real-time imaging. However, it should be noted that speculations about the future of technology in any detail are almost always wrong.

The ultrasonic harmonic scalpel for circumcision： experimental evaluation using dogs

Male circumcision is one of the most commonly performed operations worldwide, and many novel techniques have been developed for better postoperative outcomes. The purpose of this study was to explore the feasibility of applying the ultracision harmonic scalpel （UHS） for circumcision by using dogs. Sixteen adult male dogs were divided into two groups： the UHS group and the control group. The dogs were circumcised with either the UHS or a conventional scalpel. The UHS circumcision procedure and the effects were imaged 1 week after surgery. The two groups were compared with respect to the operative time and volume of blood loss. Postoperative complications, including oedema, infection, bleeding of the incision and wound dehiscence, were recorded for both groups. The mean operative time for the UHS group was only 5.1 min compared with the 35.5 min of the conventional group. The mean blood loss was less than 2 ml for the UHS group and 15 ml for the conventional group. There was only one case of mild oedema in the UHS group, but the postoperative complications in the conventional group included two cases of mild oedema, one infection of the incision and one Case of bleeding of the incision. In conclusion, circumcision using UHS is a novel technique to treat patients with phimosis and excessive foreskin, and this method has a short operative time, less blood loss and fewer complications than the conventional scalpel method. This small animal study orovides a basis for embarking on a larger-scale clinical trial of the UHS.

Dissection and ligation of the lateral circumflex femoral artery is not necessary when using the direct anterior approach for total hip arthroplasty

BACKGROUND Branches of the lateral circumflex femoral artery(LCFA) stretch across the surgical field during a direct anterior total hip arthroplasty. It is an anatomical marker in direct anterior approach. As an important vessel around the hip joint,this vessel was ligated in most situations. Although ligation of the vascular pedicle of the LCFA is a common, traditional procedure used to decrease bleeding, the ligation of the pedicle of the vessel is tedious and time-consuming.AIM To explore whether this ligation is truly necessary in a direct anterior approach to total hip arthroplasty.METHODS This single-center, single-surgeon, prospective study was performed to compare patients' bleeding undergoing ligation of the branches of the LCFA pedicle(group A) vs those treated with electrocautery from the branches of the LCFA(group B). In both groups, the pedicles were identified in the intermuscular plane between the tensor fasciae lata and the rectus femoris muscles. In group A, the pedicles were ligated with a silk ligature. In group B, the branches coming off the LCFA were controlled with electrocautery. We compared preoperative vs postoperative changes in blood hemoglobin levels, intraoperative blood loss,operative time, rates of transfusion, re-bleeding, and hematoma between the two groups.RESULTS The reduction of hemoglobin in group A was 20.9 ± 7.0, and in group B it was 21.2 ± 4.9. There was no statistically significant difference between the two groups(P > 0.05). The actual calculated blood loss in group A was 784 ± 125 mL,and in group B it was 722 ± 153 mL. There was a trend in group A having more blood loss(P = 0.078). The estimated blood loss in group A was 344 ± 88 mL, and in group B it was 346 ± 73 mL. There was no statistically significant difference between the two groups(P = 0.883). In addition, there were no significant differences in the rates of postoperative transfusion(10% vs 6.7%, P > 0.05),postoperative hematomas(6.7% vs 13.3%, P > 0.05), or re-bleeding(13.3% vs 20%,P > 0.05) between the two groups.CONCLUSION Ligation of the pedicle of the LCFA has no advantage in preventing or decreasing bleeding during or after a total hip arthroplasty using the direct anterior approach. Ligation of the pedicle of the vessel is a cumbersome, unnecessary procedure and can be replaced by electrocautery control of the branches off this artery that course through the surgical field.

Effects of medically generated electromagnetic interference from medical devices on cardiac implantable electronic devices: A review

As cardiac implantable electronic devices(CIED)become more prevalent,it is important to acknowledge potential electromagnetic interference(EMI)from other sources,such as internal and external electronic devices and procedures and its effect on these devices.EMI from other sources can potentially inhibit pacing and trigger shocks in permanent pacemakers(PPM)and implantable cardioverter defibrillators(ICD),respectively.This review analyzes potential EMI amongst CIED and left ventricular assist device,deep brain stimulators,spinal cord stimulators,transcutaneous electrical nerve stimulators,and throughout an array of procedures,such as endoscopy,bronchoscopy,and procedures involving electrocautery.Although there is evidence to support EMI from internal and external devices and during procedures,there is a lack of large multicenter studies,and,as a result,current management guidelines are based primarily on expert opinion and anecdotal experience.We aim to provide a general overview of PPM/ICD function,review documented EMI effect on these devices,and acknowledge current management of CIED interference.

Patellaplasty, as an Alternative to Replacing Patella in Total Knee Arthroplasty

Aim: In tricompartmental osteoarthritis of the knee, the patellofemoral articulation is severely affected due to degenerative changes. Patellaplasty is done as a part of total knee arthroplasty in these cases to smoothen the articular surface of patella. However, an ideal technique with easy reproducibility has been scarcely reported for the same. Method: We describe a method of using electrocautery and power saw with thin blades for patellaplasty. Results: Using this technique, we have produced results, which are comparable with cases where patellar resurfacing has been done. Conclusion: This described method for patellaplasty is easy with good reproducibility.

Effects of Denervation on the Mid-term Results of Knee Joint Functions after Non-resurfaced Total Knee Arthroplasty

Objective:Total knee arthroplasty(TKA)has become an effective treatment modality for end-stage osteoarthritis and rheumatoid arthritis.Postoperative problems such as anterior knee pain affect postoperative patient satisfaction.Patellar denervation has been proposed as a technique to relieve pain,but its efficacy remains controversial.This study evaluated the mid-and long-term effects of patellar denervation on postoperative knee joint functions,hoping to provide better guidance for clinical practice.Methods:This study is a prospective randomized controlled double-blind study.58 patients undergoing bilateral non-resurfaced total knee arthroplasty were included and randomized into two groups.Both groups underwent total knee arthroplasty while patellar denervation was performed only on the experimental group.Information regarding whether if patellar denervation was performed were withheld from all patients and outcome assessors.All surgeries were performed by the same high-level professional physician,and the post-stable knee prosthesis system(PS Scorpio NRG PS,Stryker)was used during the surgeries.The knee joint functions were evaluated by professional assessors before and after surgery.The evaluation indicators mainly include KSS scoring,Western Ontario and McMaster Universities(WOMAC)scoring and Visual Analogue Scale(VAS),FJS scoring,etc.The follow-up period was 3 years and 5 years after surgery.Results:The experimental group had better KSS and FJS scores than the control group,the difference was statistically significant.There was no significant inter-group difference in WOMAC and VAS scores.Conclusion:The patellar denervation in TKA patients has positive effects on the mid-and long-term recovery of knee joint functions,and the postoperative satisfaction is better.

In vitro study of safety and co-efficiency of the transbronchial coagulation techniques

Background The usual transbronchial coagulation techniques include microwave, argon plasma coagulation （APC）, electrocautery and cryotherapy. However, there are serious clinical problems in the safety of each. By analyzing the experimental data and clinical observations, we observed the variable effects of different coagulation techniques via bronchofibroscopy, to look for an optimal interventional management of luminal bronchus diseases, and evaluate the safety and the equivalent point. Methods Four kinds of coagulation techniques under bronchoscopy were performed on the fresh bronchus of healthy sheep, and the pathologic changes in all groups were observed under the microscope. The different treatment parameters were as follows： microwave 60 Wxl second, 3 seconds, 5 seconds and 40 W×1 second, 3 seconds, 5 seconds; APC 40 W×1 second, 3 seconds, 5 seconds; electrocautery 40 W×1 second, 3 seconds, 5 seconds; cryotherapy 100 Ω×60 seconds, 120 seconds. Results After treatment, ovine bronchial mucosa in all groups showed pathologic changes such as local necrosis and amotio of the mucosa lining epithelium, local submucosa coagulative necrosis or tissue defects, while inflammation in the surrounding tissue was not obvious. Under the same output power and action time, different methods had different outcomes. The damage by APC was the most superficial, microwave was the second, and electrocautery caused the worst damage. The study also found that effects of electrocautery at 40 W×3 seconds, microwave at 40 W×5 seconds or 60 W×3 seconds, APC at 40 W×5 seconds and cryotherapy at 100 Ω×120 seconds were the equivalent point conditions. The appearance included mucosa absence, partial submucosa absence, and collagen fiber coagulation in treatment areas. Conclusions Each coagulation technique has its own characteristic. It is very important to choose the appropriate power and action time of the suitable method according to the therapy requirement.