Electrosurgery in Otolaryngology???Head and Neck Surgery: Principles, Advances, and Complications

Avoiding Oral Burns during Electrocautery Tonsillectomy

Electrocautery tonsillectomy is a common method of tonsil removal, and electrocautery devices are widely available. Although these devices are relatively safe, inadvertent patient injury may occur with their use, such as oral cavity burns. We describe a simple surgical technique that reduces the risk of oral burns during electrocautery tonsillectomy and review additional safety considerations.

Pacemakers: some of the risks and complications you are not warned about

Pacemaker technology has advanced rapidly over the last decade. A lot of everyday interference can be regarded as transient. The media tend to cover stories of relatively insignificant transient interference incurred by pacemaker wearers while many manuals gloss over the high risks, some potentially life-threatening. These include the reliability of pacemakers and the use of monopolar diathermy which can generate electromagnetic interference, potentially causing a pacemaker to malfunction.

Suction cautery and electrosurgical risks in otolaryngology

BACKGROUND

Flash fires, mucosal injuries and commissure burns during otolaryngology procedures have been largely attributed to anesthetic and surgical errors. Reports of direct electrosurgical device related events are rare. The discovery of thermal damage to the oral commissure during routine suction cautery adenoidectomy at our institution prompted a detailed investigation of the device's thermal properties. We complement this analysis with a review of electrocautery device related injuries reported in otolaryngology literature.

METHODS

FLIR Systems Thermovision A40 infrared camera was used to evaluate temperature changes along the electrosurgical wand of suction cautery devices. Shaft temperatures were measured at specific times of continuous use, distances along the shaft, and cautery settings. A literature search of electrocautery-associated injuries during upper aerodigestive procedure was then performed. Nine pediatric otolaryngologists were then interviewed for historical experience with electrocautery injuries.

RESULTS

Temperatures exceeding 60 degrees C, and sufficient to cause thermal soft tissue damage, occurred along the suction cautery wand at a setting of 40 Watts (W). These temperatures traveled far enough to appose the oral commissure when the device was simultaneously in continuous use, in the fulgurate mode, and with the suction turned off. Literature review identified eleven articles specifically pertaining to electrosurgical injuries during routine oropharyngeal procedures. Flash fires and their associated burns were the most frequently reported complication. Conversely, seven of ten cases elicited from peer interviews were oral or commissure burns attributed to improper insulation of electrocautery devices.

CONCLUSIONS

Inadvertent electrosurgical injuries during routine otolaryngology procedures can result from inadequate equipment insulation. Techniques to reduce the likelihood of these events are discussed.

Fire/burn risk with electrosurgical devices and endoscopy fiberoptic cables

PURPOSE

The purpose of the study was to systematically explore the fire and burn risk associated with fiberoptic cables and electrosurgical devices.

MATERIALS AND METHODS

A 300-W light source was connected to a standard gray fiberoptic light cable. The end of the cable was either rested atop or buried within a cotton towel or polypropylene drape in the presence or absence of 100% oxygen for up to 10 minutes. A monopolar electrosurgical device set at 1 W, 10 W, or 30 W was tested on a cotton towel or polypropylene drape for a period of 30 seconds. All trials were repeated.

RESULTS

Resting the light cable on top of the cotton towel or polypropylene drape with or without oxygen produced no result. Burying the end of the cable within the drape produced a hole in the drape within 15 seconds both with and without oxygen. Burying the end of the cable within the cotton towel produced a yellow discoloration after 2 minutes both with and without oxygen. The monopolar electrosurgical device set at 30 W burned immediately through the polypropylene drape, producing a skin burn. All other trials with monopolar electrocautery produced no result. No flame or fire was produced in any trial.

CONCLUSIONS

Fiberoptic cables and electrosurgical generators represent a serious burn risk for surgical patients, with operating room drapes and towels affording only limited protection. Otolaryngologists should be keenly aware of the risks that these devices represent because our specialty uses them frequently.

Safety and Efficacy of Pressure-assisted Tissue-welding Tonsillectomy: A Preliminary Evaluation

We conducted a retrospective study of the safety and efficacy of a new pressure-assisted tissue-welding technology (ENTceps; Starion Instruments Corp.; Sunnyvale, Calif.) for total tonsillectomy, either alone or with adenoidectomy. The use of this instrument was compared in two groups of patients categorized by age. The younger group was made up of 50 patients aged 2 to 12 years who had undergone total tonsillectomy and adenoidectomy (T&A), and the older group was made up of 50 patients aged 13 to 47 years who had undergone either T&A or isolated total tonsillectomy. The primary safety endpoint was the presence or absence of intra- or postoperative complications—particularly the amount of intraoperative blood loss and the incidence of delayed postoperative bleeding. In each group, the mean amount of intraoperative blood loss was no more than 30 ml, and only 2 of the 100 patients experienced postoperative hemorrhage. Among the efficacy parameters were the amount of operating and recovery time and the postoperative appearance of the tonsillar fossae. The mean operating time was 13.0 minutes in the younger group and 19.5 minutes in the older group, and the mean total recovery times were 120.0 and 130.4 minutes, respectively; all tonsillar fossae were well epithelialized by 2 weeks after surgery. Finally, surgical morbidity was determined on the basis of the amount of perioperative pain medication administered, the number of unscheduled patient telephone contacts and clinic visits, and the amount of time needed to return to a normal diet and activities. Nine patients in the younger group and 6 in the older group required no pain medications during recovery; overall, pain was not a significant issue for most patients. Sixteen patients made a total of 20 telephone calls and 8 clinic visits prior to their scheduled postoperative appointment; almost all of these encounters dealt with postoperative pain. Only 1 patient, who had previously undiagnosed von Willebrand disease, had not returned to a normal diet and activities by the end of 1 week. Based on our preliminary findings—and a comparison of our results with those of other studies published in the literature relative to the amount of intraoperative bleeding, the incidence of postoperative bleeding, and operating times—we conclude that pressure-assisted tissue-welding technology is safe and compares favorably with other tonsillectomy techniques. This method of electrocautery is straightforward and relatively easy to learn.

Tissue Welding Forceps Usage in Superficial Parotidectomy: A Clinical Assessment

Tissue welding forceps (TWF) have been used effectively in a number of surgical procedures including blood vessel harvesting and tonsillectomy. Our objective was to assess the safety and efficacy of TWF usage in superficial parotidectomy. We performed a retrospective review of 25 patients between November 2002 and July 2006 who underwent superficial parotidectomy using TWF. The inpatient and outpatient records were reviewed for diagnosis, operative times, estimated blood loss, and postoperative facial paresis. Only one of the 25 patients (4%) who underwent superficial parotidectomy using TWF had transient postoperative facial weakness and no procedure had blood loss of greater than 150 cc. This initial evaluation suggests that use of TWF is safe in superficial parotidectomy and may help reduce the development of postoperative facial paresis.

[Electrosurgical concepts in ENT medicine. History, fundamentals and practice]

The beneficial use of heat in the context of medical treatments was documented even in ancient times. The development of high-frequency alternating current generators led to actual electrosurgery, in which primary heating of the tissue takes place. In day-to-day clinical practice electrosurgery is used for coagulation and for electrotomies. There are both unipolar and bipolar techniques for these procedures. When a unipolar technique is used the active electrode is in the tip of the instrument and the patient plate is usually affixed to the patient's skin at a site outside the operating field. The bipolar technique differs in that there are no electrodes that need to be attached externally; both poles are contained inside the operating instrument, e.g. in the two prongs of a forceps. In radiofrequency surgery high-frequency electrical energy is applied directly into the tissue by a unipolar or bipolar technique. In this way it is possible to cause interstitial tissue lesions while sparing the superficial mucous membranes.

Selective Percutaneous Desiccation of the Perforators with Radiofrequency for Strategic Transfer of Angiosomes in a Sequential Four-Territory Cutaneous Island Flap Model

BACKGROUND

Research in prevention of partial flap necrosis has recently concentrated on extending the safe length of a flap by ligating vessels of known territories. To advance this approach one step further, the authors decided to reveal the least invasive surgical strategy for transfer of angiosomes.

METHODS

The study was arranged into three experiments. In the first experiment (n = 17 rabbits), a cutaneous island flap model spanning four adjacent vascular territories was developed. In the second experiment (n = 15 rabbits), the flap model was used to test the possibility of desiccating those vessels supplying the angiosomes to be captured percutaneously with radiofrequency. The delay procedures were performed by means of minimal skin incisions, and the flaps were elevated after a 2-week delay period. In the third experiment, the effectiveness of selective interference of these pedicles was compared to minimize the number of target vessels for successful transfer of angiosomes.

RESULTS

The mean surviving area of the new flap model was 63 +/- 2 percent. The mean surviving flap area was 97 +/- 3 percent for the endoscopy equivalent technique and 94 +/- 4 percent for radiofrequency delay. The results were statistically insignificant between these two groups. In experiment 3, comparison of the results yielded a statistically insignificant difference for flap survival area among all four of the groups.

CONCLUSIONS

An alternative flap model is introduced for future investigation of the vascular delay process. Percutaneous desiccation of the perforators with radiofrequency was found to be a reliable method, and selective desiccation of the perforator(s) was as efficient as destruction of all vascular sources other than the pedicle.

Accidental burns during surgery

The purpose of this report is to increase awareness of intraoperative burns during standard procedures, to discuss their possible causes and warning signs and to provide recommendations for prevention and procedures to follow after their occurrence. A total of 19 patients associated with intraoperative burn accidents were treated surgically and analyzed after a mean follow-up of 5 +/- 3.5 months. Review included retrospective patient chart analysis, clinical examination, and technical device and equipment testing. A total of 15 patients recently underwent cardiac surgery, and 4 pediatric patients recovered after standard surgical procedures. A total of 15 patients had superficial and 4 presented with deep dermal or full-thickness burns. The average injured TBSA was 2.1 +/- 1% (range, 0.5-4%). Delay between primary surgery and consultation of plastic surgeons was 4.5 +/- 3.4 days. A total of 44% required surgery, including débridment, skin grafting or musculocutaneous gluteus maximus flaps, and the remaining patients were treated conservatively. Successful durable soft-tissue coverage of the burn region was achieved in 18 patients, and 1 patient died after a course of pneumonia. Technical analysis demonstrated one malfunctioning electrosurgical device, one incorrect positioned neutral electrode, three incidents occurred after moisture under the negative electrode, eight burns occurred during surgery while fluid or blood created alternate current pathways, five accidents were chemical burns after skin preparation with Betadine solution, and in one case, the cause was not clear. The surgical team should pay more attention to the probability of burns during surgery. Early patient examination and immediate involvement of plastic and burn surgeons may prevent further complications or ease handling after the occurrence.

Bipolar radiofrequency dissection tonsillectomy: a prospective randomized trial

OBJECTIVES

To conduct a prospective randomized controlled study presenting and comparing bipolar radiofrequency dissection tonsillectomy (BRDT) to cold dissection tonsillectomy (CDT) regarding intra-operative blood loss, operative time, postoperative pain, and postoperative complications including hemorrhage.

MATERIALS AND METHODS

From January 2004 to March 2005, 200 children planned to undergo tonsillectomy were included in this study. Children were prospectively randomized into two equal groups: bipolar radiofrequency dissection tonsillectomy and cold dissection tonsillectomy. The operative time and intra-operative blood loss were recorded. Children were asked to record their pain on a standardized visual analog scale on days 1, 4, 7, and 14. All children were reviewed on the 4th, 7th, and 14th day after surgery. Postoperative complications were recorded and dealt with.

RESULTS

There was a shorter operative time (mean 8.5 minutes, P < 0.001) in the radiofrequency group. BRDT showed a decrease of 7 minutes in the mean when compared to the CDT group. The amount of blood lost during BRDT was minimal (mean 13 cc), with a mean difference of 69 cc when compared to CDT (P < 0.001). There was no statistical significant difference in pain score between the two groups except in the first postoperative day where the BRDT demonstrated a statistically significant lower parameters (P < 0.05). No evidence for statistically significant difference between the two groups regarding postoperative complications.

CONCLUSION

BRDT is a new, easy, and safe technique that offers a complete eradication of the tonsillar disease, short operating time, minimal intra-operative blood loss, and a suitable cost with no additional increase in postoperative pain and hemorrhage when compared to the conventional CDT. Our experience promotes BRDT as the preferred method of tonsillectomy.

Inducing Safer Electrosurgical Handpiece Storage

Background Improper storage of the electrosurgical handpiece has been identified as an operating room hazard.

OBJECTIVE

To test among representative surgical personnel two different methods of improving safety performance: a demonstration/lecture session, and improved equipment arrangement on the operating field.

METHODS

A field experiment occurred in the classroom and in the operating room. Subjects were recruited from a surgical department in a single institution. After videotaping baseline behavior, interventions were made in education and subsequently in apparatus layout. Videotaping and behavioral coding were repeated after each intervention. Written tests preceded and followed the training lecture.

RESULTS

Results varied among team members and different aspects of the equipment. The surgeons knew the manufacturers' designated safe practice, but they did not routinely follow it, even after additional instructions and redesign of the equipment setup. Other team members responded to the interventions and changed their storage-related behavior.

CONCLUSIONS

This study demonstrates a need for effective means to help surgical teams maintain a safe environment while using hazardous technologies.

The Effect of Radiofrequency and Mitomycin C on the Closure Rate of Human Tympanostomy

OBJECTIVES

To conduct a prospective, randomized, controlled trial determining the feasibility of radiofrequency with or without topical mitomycin C application in delaying the closure time of human tympanostomy and screening its efficacy in management of recurrent acute otitis media and otitis media with effusion.

METHODS

From November 2002 to January 2004, 96 patients (180 ears) who were to undergo surgical intervention for recurrent acute otitis media or otitis media with effusion were included in this study. Sixty ears with a diagnosis of recurrent acute otitis media were equally randomized to three procedures: cold knife myringotomy (Group A), radiofrequency tympanostomy (Group B), and radiofrequency tympanostomy with topical mitomycin C application (Group C). One hundred twenty ears diagnosed as having otitis media with effusion were equally randomized to the last two procedures only. Patients were followed-up every week in the first month, every 2 weeks in the second month, and monthly after that until closure of the tympanostomy. A special follow-up setting was designed 3 months after tympanostomy closure where tympanograms and pure-tone audiograms were obtained.

RESULTS

Groups B and C showed a significantly slower rate of closure than Group A. At the same time, Group C demonstrated a slower rate when compared with Group B. The mean closure time of Group B was 3.5 weeks, with no difference between recurrent acute otitis media and otitis media with effusion. In contrast, the mean closure times for Group C were 5.3 and 7 weeks in cases of otitis media with effusion and recurrent acute otitis media, respectively, with the latter demonstrating a significantly slower closure rate. No recurrence of acute otitis media was reported in 10, 45, and 80% of Groups A, B, and C, respectively. Fifty-nine percent of Group C showed no clinical or tympanometric signs of otitis media with effusion 3 months after closure of tympanostomy. In contrast, Group B reported a lower cure rate (28%), with a statistically significant difference between both groups. Absence of recurrence and improvement in tympanometry signs correlated significantly with the duration of patency of tympanostomy (p < 0.01). The success rate was higher in patients who underwent adenoidectomy, but this did not reach statistical significance except in Group C (p < 0.01).

CONCLUSION

Radiofrequency and mitomycin C delay the closure rate of human tympanostomy. The efficacy of mitomycin C seems to be amplified in the presence of an inflamed tympanic membrane. Radiofrequency-assisted mitomycin-enhanced tympanostomy is a precise, safe, and cost-effective procedure that provides a viable approach in the management of recurrent acute otitis media and otitis media with effusion, especially when used in conjunction with adenoidectomy.

Blutungen im HNO-Bereich

Otolaryngological bleeding is a highly dangerous condition because it is frequently located close to the upper airways. Additionally, it is often unexpected, especially in children, and can injure important nervous structures of the craniocervical region. Over the years, a broad spectrum of algorithms, innovative technologies and therapeutic options have been developed to reduce the incidence of hemorrhages and improve therapy. Nowadays, close cooperation with an hemostaseologist, anesthesiologist and interventional radiologist is necessary for finding the best strategies for the management of bleeding disorders and vascular lesions. This interdisciplinary dialog, combined with an intimate knowledge of the specific otolaryngological techniques, is the precondition for finding an adequate therapy and fulfilling the increasing medico-judicial and economic requirements. We present an overview of the actual and proved concepts for the management of hemorrhage in order to enable the reader to optimize treatment, to increase safety and comfort for the bleeding patient, and to fulfill the medico-judicial and economic requirements.

Telescopic-Assisted Radiofrequency Adenoidectomy: A Prospective Randomized Controlled Trial

OBJECTIVES/HYPOTHESIS

The objective was to conduct a prospective randomized controlled trial describing and investigating the efficacy and safety of transoral telescopic-assisted radiofrequency adenoidectomy in young children.

STUDY DESIGN

Prospective randomized controlled trial.

METHODS

One hundred twenty patients who were 36 months of age or less and planned to undergo adenoidectomy or adenoidectomy with insertion of tympanostomy tubes were included in the study. Children were prospectively and randomly assigned into two equal treatment groups: the telescopic-assisted adenoidectomy using radiofrequency curette and the conventional adenoid-curette adenoidectomy. The main parameters included visual analogue scale score for nasal breathing, amount of blood loss, operating time, completeness of adenoid resection, smoothness of postoperative recovery, and complications.

RESULTS

Both groups had a significant improvement in the visual analogue scale score after surgery with no evidence for a significant difference between the conventional adenoid-curette and radiofrequency groups. The amount of blood lost during radiofrequency adenoidectomy was minimal, with a mean difference of 31 mL and a median difference of 26 mL. There was a tendency for shorter operative time in the radiofrequency group, but this did not reach a statistical significance. No evidence for a significant difference was noticed in the smoothness of postoperative recovery or complication rate.

CONCLUSION

Telescopic-assisted radiofrequency-curette adenoidectomy allows removal of huge adenoids completely in a precise, easy, and cost-effective procedure, with minimal blood loss and short operating time. The use of transoral telescopes provides a clear visualization that helps complete removal of the adenoids, reduction of unnecessary trauma, and effective control of bleeding.

Electrosurgery after Cochlear Implantation: Eighth Nerve Electrophysiology

HYPOTHESIS

Monopolar electrosurgery below the neck in cochlear implant recipients can be performed without damage to the internal cochlear stimulator, electrode array, and the cochlear nerve.

STUDY DESIGN

Prospective pre- and postintervention electrically evoked compound action potential (ECAP) study of cochlear nerve function and behavioral sound perception assessment.

METHODS

Neural response telemetry (NRT) was used to measure ECAPs before and after the use of monopolar electrosurgery during coronary artery bypass surgery to assess prosthetic device function and electrophysiologic function of the cochlear nerve. In addition, electrode voltage impedances and behavioral sound perception was measured at the same time intervals.

RESULTS

ECAPs, behavioral sound perception, and electrode voltage impedances were within the normal range, within compliance, and similar preoperatively and on postoperative day 6.

CONCLUSION

The studies reported herein were a series of measurements designed to test neural integrity and prosthetic device function before and after the use of monopolar electrosurgery. With appropriate precautions, use of monopolar electrosurgery below the neck in cochlear implant recipients can be performed safely.

Nerve sparing radical prostatectomy: effects of hemostatic energy sources on the recovery of cavernous nerve function in a canine model

PURPOSE

To preserve sexual function following radical prostatectomy, one must avoid injury to the neurovascular bundles (NVBs). In the conventional open surgical technique, the use of energy sources for hemostasis is avoided to prevent damage to the cavernous nerves. In contrast, during laparoscopic radical prostatectomy, electrosurgical and ultrasonic energy sources are frequently used for hemostasis during dissection of the prostate. In this study, we evaluated the acute and chronic physiological effects of various hemostatic energy sources on cavernous nerve function in the canine model.

MATERIALS AND METHODS

A total of 12 dogs were divided into 4 groups based on the type of energy source used for hemostasis during unilateral dissection of the NVB. The groups included conventional dissection with suture ligatures (group 1), monopolar (group 2) or bipolar (group 3) electrosurgery and ultrasonic shears (group 4). The contralateral NVB was left undissected as a control. Erectile function was assessed acutely and after 2 weeks of survival by measuring peak intracavernous pressures in response to cavernous nerve stimulation.

RESULTS

Following conventional techniques of nerve sparing, the erectile response to nerve stimulation was unaffected. In contrast, the use of energy sources in proximity to the NVB during nerve preservation was associated with a substantial decrease in erectile response both acutely (74% to 91% decrease compared to controls) and after 2 weeks (93% to 96% decrease).

CONCLUSIONS

In the chronic canine model, use of hemostatic energy sources in proximity to the prostate during dissection of the neurovascular bundle is associated with a significantly decreased erectile response to cavernous nerve stimulation.

Recurrent laryngeal nerve paralysis: anatomy and etiology

Etiologies of adult vocal paralysis are varied by the site of the lesion as well as the extent and cause of the damage. Most large series point to surgery and neoplastic causes for recurrent nerve paralysis. A detailed history is important when working up a patient with this voice disorder. Knowledge of the anatomy of the head, neck, and chest as well as the mechanisms behind vocal fold paralysis is essential in the evaluation and treatment of recurrent nerve paralysis. Many of the surgical and traumatic causes of hoarseness are from compression type injuries. Recovery is dependent on the type, extent, and site of nerve lesion. Familiarity with this data allows the otolaryngologist to tailor management to suit each patient with vocal fold paralysis.

Smoke in the Operating Theater: An Unregarded Source of Danger

Monopolar electrocautery devices are being used in operating theaters worldwide and have become a "sine qua non" in modern surgery. Despite being widespread, the use of electrocautery is not harmless, because by burning the tissue with rather low temperatures as compared with usual combustion, toxic gases evolve and particles are dispersed and are inhaled by the staff in the operating theater. Samples of this smoke, which evolves particularly densely during reduction mammaplasty, were analyzed using a carbon dioxide laser photoacoustic spectrometer. Eleven gas components could be identified and quantified. In particular, the established concentration of 2-fur-ancarboxaldehyde (furfural) measured at 2 cm from the point of origin was outstandingly high, being 12 times higher than the occupational exposure limit. More than half of the identified gases do not even have any occupational exposure limit specifications. Because of the expected dilution at the height of the operating distance (the surgeon's nose), the present measured concentrations do not allow any conclusion on a direct health danger to the operating team. Because of laser spectroscopy, the present work reveals not only the involved gases but also their respective concentrations near the point of origin. These data are prerequisite for further studies, which are mandatory, verifying the effective concentrations of the inhaled gases.

[Effect of high frequency application on the tongue base. In vitro results of "radiofrequency application" on the porcine tongue base]

BACKGROUND AND OBJECTIVE

A newly developed radio-frequency monopolar needle electrode was evaluated in vitro on porcine tongues.

PATIENTS AND METHODS

Porcine tongues with different tissue temperatures (20+/-1) degrees C and (32+/-2) degrees C were coagulated for 90 s. In a second step, 23 coagulations at 7 W were applied (34+/-2) degrees C.

RESULTS

The volume of the lesion correlated well with increasing temperature. In step two, the mean energy was 238 J and the mean volume of the lesion was 507 mm(3) (100+/-15)%. Prolonged energy application did not correlate with a larger volume of the lesion.

CONCLUSION

The new radio-frequency needle electrode can reduce tongue volume in a precise and controlled manner (SD+/-15%).

Pediatric total tonsillectomy using coblation compared to conventional electrosurgery: a prospective, controlled single-blind study

OBJECTIVE

Postoperative recovery after tonsillectomy using Coblation excision (CES) was compared with conventional electrosurgery (ES).

STUDY DESIGN AND SETTING

Patients aged 3 to 12 years from 3 clinical sites were randomly assigned and blinded to receive tonsillectomy using CES (n = 44) or ES (n = 45).

RESULTS

Operative parameters did not differ between groups. Return to normal diet, activity, and pain-free status were similar, although fewer CES patients contacted the physician regarding postoperative complications (33% vs 54%; p = 0.081), experienced nausea (35% vs 62%, p = 0.013), or had localized site-specific swelling (p < 0.05) during the 2 weeks after surgery. In addition, CES children tended to discontinue prescription narcotics 1 day earlier than ES patients (7 vs 8 days, p = 0.071) and took one half as many daily doses. More CES than ES parents rated the postoperative experience as 'better than expected' (79% vs 60%, p = 0.055).

CONCLUSION AND SIGNIFICANCE

Children who received CES tonsillectomy appeared to experience a better quality postoperative course, with no detriment to operative benefits of conventional electrosurgery.

Effects of steel scalpel, ultrasonic scalpel, CO2 laser, and monopolar and bipolar electrosurgery on wound healing in guinea pig oral mucosa

OBJECTIVE

The study's objective was to compare instrument performance and tissue healing when steel scalpel, ultrasonic scalpel, monopolar or bipolar electrosurgical instruments, or CO2 laser was used in an animal oral surgery model.

STUDY DESIGN

Prospective, blinded, randomized.

METHODS

Adult guinea pigs (N = 70) were randomly assigned to 5 groups (14 animals per group) for excision of 2-cm, full-thickness oral mucosa using steel scalpel, ultrasonic scalpel, monopolar or bipolar electrosurgical instruments, or CO2 laser. Postoperative pain was measured indirectly using weekly body weight changes. Animals from each group were killed on days 0, 7, 14, 21, and 28. Specimens were harvested for blinded histopathological study and tensile strength measurement. Instrument performance (hemostasis, tissue coagulation, tissue sticking) and wound healing (tissue re-epithelialization, degree of inflammation) were primary outcomes. Statistical analysis was performed using analysis of variance.

RESULTS

The ultrasonic scalpel was the best tool in controlling hemostasis, tissue coagulation, and tissue sticking. Significantly higher body weight gain ( P<.05) was noted at day 7 for monopolar and CO2 laser groups. Greatest tensile strength was seen in the steel scalpel and ultrasonic scalpel groups at the end of 28 days. Tissue re-epithelialization was fastest for the steel scalpel and ultrasonic scalpel groups (complete by day 7). Complete re-epithelialization of wounds of all treatment groups occurred by day 28. All groups had acute inflammation. Complete resolution of inflammation by day 14 took place in the steel scalpel and ultrasonic scalpel groups only.

CONCLUSION

Use of the ultrasonic scalpel produced faster re-epithelialization and greater tensile strength than laser or electrosurgical instruments, with results comparable to those seen with the steel scalpel.

A third-degree burn caused by a neurogenic motor-evoked potential monitoring electrode during spinal surgery: a case report

STUDY DESIGN

A case report is presented.

OBJECTIVE

To report a previously undescribed complication related to use of a neurogenic motor-evoked potential monitoring electrode and electrosurgery during spinal surgery.

SUMMARY OF BACKGROUND DATA

Although electrosurgery is one of the most commonly used technologies in the operating room, its electrophysical properties, including the potential for complications, are poorly understood by many surgeons. Complications related to the use of electrosurgical instruments, monitoring electrodes, and radiofrequency current are underreported in the literature.

METHODS

Clinical case analysis and investigation report were used.

RESULTS

A case of third-degree skin burn at the site of a neurogenic motor-evoked potential monitoring electrode during posterior spinal fusion surgery is described.

CONCLUSIONS

A burn resulting from a neurogenic motor-evoked potential monitoring electrode is rare. However, surgeons and electrophysiologists should be familiar with this potential complication in order to prevent it.

Electrocautery adenoidectomy compared with curettage and power-assisted methods

OBJECTIVE

To compare electrocautery adenoidectomy with conventional (curettage) and power-assisted (endoscopic shaver) methods.

STUDY DESIGN

Comparative review.

METHODS

Prospective and retrospective studies comparing electrocautery adenoidectomy and conventional curettage or power-assisted methods were reviewed to provide direct comparisons regarding specific outcome variables.

RESULTS

Electrocautery adenoidectomy is a precise, effective technique for removing adenoid tissue. Compared with curettage techniques, electrocautery involves less blood loss and shorter operating times. Power-assisted adenoidectomy also offers shorter operating times and less blood loss, but the necessary equipment is more expensive and more experience is required to attain proficiency with the technique.

CONCLUSION

Electrocautery adenoidectomy provides the benefits of minimization of operating time and blood loss at a lower cost than power-assisted adenoidectomy.

Radiofrequency treatment of tonsillar hypertrophy

OBJECTIVE

To describe radiofrequency electrosurgery and the devices and techniques available for using this technology to treat tonsillar hypertrophy.

STUDY DESIGN

Review.

METHODS

Electrosurgical devices, which include the Bovie, Elmed, somnoplasty, and coblation systems and argon plasma coagulators, use energy transfer by means of electromagnetic radiation to generate heat within tissue for cutting and coagulation. With these devices, tonsillar tissue can be removed completely, partly ablated, or decreased in volume.

RESULTS

Tissue ablation with radiofrequency that preserves the outer portion of the tonsillar capsule may reduce postoperative pain and allow earlier return to normal diet and activity. Removal of the entire tonsil using the coblation method may produce less damage in adjacent tissue than standard electrosurgery, thereby decreasing postoperative pain and healing time. Tissue reduction procedures may have a reduced risk of bleeding and produce less patient discomfort than other methods and can be performed in the office setting in some patients.

CONCLUSION

Use of radiofrequency technology may decrease the morbidity associated with treatment of tonsillar hypertrophy. Preliminary trials of radiofrequency procedures have yielded promising results, but larger studies evaluating costs and benefits are needed.