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Law RH, Cena L, Sporn A, Buzi A, Rizzi MD, Ruiz RL, Fedrigo S, Giordano T, Fahmy AN, Dedhia K. Nanoparticle Concentration in Surgical Plume During Tonsillectomy: A Comparison of Four Techniques. Laryngoscope 2024; 134:2444-2448. [PMID: 37983867 DOI: 10.1002/lary.31185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/15/2023] [Accepted: 11/08/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE Surgical plume has known potential occupational health hazards. This study compares nanoparticle concentrations in surgical plumes generated between different pediatric tonsillectomy surgical techniques and assesses the efficacy of mitigation measures. METHODS This is a cross-sectional study performed at a tertiary care academic center. Extracapsular or intracapsular tonsillectomy was performed in 60 patients using four techniques and in 10 additional patients using mitigation measures. Two nanoparticle counters were used to measure particulate concentrations: CPC™ and DiSCmini™. Tonsillectomy techniques included: (1) microdebrider (MD), (2) Bovie with manual suctioning by an assistant (B), (3) Bovie with built-in smoke evacuation system (BS), and (4) Coblator™ (CB). An additional Yankauer suction was used in the mitigation groups (BSY) and (CBY). Comparative analysis was performed using one-way ANOVA on ranks and pairwise comparisons between the groups. RESULTS The mean concentrations (particles/cm3) and coefficient of variants for the DiSCmini particulate counter were MD: 5140 (1.6), B: 30700 (1.5), BS: 25001 (0.8), CB: 54814 (1.7), CBY: 2395 (1.3) and BSY: 11552 (1.0). Mean concentrations for the CPC particulate counter were MD: 1223 (1.4), B: 3405 (0.7), BS: 5002 (0.9), CB: 13273 (1.0), CBY: 1048 (1.2) and BSY: 3046 (0.6). The lowest mean concentrations were noted in cases using MD and the highest in cases using CB. However, after mitigation, CBY had the lowest overall levels. CONCLUSION Tonsillectomy technique does impact the levels of nanoparticles emitted within the surgical plume, which may present an occupational hazard for operating room personnel. LEVEL OF EVIDENCE 3 Laryngoscope, 134:2444-2448, 2024.
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Affiliation(s)
- Richard H Law
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lorenzo Cena
- Department of Health, West Chester University, West Chester, Pennsylvania, USA
| | - Alec Sporn
- Department of Health, West Chester University, West Chester, Pennsylvania, USA
| | - Adva Buzi
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mark D Rizzi
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ryan L Ruiz
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sabrina Fedrigo
- Department of Health, West Chester University, West Chester, Pennsylvania, USA
| | - Terri Giordano
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Alexander N Fahmy
- School of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Kavita Dedhia
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Ostby SA, Blanchard CT, Sanjanwala AR, Szychowski JM, Leath CA, Huh WK, Subramaniam A. Feasibility, Safety, and Provider Perspectives of Bipolar Electrosurgical Cautery Device for (Opportunistic or Complete) Salpingectomy at the Time of Cesarean Delivery. Am J Perinatol 2024; 41:804-813. [PMID: 35728603 DOI: 10.1055/s-0042-1748525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The aim of the study is to evaluate the use of a bipolar electrocautery device for complete salpingectomy at cesarean to improve procedure completion rates, operative time, and surgeon reported satisfaction as compared with standard bilateral tubal ligation (BTL) and suture-cut-tie salpingectomy. STUDY DESIGN This is a prospective cohort study of women undergoing planned, non-emergent cesarean with desired sterilization with complete salpingectomy utilizing a bipolar electrocautery device. Study patients were compared with historic controls from a randomized controlled trial (RCT) of complete salpingectomy via suture-cut-tie method versus BTL conducted at our institution (SCORE trial, NCT02374827). Outcomes were compared with groups from the original RCT. RESULTS Thirty-nine women were consecutively enrolled (12/2018-11/2019) into the device arm of the study and compared with the original SCORE cohort (n = 40 BTL, n = 40 salpingectomy without a device). Salpingectomy performance with the bipolar electrocautery device was successfully completed in 100% (39/39) of enrolled women, with one device failure requiring the use of a second device, as compared with 95% (38/40) in the BTL (p = 0.49) and 67.5% (27/40) in salpingectomies without a device (p < 0.001). Mean operative time of sterilization procedure alone demonstrated device use as having the shortest operative time of all (device salpingectomy 5.0 ± 3.6 vs. no device 18.5 ± 8.3 minutes, p < 0.001; and vs. BTL 6.9 ± 5.0, p = 0.032). Mean sterilization procedure endoscopic band ligation (EBL) was demonstrated to be significantly different between each group, least amongst BTL followed by device (6.3 ± 4.8 vs. 8.4 ± 24.8, p < 0.001), and most by suture-cut-tie method (17.7 ± 14.3, p < 0.001 compared with device). Surgeon reported attitudes of complete salpingectomy performance in general practice outside an academic setting was greater with a device than without (79.5 vs. 35.3%; p < 0.001). CONCLUSION Use of a bipolar electrocautery device improved operative times and surgeon satisfaction for salpingectomy at cesarean over standard suture ligation. Device use improved surgeon reported outcomes and may improve incorporation of complete salpingectomy at cesarean. KEY POINTS · Electrocautery bipolar device use was safe at the time of salpingectomy during cesarean.. · Greater surgeon satisfaction occurs using a device than without.. · Decreased surgical time with device use is seen making the procedure equal to BTL..
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Affiliation(s)
- Stuart A Ostby
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Center for Women's Reproductive Health, Birmingham, Alabama
| | - Christina T Blanchard
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Center for Women's Reproductive Health, Birmingham, Alabama
| | - Aalok R Sanjanwala
- Division of Maternal-Fetal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jeff M Szychowski
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Center for Women's Reproductive Health, Birmingham, Alabama
| | - Charles A Leath
- Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Warner K Huh
- Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Akila Subramaniam
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Center for Women's Reproductive Health, Birmingham, Alabama
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Zorzato PC, Ferrari FA, Garzon S, Franchi M, Cianci S, Laganà AS, Chiantera V, Casarin J, Ghezzi F, Uccella S. Advanced bipolar vessel sealing devices vs conventional bipolar energy in minimally invasive hysterectomy: a systematic review and meta-analysis. Arch Gynecol Obstet 2024; 309:1165-1174. [PMID: 37955717 PMCID: PMC10894136 DOI: 10.1007/s00404-023-07270-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/16/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE To compare conventional bipolar electrosurgery with advanced bipolar vessel sealing (ABVS) devices for total laparoscopic hysterectomy (TLH). METHODS A systematic review was conducted by searching Scopus, PubMed/MEDLINE, ScienceDirect, and Cochrane Library from January 1989 to November 2021. We identified all studies comparing ABVS devices with conventional bipolar electrosurgery in TLH and reporting at least one of the following outcomes: total blood loss, total operative time, hospital stay, perioperative complications, or costs. Meta-analysis was conducted with a random effect model reporting pooled mean differences and odds ratios (ORs) with related 95% confidence intervals (CIs). RESULTS Two randomized controlled trials and two retrospective studies encompassing 314 patients were included out of 615 manuscripts. The pooled estimated total blood loss in the ABVS devices group was lower than conventional bipolar electrosurgery of 39 mL (95% CI - 65.8 to - 12.6 mL; p = .004). The use of ABVS devices significantly reduced the total operative time by 8 min (95% CI - 16.7 to - 0.8 min; p = .033). Hospital stay length did not differ between the two groups, and a comparable overall surgical complication rate was observed [OR of 0.9 (95% CI 0.256 - 3.200; p = .878]. CONCLUSIONS High-quality evidence comparing ABVS devices with conventional bipolar electrosurgery for TLH is lacking. ABVS devices were associated with reduced total blood loss and operative time; however, observed differences seem clinically irrelevant. Further research is required to clarify the advantages of ABVS devices over conventional bipolar electrosurgery and to identify cases that may benefit more from their use.
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Affiliation(s)
- Pier Carlo Zorzato
- Unit of Obstetrics and Gynecology, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, AOUI Verona, Verona, Italy
| | - Filippo Alberto Ferrari
- Unit of Obstetrics and Gynecology, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, AOUI Verona, Verona, Italy
| | - Simone Garzon
- Unit of Obstetrics and Gynecology, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, AOUI Verona, Verona, Italy.
| | - Massimo Franchi
- Unit of Obstetrics and Gynecology, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, AOUI Verona, Verona, Italy
| | - Stefano Cianci
- Department of Obstetrics and Gynecology, University of Messina, Messina, Italy
| | - Antonio Simone Laganà
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
- Unit of Obstetrics and Gynecology, Paolo Giaccone Hospital, Palermo, Italy
| | - Vito Chiantera
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
- Unit of Gynecologic Oncology, National Cancer Institute - IRCCS - Fondazione "G. Pascale", Naples, Italy
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Stefano Uccella
- Unit of Obstetrics and Gynecology, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, AOUI Verona, Verona, Italy
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Xu Q, Huang Z, Shen S, Yan M, Gong T, Ji C. A modified needle knife using electrosurgical electrode in skin surgery. J Am Acad Dermatol 2024; 90:e99-e100. [PMID: 36967020 DOI: 10.1016/j.jaad.2023.02.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 02/09/2023] [Accepted: 02/19/2023] [Indexed: 04/20/2023]
Affiliation(s)
- Qiuyun Xu
- Department of Dermatology, Institute of Dermatology and Venereology, Fujian Dermatology and Venereology Research Institute, Key Laboratory of Skin Cancer of Fujian Higher Education Institutions, the First Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Zugen Huang
- Department of Plastic & Cosmetic Surgery, the First Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Shuyi Shen
- Department of Dermatology, Institute of Dermatology and Venereology, Fujian Dermatology and Venereology Research Institute, Key Laboratory of Skin Cancer of Fujian Higher Education Institutions, the First Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Manlin Yan
- Fuzhou Kangtai Physical Examination Center, Fuzhou, People's Republic of China
| | - Ting Gong
- Central Laboratory, the First Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Chao Ji
- Department of Dermatology, Institute of Dermatology and Venereology, Fujian Dermatology and Venereology Research Institute, Key Laboratory of Skin Cancer of Fujian Higher Education Institutions, the First Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China.
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Bonnet M, Gerelli S, Naem N, Bayard NF, Mangin L. Transcatheter Antegrade Electrosurgical Laceration of Mitral Valve Chordae Followed by Transcatheter Edge-to-Edge Repair. JACC Cardiovasc Interv 2024; 17:577-579. [PMID: 38244004 DOI: 10.1016/j.jcin.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 01/22/2024]
Affiliation(s)
- Marc Bonnet
- Cardiology Department, Hospital Annecy-Genevois, Metz-Tessy, France.
| | - Sébastien Gerelli
- Cardiac-Surgery Department, Hospital Annecy-Genevois, Metz-Tessy, France
| | - Nora Naem
- Cardiology Department, Hospital Annecy-Genevois, Metz-Tessy, France
| | - Nathanael F Bayard
- Cardiac-Surgery Department, Hospital Annecy-Genevois, Metz-Tessy, France
| | - Lionel Mangin
- Cardiology Department, Hospital Annecy-Genevois, Metz-Tessy, France
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Cahn J. Clinical Issues - February 2024. AORN J 2024; 119:169-173. [PMID: 38275264 DOI: 10.1002/aorn.14082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 10/17/2023] [Indexed: 01/27/2024]
Abstract
Retaining count sheets in the patient's medical record Key words: count sheet, medical record, procedural risk factor, retained surgical item, surgical count. Counting instruments during cavity closure Key words: uterine cavity, abdominal cavity, fetal procedure, cesarean delivery, instrument count. Surgical wound classification of procedures involving cancer removal Key words: cancer, contamination, infection, surgical wound classification, decision making. Placing an electrosurgical unit dispersive electrode over a tattoo Key words: dispersive electrode placement, metallic pigment, burn, tattoo, electrosurgical unit (ESU).
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Mitsui T, Yoda Y. Objective indicators of endoscopic submucosal dissection skills through electrosurgical unit analysis. Dig Endosc 2024; 36:28-29. [PMID: 37733463 DOI: 10.1111/den.14666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 08/20/2023] [Indexed: 09/23/2023]
Affiliation(s)
- Tomohiro Mitsui
- Division of Endoscopy, Saitama Cancer Center, Saitama, Japan
| | - Yusuke Yoda
- Division of Endoscopy, Saitama Cancer Center, Saitama, Japan
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Kondo A, Tamate M, Nishihara Y, Watanabe Y. Hybrid Train-The-Trainer course for the Fundamental Use of Surgical Energy certificates improves self-confidence in knowledge of surgical energy and develops teaching skills: a feasibility study. Surg Endosc 2024; 38:368-376. [PMID: 37798531 DOI: 10.1007/s00464-023-10422-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/31/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Several well-trained expert instructors who completed the "Train-The-Trainer (TTT)" course are required to disseminate the safe use of surgical energy devices, which can be learned through the Fundamental Use of Surgical Energy (FUSE) program. This study aimed to explore whether the hybrid FUSE TTT course is feasible and effective, which can improve teaching skills of surgical energy. METHODS The hybrid TTT course, which was designed to train FUSE-certified personnel as instructors, comprised three virtual sessions spread over 5 h in total and a 1-day in-person training, followed by a 100-min FUSE electrosurgery hands-on workshop in practice as an instructor. The participants reported on self-confidence regarding knowledge of various energy devices or adverse events before, immediately after, and 6 months after the course. Participants and experienced FUSE instructors assessed the trainees' presentation skills at the beginning of the in-person training and after the hands-on workshop. The primary outcomes were the feasibility and completion rate of the entire course. RESULTS Seventeen participants completed the entire couse; most (94%) were satisfied with the course. Self-confidence in knowledge about various contents improved significantly: the fundamentals of electrosurgery (post, p < 0.001; 6 months, p = 0.01), mechanism and prevention of adverse events (post, p = 0.001; 6 months, p = 0.04), monopolar instruments (post, p = 0.002; 6 months, p = 0.01), bipolar instruments (post, p = 0.01; 6 months, p = 0.06), and integration with other medical devices (post, p = 0.006; 6 months, p = 0.02). The presentation skill index scores of self- and peer assessments improved after the in-person training (self-assessment [pre 44 vs. post 56, p < 0.001], peer assessment [pre 39 vs. post 68, p < 0.001]). CONCLUSIONS The hybrid TTT course can provide FUSE-certified personnel with an improved self-confidence concerning knowledge of surgical energy and improve their presentation skills with midterm retention. This can help build trainees' self-confidence as instructors.
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Affiliation(s)
- Akihiro Kondo
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Takamatsu, Kagawa, Japan
| | - Masato Tamate
- Department of Obstetrics and Gynecology, Sapporo Medical University Hospital, Sapporo, Hokkaido, Japan
| | - Yuichi Nishihara
- Department of Surgery, Sassa General Hospital, Nishitokyo, Tokyo, Japan
| | - Yusuke Watanabe
- Clinical Research and Medical Innovation Center, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Kita 14 Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
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Song Y, Zhang M, Zhang C, Du S, Zhai F. HPV E6/E7 mRNA combined with thin-prep cytology test for the diagnosis of residual/recurrence after loop electrosurgical excision procedure in patients with cervical intraepithelial neoplasia. Diagn Microbiol Infect Dis 2024; 108:116119. [PMID: 37890308 DOI: 10.1016/j.diagmicrobio.2023.116119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 10/29/2023]
Abstract
To evaluate the diagnostic value of combining HPV E6/E7 mRNA testing with Thin-Prep cytology (TCT) for residual/recurrence detection, a total of 289 patients who underwent loop electrosurgical excision procedure (LEEP) for high-grade cervical lesions were included. Patients were followed up at different time points, and residual/recurrent lesions were confirmed through vaginoscopy. TCT, HPV-DNA, and HPV E6/E7 mRNA tests were conducted. Diagnostic performance, including sensitivity, specificity, positive predictive value, negative predictive value, and accuracy, was assessed. Among the patients, 76 cases showed residual lesions/recurrence, while 213 cases showed no residual/recurrence. Positive margins in the cervical-vaginal and cervical canal areas were associated with a higher risk of residual/recurrence. The combined HPV E6/E7 mRNA and TCT test showed higher diagnostic efficacy than individual tests at 6-, 12-, and 24-months follow-up. The combined test consistently demonstrated higher specificity and sensitivity, with significantly larger area under the curve (AUC) values compared to the individual tests.
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Affiliation(s)
- Yinghui Song
- Department of Gynecology, Cangzhou Central Hospital, No. 16 Xinhua West Road, Cangzhou 061000, Hebei, China.
| | - Min Zhang
- Department of Gynecology, Cangzhou Central Hospital, No. 16 Xinhua West Road, Cangzhou 061000, Hebei, China
| | - Cui Zhang
- Department of Gynecology, Cangzhou Central Hospital, No. 16 Xinhua West Road, Cangzhou 061000, Hebei, China
| | - Shiyu Du
- Cangzhou Central Hospital, No. 16 Xinhua West Road, Cangzhou 061000, Hebei, China
| | - Furui Zhai
- Department of Gynecology, Cangzhou Central Hospital, No. 16 Xinhua West Road, Cangzhou 061000, Hebei, China
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Wang Y, Ma W, Lin X, Long F. Bronchoscopic electrosurgical removal of an endobronchial angiofibroma presenting with the hemoptysis sympton. Asian J Surg 2023; 46:5852-5854. [PMID: 37673745 DOI: 10.1016/j.asjsur.2023.08.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/25/2023] [Indexed: 09/08/2023] Open
Affiliation(s)
- Yonggang Wang
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital, Shandong University, No.324, Jingwu Road, Jinan, Shandong, 250021, China
| | - Weixia Ma
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital, Shandong University, No.324, Jingwu Road, Jinan, Shandong, 250021, China
| | - Xiaoyan Lin
- Department of Pathology, Shandong Provincial Hospital, Shandong University, No.324, Jingwu Road, Jinan, Shandong, 250021, China
| | - Fei Long
- Department of Pulmonary and Critical Care Medicine, The Third Affiliated Hospital of Shandong First Medical University (Affiliated Hospital of Shandong Academy of Medical Sciences), No.38, Wuyingshan Road, Jinan, Shandong, 250021, China.
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Yao G, Wu F, Lucas M, Zheng L, Wang C, Gu H. Effect of longitudinal-bending elliptical ultrasonic vibration assistance on electrosurgical cutting and hemostasis. Ultrasonics 2023; 135:107113. [PMID: 37517346 DOI: 10.1016/j.ultras.2023.107113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 06/24/2023] [Accepted: 07/18/2023] [Indexed: 08/01/2023]
Abstract
Electrosurgical devices are widely used for tissue cutting and hemostasis in minimally invasive surgery (MIS) for their high precision and low trauma. However, tissue adhesion and the resulting thermal injury can cause infection and impede the wound-healing process. This paper proposes a longitudinal-bending elliptical ultrasonic vibration-assisted (EUV-A) electrosurgical cutting system that incorporates an ultrasonic vibration in the direction of the cut by introducing an elliptical motion of the surgical tip. Compared with a solely longitudinal ultrasonic vibration-assisted (UV-A) electrosurgical device, the EUV-A electrode contacts the tissue intermittently, thus allowing for a cooler cut and preventing tissue accumulation. The experimental results reveal that the EUV-A electrode demonstrates better performance than the UV-A electrode for both anti-adhesion and thermal injury through in vitro experiments in porcine samples. The tissue removal mechanism of EUV-A electrosurgical cutting is modeled to investigate its anti-adhesion effect. In addition, lower adhesion, lower temperature, and faster cutting are demonstrated through in vivo experiments in rabbit samples. Results show that the EUV-A electrode causes lower thermal injury, indicative of faster postoperative healing. Finally, efficacy of the hemostatic effect of the EUV-A electrode is demonstrated in vivo for vessels up to 3.5 mm (equivalent to that of electrocautery). The study reveals that the EUV-A electrosurgical cutting system can achieve safe tissue incision and hemostasis.
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Affiliation(s)
- Guang Yao
- Guangdong Provincial Key Laboratory of Minimally Invasive Surgical Instruments and Manufacturing Technology, Guangdong University of Technology, Guangzhou 510006, China
| | - Fei Wu
- Guangdong Provincial Key Laboratory of Minimally Invasive Surgical Instruments and Manufacturing Technology, Guangdong University of Technology, Guangzhou 510006, China
| | - Margaret Lucas
- James Watt School of Engineering, University of Glasgow, Glasgow G12 8QQ, UK
| | - Lijuan Zheng
- Guangdong Provincial Key Laboratory of Minimally Invasive Surgical Instruments and Manufacturing Technology, Guangdong University of Technology, Guangzhou 510006, China
| | - Chengyong Wang
- Guangdong Provincial Key Laboratory of Minimally Invasive Surgical Instruments and Manufacturing Technology, Guangdong University of Technology, Guangzhou 510006, China.
| | - Heng Gu
- Guangdong Institute of Medical Instruments, Guangzhou 510500, China
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Curio J, Kuhn EW, Körber MI, Baldus S, Khan JM, Adam M. Electrosurgical laceration and stabilisation of three clip devices (ELASTA-Clip) to enable transcatheter mitral valve implantation. EUROINTERVENTION 2023; 19:744-745. [PMID: 37982165 PMCID: PMC10658197 DOI: 10.4244/eij-d-23-00596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 08/21/2023] [Indexed: 11/21/2023]
Affiliation(s)
- Jonathan Curio
- Department of Cardiology, Heart Center Cologne, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Elmar W Kuhn
- Department of Heart Surgery, Heart Center Cologne, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Maria Isabel Körber
- Department of Cardiology, Heart Center Cologne, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Stephan Baldus
- Department of Cardiology, Heart Center Cologne, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Jaffar M Khan
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, D.C., USA
- Department of Interventional Cardiology, St. Francis Hospital and Heart Center, Roslyn, NY, USA
| | - Matti Adam
- Department of Cardiology, Heart Center Cologne, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
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Hwang S, Lee S, Yoon B, Jeong B, Kim J, Kim S, Kim J. GaN-Based 4-MHz Full-Bridge Electrosurgical Generator Using Zero-Voltage Switching Over Wide Load Impedance Range. IEEE Trans Biomed Circuits Syst 2023; 17:1125-1134. [PMID: 37651483 DOI: 10.1109/tbcas.2023.3310880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
In this article, a 4-MHz full-bridge inverter system for an electrosurgical generator (ESG) is presented with zero-voltage switching (ZVS) turn-on over a wide load impedance range based on wideband gap material gallium nitride (GaN) technology. The proposed resonant circuit is used for impedance matching and limits the current when the load is short state while performing ZVS over a wide load impedance range. It also ensures high power performance at high frequencies for electric surgery. The implementation methods of the GaN switch at 4 MHz with high output performance are guided by the low inductance from the gate-driver output to the switch gate node and the effective heating management structure of the GaN-based inverter. The proposed generator achieved a maximum output power of 99 W to the load and a maximum overall efficiency of 89% with overcurrent of <3 A at short state of the load. The ESG can generate constant output power of 20, 50, 70 W through mode control of 2, 5, and 7 s. The overcurrent Moreover, the proposed generator is tested on porcine tissue samples to verify its effectiveness as an ESG.
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Li K, Xie Y, Yang S, Ritasalo R, Mariam J, Yu M, Bi J, Ding H, Lu L. Synergetic Effects of Nanoscale ALD-HfO 2 Coatings and Bionic Microstructures for Antiadhesive Surgical Electrodes: Improved Cutting Performance, Antibacterial Property, and Biocompatibility. ACS Appl Mater Interfaces 2023; 15:43550-43562. [PMID: 37672350 DOI: 10.1021/acsami.3c09374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
The high temperature induced by surgical electrodes is highly susceptible to severe surface adhesion and thermal damage to adjacent tissues, which is a major challenge in improving the quality of electrosurgery. Herein, we reported a coupled electrode with micro/nano hierarchical structures fabricated by depositing nanoscale hafnium oxide (HfO2) coatings on bionic microstructures (BMs) via laser texturing, acid washing, and atomic layer deposition (ALD) techniques. The synergistic effect of HfO2 coatings and BMs greatly enhanced the hemophobicity of the electrode with a blood contact angle of 162.15 ± 3.16°. Furthermore, the coupled surface was proven to have excellent antiadhesive properties to blood when heated above 100 °C, and the underlying mechanism was discussed. Further experiments showed that the coupled electrode had significant advantages in reducing cutting forces, thermal damage, and tissue adhesion mass. Moreover, the antibacterial rates against Escherichia coli and Staphylococcus aureus were 97.2% and 97.9%, respectively. In addition, the noncytotoxicity levels of HfO2 coatings were verified by cell apoptosis and cycle assays, indirectly endowing the coupled electrode with biocompatibility. Overall, the coupled electrode was shown to have broad potential for application in the field of electrosurgery, and this work could provide new insights into antiadhesion properties under high-temperature conditions.
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Affiliation(s)
- Kaikai Li
- School of Mechanical & Automotive Engineering, South China University of Technology, Guangzhou 510641, China
| | - Yingxi Xie
- School of Mechanical & Automotive Engineering, South China University of Technology, Guangzhou 510641, China
| | - Shu Yang
- School of Mechanical & Automotive Engineering, South China University of Technology, Guangzhou 510641, China
| | | | | | - Min Yu
- Department of General Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou 510080, China
| | - Junming Bi
- Department of Urology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Huanwen Ding
- Department of Orthopedics, Guangzhou First People's Hospital, Guangzhou 510180, China
| | - Longsheng Lu
- School of Mechanical & Automotive Engineering, South China University of Technology, Guangzhou 510641, China
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Abraham C, Kim R, Oner C, Bucknor A. Colposcopy and Loop Electrosurgical Excision Procedure: A Simulated Exercise. MedEdPORTAL 2023; 19:11344. [PMID: 37691878 PMCID: PMC10485179 DOI: 10.15766/mep_2374-8265.11344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 06/12/2023] [Indexed: 09/12/2023]
Abstract
Introduction Cervical intraepithelial neoplasia 3 is associated with a high degree of progression to cervical cancer. Its risk is markedly reduced after excisional treatment. Hence, it is critical that providers accurately diagnose and treat this condition. We present a simulation-based module focused on resident mastery of performance of colposcopy and loop electrosurgical excision procedure (LEEP). Methods Learners were obstetrics and gynecology residents. Guidelines on performance of colposcopy and LEEP were presented prior to module participation. We used pelvic task trainers, kielbasa sausages, and routine equipment for performance of colposcopy and LEEP. Colposcopy and LEEP sessions each lasted 30 minutes. Learners completed questionnaires before and after regarding comfort level on aspects of colposcopy and LEEP performance and level of agreement with statements on performing procedures independently. Comfort levels and degrees of agreement were based on 5-point Likert scales (1 = very uncomfortable/strongly disagree, 3 = neither comfortable nor uncomfortable/neutral, 5 = very comfortable/strongly agree, respectively). Results Modules were held in November 2021 and May 2022. Thirty-four residents participated. Mean comfort scores significantly increased from 3.1 to 4.3 (p < .001) before and after the module for all steps. There was an increase in level of agreement with statements on being able to independently perform colposcopy (2.2 to 3.5, p < .01) and LEEP (2.9 to 3.6, p = .06). Discussion Simulation-based modules on performance of colposcopy and LEEP significantly increased resident learner comfort in the performance of these procedures. Comfort in performing these procedures is important in providing comprehensive gynecologic care.
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Affiliation(s)
- Cynthia Abraham
- Attending Physician, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai and Mount Sinai Health System
| | - Renita Kim
- Attending Physician, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai and Mount Sinai Health System
| | - Ceyda Oner
- Attending Physician, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai and Mount Sinai Health System
| | - Adjoa Bucknor
- Attending Physician, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai and Mount Sinai Health System
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16
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Tauber J, Tingley JP, Barmettler A. Implantable Electronic Cardiovascular Device Complications Related to Electrocautery During Ophthalmology Surgery: A Systematic Review. Ophthalmic Plast Reconstr Surg 2023; 39:108-116. [PMID: 36136730 DOI: 10.1097/iop.0000000000002271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Implantable electronic cardiovascular device such as cardiac pacemakers and implantable defibrillators are common life-saving devices. Device-related complications can arise when undergoing surgical interventions with electrosurgical tools due to electromagnetic interference, based on electrocautery type, implantable electronic cardiovascular device type, electrocautery location, and a number of other factors. The risk of device-related complications due to electrocautery in oculoplastic surgery has not been established. This systematic literature review assesses prevalence, risk factors, and outcomes of electrocautery-related device complications in oculoplastic surgery. METHODS Systematic literature review followed Preferred Reporting Items for Systematic and Meta-Analysis guidelines and used the search terms "pacemaker," "implantable cardioverter defibrillator," "electrocautery," "cautery," and "electrosurgery" through June 2022. Inclusion criteria were full-text articles, discussing ocular, oculoplastic, or other facial surgery. Exclusion criteria were non-English language or surgery focused on other parts of the body. Full-text manuscripts of identified articles were reviewed and relevant data were extracted. RESULTS Twelve studies met inclusion criteria. Two studies were level I and II evidence, while 10 studies were level III or IV. There were no reports of electromagnetic interference with bipolar cautery use. With monopolar cautery use, cases of electromagnetic interference were reported, but without related significant morbidity or mortality. Safety recommendations to minimize electrical flow through the implantable electronic cardiovascular device are described. CONCLUSIONS There were no reports of implantable electronic cardiovascular device-related complications from bipolar or thermocautery use in ophthalmic or oculoplastic surgeries. Monopolar have been associated with electromagnetic interference, but additional preoperative and perioperative measures can be taken to mitigate this risk.
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Affiliation(s)
- Jenna Tauber
- Department of Ophthalmology and Visual Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, U.S.A
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17
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Lyra S, Mustafa A, Rixen J, Borik S, Lueken M, Leonhardt S. Conditional Generative Adversarial Networks for Data Augmentation of a Neonatal Image Dataset. Sensors (Basel) 2023; 23:999. [PMID: 36679796 PMCID: PMC9864455 DOI: 10.3390/s23020999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 06/17/2023]
Abstract
In today's neonatal intensive care units, monitoring vital signs such as heart rate and respiration is fundamental for neonatal care. However, the attached sensors and electrodes restrict movement and can cause medical-adhesive-related skin injuries due to the immature skin of preterm infants, which may lead to serious complications. Thus, unobtrusive camera-based monitoring techniques in combination with image processing algorithms based on deep learning have the potential to allow cable-free vital signs measurements. Since the accuracy of deep-learning-based methods depends on the amount of training data, proper validation of the algorithms is difficult due to the limited image data of neonates. In order to enlarge such datasets, this study investigates the application of a conditional generative adversarial network for data augmentation by using edge detection frames from neonates to create RGB images. Different edge detection algorithms were used to validate the input images' effect on the adversarial network's generator. The state-of-the-art network architecture Pix2PixHD was adapted, and several hyperparameters were optimized. The quality of the generated RGB images was evaluated using a Mechanical Turk-like multistage survey conducted by 30 volunteers and the FID score. In a fake-only stage, 23% of the images were categorized as real. A direct comparison of generated and real (manually augmented) images revealed that 28% of the fake data were evaluated as more realistic. An FID score of 103.82 was achieved. Therefore, the conducted study shows promising results for the training and application of conditional generative adversarial networks to augment highly limited neonatal image datasets.
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Affiliation(s)
- Simon Lyra
- Medical Information Technology, Helmholtz Institute for Biomedical Engineering, RWTH Aachen University, 52074 Aachen, Germany
| | - Arian Mustafa
- Medical Information Technology, Helmholtz Institute for Biomedical Engineering, RWTH Aachen University, 52074 Aachen, Germany
| | - Jöran Rixen
- Medical Information Technology, Helmholtz Institute for Biomedical Engineering, RWTH Aachen University, 52074 Aachen, Germany
| | - Stefan Borik
- Department of Electromagnetic and Biomedical Engineering, Faculty of Electrical Engineering and Information Technology, University of Zilina, 010 26 Zilina, Slovakia
| | - Markus Lueken
- Medical Information Technology, Helmholtz Institute for Biomedical Engineering, RWTH Aachen University, 52074 Aachen, Germany
| | - Steffen Leonhardt
- Medical Information Technology, Helmholtz Institute for Biomedical Engineering, RWTH Aachen University, 52074 Aachen, Germany
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Serenko АA, Hroma VH, Minukhin DV, Yevtushenko DO, Tkachenko VV, Kritsak VV, Korzh PI. TREATMENT EXPERIENCE OF CHRONIC LUNG ABSCESSES USING MINI-INVASIVE ELECTROSURGICAL TECHNIQUES. Wiad Lek 2023; 76:2277-2282. [PMID: 37948726 DOI: 10.36740/wlek202310122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
OBJECTIVE The aim: To increase the efficiency of surgical treatment of patients with chronic lung abscesses by developing mini-invasive methods of surgical treatment using electrosurgical technologies. PATIENTS AND METHODS Materials and methods: Conducted study of the results of surgical treatment of 78 patients with chronic lung abscesses operated from 2011 to 2021. Patients were divided into two groups: the main group (37 patients who were treated using developed technologies) and a comparison group (41 patients, treated using traditional tactics). RESULTS Results: Transthoracic and endobronchial sanitation of the purulent cavity in the lung at the first stage of treatment contributed to the rapid elimination of inflammation and significantly accelerated the regeneration of lung tissue. Clinical effectiveness in the main group was expressed in reducing the phenomena of intoxication, decrease in Leukocyte intoxication index (LII) (early as on day 5 after surgery), on the 10th day, a significant reduction in patients bacterial excretion was noted (in the main group by 18.9%, in the comparison group - by 14.6%), the average time of reducing the abscess cavity by 1/4 of the volume 6 days less, the healing time of the cavity of the AL which is on average 13 and 16 days, respectively, less. CONCLUSION Conclusions: The developed methods of surgical interventions made it possible to significantly positively influence the level of endogenous intoxication indicators, avoid resection surgical interventions, reduce the number of postoperative complications, avoid damage to neighboring organs, reduce the time of patients with achieving a stable positive effect.
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Affiliation(s)
- Аnton A Serenko
- STATE INSTITUTION «INSTITUTE OF GENERAL AND EMERGENCY SURGERY V. T. ZAITSEV NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE», KHARKIV, UKRAINE
| | - Vasyl H Hroma
- STATE INSTITUTION «INSTITUTE OF GENERAL AND EMERGENCY SURGERY V. T. ZAITSEV NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE», KHARKIV, UKRAINE; KHARKIV NATIONAL MEDICAL UNIVERSITY, KHARKIV, UKRAINE
| | - Dmytro V Minukhin
- STATE INSTITUTION «INSTITUTE OF GENERAL AND EMERGENCY SURGERY V. T. ZAITSEV NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE», KHARKIV, UKRAINE; KHARKIV NATIONAL MEDICAL UNIVERSITY, KHARKIV, UKRAINE
| | - Denis O Yevtushenko
- STATE INSTITUTION «INSTITUTE OF GENERAL AND EMERGENCY SURGERY V. T. ZAITSEV NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE», KHARKIV, UKRAINE; KHARKIV NATIONAL MEDICAL UNIVERSITY, KHARKIV, UKRAINE
| | - Volodymyr V Tkachenko
- STATE INSTITUTION «INSTITUTE OF GENERAL AND EMERGENCY SURGERY V. T. ZAITSEV NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE», KHARKIV, UKRAINE; EDUCATIONAL AND SCIENTIFIC MEDICAL INSTITUTE OF THE NATIONAL TECHNICAL UNIVERSITY «KHARKIV POLYTECHNIC INSTITUTE», KHARKIV, UKRAINE
| | - Vasyl V Kritsak
- STATE INSTITUTION «INSTITUTE OF GENERAL AND EMERGENCY SURGERY V. T. ZAITSEV NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE», KHARKIV, UKRAINE; EDUCATIONAL AND SCIENTIFIC MEDICAL INSTITUTE OF THE NATIONAL TECHNICAL UNIVERSITY «KHARKIV POLYTECHNIC INSTITUTE», KHARKIV, UKRAINE
| | - Pavlo I Korzh
- STATE INSTITUTION «INSTITUTE OF GENERAL AND EMERGENCY SURGERY V. T. ZAITSEV NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE», KHARKIV, UKRAINE; EDUCATIONAL AND SCIENTIFIC MEDICAL INSTITUTE OF THE NATIONAL TECHNICAL UNIVERSITY «KHARKIV POLYTECHNIC INSTITUTE», KHARKIV, UKRAINE
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19
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Piemontese A, Cohen L, Wright GWJ, Robledinos-Antón N, Jamous N, Tommaselli GA, Galvain T. Adopting a portfolio of ultrasonic and advanced bipolar electrosurgery devices from a single manufacturer compared to currently used ultrasonic and advanced bipolar devices: a probabilistic budget impact analysis from a Spanish hospital perspective. J Med Econ 2023; 26:179-188. [PMID: 36646702 DOI: 10.1080/13696998.2023.2169496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
AIMS Advanced energy devices are commonly used in electrosurgery, including ultrasonic and advanced bipolar (ABP) devices. Smoke evacuation and reusable dispersive electrodes are also utilized during electrosurgery to improve staff and patient safety. This study assessed the budget impact of adopting a portfolio of Ethicon energy devices compared to devices from other manufacturers from a Spanish hospital perspective. METHODS The main analysis compared the Ethicon advanced energy device portfolio (ultrasonic and ABP devices) to Non-Ethicon advanced energy devices. It was assumed that 4,000 procedures using one advanced energy device each were performed annually, and the cost impact of operating room time, length of stay, and transfusions were considered. A probabilistic budget impact analysis with 10,000 iterations was conducted for generalizability to other hospitals in Spain and Europe. Secondary analysis assessed whether cost savings from the Ethicon advanced energy device portfolio could offset costs of adopting smoke evacuation and reusable dispersive electrodes (Full Ethicon energy portfolio). RESULTS In the main analysis, the annual budget impact of introducing the Ethicon advanced energy device portfolio was cost saving in 79.8% of probabilistic iterations (mean: -€945,214; 95% credible interval [CrI]: -€3,242,710; €1,285,942) with a mean budget impact per procedure of -€236 (95% CrI: -€811; €321). In the secondary analysis, adding smoke evacuation and reusable dispersive electrodes was still cost saving in 75.3% of iterations compared to Non-Ethicon advanced energy devices (mean: -€778,208; 95% CrI: -€3,075,086; €1,464,728) with a mean budget impact per procedure of -€97 (95% CrI: -€384; €183). Savings resulted from differences in operating room time, length of hospital stay, and volume of disposable electrodes. CONCLUSIONS Adopting Ethicon advanced energy devices demonstrated economic benefits compared to non-Ethicon devices. Introducing the advanced portfolio may improve surgical care quality and the full portfolio was cost saving while improving OR safety for staff and patients.
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Affiliation(s)
- Alessandra Piemontese
- EMEA Health Economics & Market Access, Johnson & Johnson Medical Devices Companies, Diegem, Belgium
| | | | | | | | - Nadine Jamous
- EMEA Health Economics & Market Access, Johnson & Johnson Medical Devices Companies, Diegem, Belgium
| | | | - Thibaut Galvain
- Global Health Economics, Johnson and Johnson Medtech, New Brunswick, NJ, USA
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20
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Riopelle AM, Potter CT, Jeong D, Schanbacher CF. Plume Generated by Different Electrosurgical Techniques: An In Vitro Experiment on Human Skin. Dermatol Surg 2022; 48:949-953. [PMID: 36054048 DOI: 10.1097/dss.0000000000003518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Plume generated by electrosurgical techniques is a health hazard to patients and dermatologists. OBJECTIVE To compare the particle concentration generated by various energy devices used in dermatologic surgery. MATERIALS AND METHODS Five surgical techniques were tested on human tissue samples in a closed chamber. A particle counter, positioned at a fixed point 20 cm away from the sample, recorded the concentrations of aerosolized particles generated over 7 particle sizes (0.3, 0.5, 0.7, 1, 2.5, 5, and 10 μm). RESULTS Monopolar electrocoagulation created the greatest concentration of particles followed by electrocautery, electrodesiccation, electrofulguration, and bipolar electrocoagulation. Bipolar electrocoagulation created 80 times fewer 0.3 μm particles and 98 times fewer 0.5 μm particles than monopolar electrocoagulation. Across all electrosurgical techniques, the greatest concentrations of particles generated were of the 0.3 and 0.5 μm particle size. CONCLUSION Bipolar electrocoagulation created the lowest concentration of particulate matter. Given the noxious and hazardous nature of surgical plume, the bipolar forceps offer surgeons a safer method of performing electrical surgery for both the surgical staff and the patient.
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Affiliation(s)
| | | | | | - Carl F Schanbacher
- Kuchnir Dermatology, Milford, Massachusetts
- Department of Dermatology, Tufts University School of Medicine, Boston, Massachusetts
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21
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Olasky J, Jones EL, Jones DB, Robinson TN. Safer operating room teams: rationale for the fundamental use of surgical energy (FUSE) hospital compliance module. Surg Endosc 2022; 36:6647-6652. [PMID: 35022829 DOI: 10.1007/s00464-021-08931-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/22/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The Fundamental Use of Surgical Energy (FUSE) program was developed by The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) to promote the safe use of surgical energy. A curriculum that could be used in hospital educational programs was needed to expand access. The goal of this project was to develop a short, inexpensive, online module that emphasizes key FUSE learning objectives. The accompanying survey assessed perceived relevancy. METHODS The SAGES FUSE Committee developed the Hospital Compliance Module. The target audience included all OR personnel. The Module was piloted at Beth Israel Deaconess Medical Center. The data were analyzed using Chi-square with Yates' correction two-tailed test. RESULTS Three-hundred-eighty individuals completed the survey: 198 (52%) surgeons, 139 (37%) nurses, 28 (7%) surgical technicians, and 15 (4%) house staff. For "…the Module taught me valuable information" 155 (41%) responded extremely and 350 (92%) responded at least somewhat. For "As a result of [the Module] how likely are you to change how you set up or use energy devices…?" 103 (27%) responded extremely and 305 (80%) responded at least somewhat. For "How likely are you to recommend this compliance module…?" 143 (38%) responded extremely and 333 (88%) responded at least somewhat. CONCLUSION The FUSE Hospital Compliance Module is effective and efficient. It should be considered for widespread distribution by hospitals to enhance staff education.
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Affiliation(s)
- Jaisa Olasky
- Department of Surgery, Harvard Medical School, Mount Auburn Hospital, 330 Mount Auburn St., Ste 407, Cambridge, MA, 02138, USA.
| | - Edward L Jones
- Department of Surgery, Rocky Mountain Regional VA Medical Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Daniel B Jones
- Department of Surgery, Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Thomas N Robinson
- Department of Surgery, Rocky Mountain Regional VA Medical Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Ehrlich J, Jamzad A, Asselin M, Rodgers JR, Kaufmann M, Haidegger T, Rudan J, Mousavi P, Fichtinger G, Ungi T. Sensor-Based Automated Detection of Electrosurgical Cautery States. Sensors 2022; 22:s22155808. [PMID: 35957364 PMCID: PMC9371045 DOI: 10.3390/s22155808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 07/30/2022] [Accepted: 08/01/2022] [Indexed: 02/04/2023]
Abstract
In computer-assisted surgery, it is typically required to detect when the tool comes into contact with the patient. In activated electrosurgery, this is known as the energy event. By continuously tracking the electrosurgical tools’ location using a navigation system, energy events can help determine locations of sensor-classified tissues. Our objective was to detect the energy event and determine the settings of electrosurgical cautery—robustly and automatically based on sensor data. This study aims to demonstrate the feasibility of using the cautery state to detect surgical incisions, without disrupting the surgical workflow. We detected current changes in the wires of the cautery device and grounding pad using non-invasive current sensors and an oscilloscope. An open-source software was implemented to apply machine learning on sensor data to detect energy events and cautery settings. Our methods classified each cautery state at an average accuracy of 95.56% across different tissue types and energy level parameters altered by surgeons during an operation. Our results demonstrate the feasibility of automatically identifying energy events during surgical incisions, which could be an important safety feature in robotic and computer-integrated surgery. This study provides a key step towards locating tissue classifications during breast cancer operations and reducing the rate of positive margins.
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Affiliation(s)
- Josh Ehrlich
- School of Computing, Queen’s University, Kingston, ON K7L 3N6, Canada; (J.E.); (A.J.); (M.A.); (J.R.R.); (P.M.); (G.F.)
| | - Amoon Jamzad
- School of Computing, Queen’s University, Kingston, ON K7L 3N6, Canada; (J.E.); (A.J.); (M.A.); (J.R.R.); (P.M.); (G.F.)
| | - Mark Asselin
- School of Computing, Queen’s University, Kingston, ON K7L 3N6, Canada; (J.E.); (A.J.); (M.A.); (J.R.R.); (P.M.); (G.F.)
| | - Jessica Robin Rodgers
- School of Computing, Queen’s University, Kingston, ON K7L 3N6, Canada; (J.E.); (A.J.); (M.A.); (J.R.R.); (P.M.); (G.F.)
| | - Martin Kaufmann
- Department of Surgery, Kingston Health Sciences Centre, Kingston, ON K7L 2V7, Canada; (M.K.); (J.R.)
| | - Tamas Haidegger
- University Research and Innovation Center (EKIK), Óbuda University, 1034 Budapest, Hungary
- Correspondence: (T.H.); (T.U.)
| | - John Rudan
- Department of Surgery, Kingston Health Sciences Centre, Kingston, ON K7L 2V7, Canada; (M.K.); (J.R.)
| | - Parvin Mousavi
- School of Computing, Queen’s University, Kingston, ON K7L 3N6, Canada; (J.E.); (A.J.); (M.A.); (J.R.R.); (P.M.); (G.F.)
| | - Gabor Fichtinger
- School of Computing, Queen’s University, Kingston, ON K7L 3N6, Canada; (J.E.); (A.J.); (M.A.); (J.R.R.); (P.M.); (G.F.)
| | - Tamas Ungi
- School of Computing, Queen’s University, Kingston, ON K7L 3N6, Canada; (J.E.); (A.J.); (M.A.); (J.R.R.); (P.M.); (G.F.)
- Correspondence: (T.H.); (T.U.)
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Wright R. Clinical Issues-August 2022. AORN J 2022; 116:185-192. [PMID: 35880919 DOI: 10.1002/aorn.13750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 11/07/2022]
Abstract
Use of sterile vests Key words: sterile technique, surgical attire, gown, contaminated, back. Bare arms for unscrubbed personnel Key words: long sleeves, cover jacket, disposable jacket, patient skin antisepsis, surgical site infection (SSI). Preventing thermal injury from electrosurgical devices Key words: electrosurgical unit (ESU), monopolar electrosurgical device, electrode, alternate site thermal injury, burn. Preoperative site marking for minimally invasive procedures Key words: surgical site, wrong-site surgery, alternative site marking, point of access, preprocedure verification.
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Cha HH, Seong WJ, Kim HM, Seol HJ, Sung JH, Park HS, Hwang HS, Kwon H, Jung YJ, Kwon JY, Oh SY. Midtrimester cervical elastography in pregnant women with a history of loop electrosurgical excision procedure (LEEP). Sci Rep 2022; 12:9191. [PMID: 35655076 PMCID: PMC9163180 DOI: 10.1038/s41598-022-13170-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 05/20/2022] [Indexed: 11/10/2022] Open
Abstract
We aimed to compare cervical elastographic parameters based on a previous loop electrosurgical excision procedure (LEEP) and to determine whether they can predict preterm delivery in pregnant women with a history of LEEP. This multicenter prospective case-control study included 71 singleton pregnant women at 14-24 weeks of gestation with a history of LEEP and 1:2 gestational age-matched controls. We performed cervical elastography using E-cervix and compared maternal characteristics, delivery outcomes, cervical length (CL), and elastographic parameters between the two groups. The median mid-trimester CL was significantly shorter in the LEEP group. Most elastographic parameters, including internal os (IOS), external os (EOS), elasticity contrast index (ECI), and hardness ratio (HR), were significantly different in the two groups. In the LEEP group, the sPTD group compared to the term delivery (TD) group showed a higher rate of previous sPTD (50% vs. 1.7%, p < 0.001), higher IOS and ECI (IOS: 0.28 [0.12-0.37] vs. 0.19 [0.10-0.37], p = 0.029; ECI: 3.89 [1.79-4.86] vs. 2.73 [1.48-5.43], p = 0.019), and lower HR (59.97 [43.88-92.43] vs. 79.06 [36.87-95.40], p = 0.028), but there was no significant difference in CL (2.92 [2.16-3.76] vs. 3.13 [1.50-3.16], p = 0.247). In conclusion, we demonstrated that a history of LEEP was associated with a change in cervical strain measured in mid-trimester as well as with CL shortening. We also showed that cervical elastography can be useful in predicting sPTD in pregnant women with previous LEEP.
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Affiliation(s)
- Hyun-Hwa Cha
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University Chilgok Hospital, Kyungpook National University, Daegu, Korea
| | - Won Joon Seong
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University Chilgok Hospital, Kyungpook National University, Daegu, Korea
| | - Hyun Mi Kim
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University Chilgok Hospital, Kyungpook National University, Daegu, Korea
| | - Hyun-Joo Seol
- Department of Obstetrics and Gynecology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Ji-Hee Sung
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Hyun Soo Park
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Dongguk University, Goyang, Korea
| | - Han-Sung Hwang
- Department of Obstetrics and Gynecology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Hayan Kwon
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Yun Ji Jung
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Ja-Young Kwon
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Soo-Young Oh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea.
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Grube M, Weiss M, Walter CB, Neis F, Hoffmann S, Andress J, Kommoss S, Brucker SY, Krämer B. Electrosurgery and Other Technical Advancements in Minimally Invasive Gynecological Surgery - An Update. Surg Technol Int 2022; 40:190-196. [PMID: 35443283 DOI: 10.52198/22.sti.40.gy1544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Electrosurgery in gynecology has changed over the past few decades. The use of energy-based devices, especially in minimally invasive procedures, is extremely important for preparation, short reconvalescence and patient safety. Recently, there have been major advances in energy-based surgical devices that have further shortened OR time and increased patient safety. Although bipolar and monopolar electrosurgery is still very important, the introduction of high-frequency ultrasound in gynecologic surgery has improved cutting and coagulation by lowering thermal damage in the surrounding tissue. Furthermore, new technical inventions have fundamentally changed the treatment of specific diseases. The introduction of ablation in the therapy of uterine fibroids, for example, has made conventional myomectomy no longer necessary in some cases, as necrosis of fibroids can be induced by placing very small thermal probes into the fibroids. Robotic surgery will change the face of gynecological surgery in the near future, as the initial studies could show lower surgical morbidity and faster recovery of patients after robotic-assisted laparoscopy. In this article we provide a short overview of current technical advances, review possible indications as well as limitations, and take a look into the future of minimally invasive surgery in gynecology.
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Affiliation(s)
- Marcel Grube
- Department of Women's Health, Tuebingen University Hospital, Tuebingen, Germany
| | - Martin Weiss
- Department of Women's Health, Tuebingen University Hospital, Tuebingen, Germany
| | - Christina B Walter
- Department of Women's Health, Tuebingen University Hospital, Tuebingen, Germany
| | - Felix Neis
- Department of Women's Health, Tuebingen University Hospital, Tuebingen, Germany
| | - Sascha Hoffmann
- Department of Women's Health, Tuebingen University Hospital, Tuebingen, Germany
| | - Juergen Andress
- Department of Women's Health, Tuebingen University Hospital, Tuebingen, Germany
| | - Stefan Kommoss
- Department of Women's Health, Tuebingen University Hospital, Tuebingen, Germany
| | - Sara Y Brucker
- Department of Women's Health, Tuebingen University Hospital, Tuebingen, Germany
| | - Bernhard Krämer
- Department of Women's Health, Tuebingen University Hospital, Tuebingen, Germany
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Bai ZP, Yao HW, Zhang HH. Experimental study on fire characteristics in cable compartment of utility tunnel with natural ventilation. PLoS One 2022; 17:e0266773. [PMID: 35395056 PMCID: PMC8992984 DOI: 10.1371/journal.pone.0266773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/27/2022] [Indexed: 11/19/2022] Open
Abstract
The fire characteristics under natural ventilation in the cable compartment of the utility tunnel are studied. A series of small-scale fire experimental tests are conducted to obtain the maximum temperature below the ceiling of different ignition vertical heights and cable types. In this paper, the ceiling temperature decay and heat release rate (HRR) are studied in the cable compartment of utility tunnel. Through experimental tests, the fire characteristics of placing the fire source on the near wall side 3.0 m away from the shaft of the utility tunnel cable compartment are studied. The results showed that under the action of natural ventilation, with the decrease of fuel quantity, the mass loss of cable decreases, and the maximum temperature below the ceiling of the cable compartment in the utility tunnel decreases. ZRYJV cables burn more sufficient combustion than RVVR cables. A new empirical association for total HRR is proposed. Those experimental test results are used as validation data for the newly proposed empirical correlation of total HRR. This paper hopes to provide some basic fire safety references for the utility tunnel planning of the urban underground cable compartment.
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Affiliation(s)
- Z. P. Bai
- Department of College of Building Environment Engineering, Zhengzhou University of Light Industry, Zhengzhou, China
| | - H. W. Yao
- Department of College of Building Environment Engineering, Zhengzhou University of Light Industry, Zhengzhou, China
- * E-mail: (HWY); (HHZ)
| | - H. H. Zhang
- Zhengzhou Real Estate Group Investment Management Co., Ltd, Zhengzhou, China
- * E-mail: (HWY); (HHZ)
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Neuhaus H. What can therapeutic endoscopists learn from the use of electrosurgery in papillectomy? Gastrointest Endosc 2022; 95:777-779. [PMID: 35183360 DOI: 10.1016/j.gie.2021.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 12/17/2021] [Indexed: 12/11/2022]
Affiliation(s)
- Horst Neuhaus
- Department of Internal Medicine, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany
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Ostapovych U, Vortman R. Implementing a Surgical Smoke Evacuation Policy and Procedure: A Quality Improvement Project. AORN J 2022; 115:139-146. [PMID: 35084765 DOI: 10.1002/aorn.13603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/09/2021] [Accepted: 05/03/2021] [Indexed: 11/11/2022]
Abstract
Energy-generating surgical devices (eg, electrosurgical units, lasers) produce surgical smoke that can cause negative health effects in exposed individuals. In 2019, a review of nursing documentation at an urban teaching hospital revealed that personnel were properly evacuating surgical smoke during less than 0.5% of applicable procedures. To address the noncompliance and reduce exposure to surgical smoke, an interdisciplinary team initiated a quality improvement project to implement a surgical smoke evacuation policy for all smoke-generating procedures. The project included creation and implementation of a smoke evacuation policy, staff member education on the hazards of surgical smoke and proper evacuation device use, and acquisition of the proper smoke evacuation equipment. After instituting the policy in June 2020, results of a three-month chart audit showed that there was nursing documentation confirming personnel used energy-generating devices and the corresponding surgical smoke evacuation devices during 664 of 2,224 procedures, for a compliance rate of 30%.
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Abstract
Electrosurgery applies high frequency alternating electrical currents to generate heat, thereby creating tissue damage required for cutting, hemostasis, or destruction. Electrosurgery can be delivered in a variety of different ways and can be tailored to achieve the desired clinical effect. Having a command of the underlying principles of electrosurgery will help dermatologic surgeons use the appropriate form of electrosurgery to safely achieve the desired results. We reviewed basic principles of electrosurgery, described the various techniques and devices, and delineated associated risks of electrosurgery for specific patient populations and providers. All modalities of electrosurgery present a risk of electromagnetic interference, which can negatively affect patients with implanted devices, such as pacemakers, defibrillators, cochlear implants, and deep brain stimulators. In particular, electrosurgery may create a smoke plume containing a number of volatile organic compounds potentially noxious; however, the risk of such exposure remains unknown.
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Affiliation(s)
- Ariana Eginli
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
| | - Wasim Haidari
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Michael Farhangian
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Phillip M Williford
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Chung MH, De Vuyst H, Greene SA, Mugo NR, Querec TD, Nyongesa-Malava E, Cagle A, Sakr SR, Luchters S, Temmerman M, Unger ER, McGrath CJ. Human Papillomavirus Persistence and Association With Recurrent Cervical Intraepithelial Neoplasia After Cryotherapy vs Loop Electrosurgical Excision Procedure Among HIV-Positive Women: A Secondary Analysis of a Randomized Clinical Trial. JAMA Oncol 2021; 7:1514-1520. [PMID: 34351377 PMCID: PMC8343498 DOI: 10.1001/jamaoncol.2021.2683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IMPORTANCE Persistence of cervical high-risk human papillomavirus (hrHPV) after treatment for cervical intraepithelial neoplasia grade 2 or higher (CIN2+) has not been compared between cryotherapy and loop electrosurgical excision procedure (LEEP) among HIV-positive women. OBJECTIVE To evaluate whether cryotherapy or LEEP is more effective at clearing hrHPV and whether persistent hrHPV is associated with CIN2+ recurrence among HIV-positive women. DESIGN, SETTING, AND PARTICIPANTS This is a secondary analysis of a randomized clinical trial conducted among women with HIV, hrHPV, and CIN2+ in Nairobi, Kenya. From June 2011 to September 2016, 354 HIV-positive women with CIN2+ disease had hrHPV cervical samples collected before and after treatment with cryotherapy or LEEP. Data were analyzed from September 2018 to January 2021. INTERVENTIONS Women were randomized 1:1 to receive cryotherapy or LEEP and were followed up every 6 months for 24 months with hrHPV cervical swab and Papanicolaou test with confirmatory biopsy. MAIN OUTCOMES AND MEASURES The main outcomes of this analysis were hrHPV positivity defined as having 1 of 12 hrHPV types (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59) and disease recurrence defined as CIN grade 2 or higher as determined with cervical biopsy. RESULTS A total of 354 HIV-positive women with CIN2+ were included in the study; mean (SD) age was 37 (8) years in the cryotherapy arm and 38 (9) years in the LEEP arm. Baseline hrHPV prevalence was 90% (160 of 177) in the cryotherapy arm and 94% (166 of 177) in the LEEP arm (P = .24), and the most common hrHPV types detected were 16 (87 of 326 [27%]), 58 (87 of 326 [27%]), 35 (86 of 326 [26%]), 52 (66 of 326 [20%]), and 18 (56 of 325 [17%]). Over 24 months, clearance of hrHPV was significantly higher among those who underwent LEEP compared with cryotherapy (hazard ratio, 1.40; 95% CI, 1.03-1.90; P = .03). In multivariable analysis, hrHPV type-specific persistence at 12-month follow-up was significantly associated with CIN2+ recurrence from 12 months to 24 months (adjusted hazard ratio, 4.70; 95% CI, 2.47-8.95; P < .001). Performance of hrHPV testing at 12 months for recurrent CIN2+ was 93% sensitivity, 46% specificity, 38% positive predictive value, and 95% negative predictive value. CONCLUSIONS AND RELEVANCE In this secondary analysis of a randomized clinical trial, HIV-positive women who received LEEP were more likely to clear hrHPV infection compared with those undergoing cryotherapy, reinforcing the efficacy of LEEP in this population. Persistent hrHPV was significantly associated with recurrent CIN2+, suggesting that LEEP's benefits may be related in part to its ability to clear hrHPV infection. Screening for hrHPV infection after treatment among HIV-positive women may be used to rule out recurrent CIN disease given its high sensitivity and negative predictive value. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01298596.
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Affiliation(s)
- Michael H Chung
- Department of Medicine, Emory University, Atlanta, Georgia
- Department of Global Health, University of Washington, Seattle
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Hugo De Vuyst
- Early Detection, Prevention, and Infections Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France
| | - Sharon A Greene
- Department of Global Health, University of Washington, Seattle
| | - Nelly R Mugo
- Department of Global Health, University of Washington, Seattle
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Troy D Querec
- Chronic Viral Diseases Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Anthony Cagle
- Department of Global Health, University of Washington, Seattle
| | | | - Stanley Luchters
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Department of Population Health, Aga Khan University, Nairobi, Kenya
| | - Marleen Temmerman
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Department of Obstetrics and Gynecology, Aga Khan University, Nairobi, Kenya
| | - Elizabeth R Unger
- Chronic Viral Diseases Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
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Leung SOA, Vitonis AF, Feldman S. Loop Electrosurgical Excision Procedure in Managing Persistent Low-Grade Abnormality or Human Papillomavirus Positivity. J Low Genit Tract Dis 2021; 25:281-286. [PMID: 34284456 DOI: 10.1097/lgt.0000000000000619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aims of the study were to estimate the rate and to identify predictors of high-grade abnormalities among women with persistent low-grade abnormalities or high-risk human papillomavirus (hrHPV) positivity for at least 2 years stratified by presence (high risk) or absence (low risk) of previous high-grade results or HPV 16/18. MATERIALS AND METHODS A retrospective cohort study of patients who underwent a loop electrosurgical excision procedure (LEEP) for persistent low-grade or hrHPV positivity was performed. Patients were stratified based on whether they had a history of high-grade and/or HPV 16/18 positivity. Rates of high-grade or worse abnormalities on LEEP were compared using Fisher exact tests. Logistic regression was used to evaluate the associations between patient characteristics and high-grade results on the LEEP. RESULTS Three hundred eleven LEEPs were performed for persistent low-grade or hrHPV positivity. The rates of occult high grade were 12% and 22% among the low- and high-risk groups, respectively. Compared with those 45 years and older, the adjusted odds of high grade was 3.79 (95% CI = 1.19-12.1) for women aged 25-29 years. The odds of high grade was higher among current versus never smokers (6.40; 95% CI = 2.01-20.4) and those with a history of high-grade abnormality (2.23; 95% CI = 1.12-4.43). At 2 years, approximately half had an abnormal cytology and/or hrHPV positivity result independent of whether high grade was identified on their LEEP specimen. CONCLUSIONS Patients with persistent low-grade abnormalities or persistent hrHPV should be counseled on the risks and benefits of a LEEP given that 12%-22% have a risk of occult high grade, especially if they have a history of high-grade dysplasia.
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Affiliation(s)
- Shuk On Annie Leung
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, McGill University Health Centre, McGill University, Montreal, QC
| | - Allison F Vitonis
- Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital, Boston, MA
| | - Sarah Feldman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA
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Balytskyy V, Zakharash M, Kuryk O. THE RESULTS OF SURGICAL TRATMENT OF COMBINED ANORECTAL DISEASES USING RADIO-FREQUENCY AND HIGH-FREQUENCY ELECTROSURGICAL DEVICES. Georgian Med News 2021:13-19. [PMID: 34628371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The combined pathology of the anal canal and rectum is a very important problem today, due to its progressive growth, especially in industrialized countries over the past two or three decades. The aim of the study was to conduct a comparative assessment of using high-frequency electrosurgical devices and also radio-frequency device for treatment of combined anal саnal and rectal pathology. The results of treatment of 635 patients with combined anal canal and rectal diseases have been analyzed. Using high-frequency electrosurgical device "ERBE ICC 200" (ERBE Elektromedizin GmbH, Germany) have been operated on 169 (26,6%) patients, high-frequency electrosurgical device "EFA" (Russia) - 114 (17,9%) patients, high-frequency electrosurgical device "KLS Martin" (KLS Martin Group, Germany)- 107 (16,9%) patients and radio-frequency device "Surgitron" (Ellman International, USA) - 245 (38,6%) patients. After operations for assessment the effectiveness of using the above technologies all patients in each group were underwent to morphological investigations of anal canal and rectal tissues to study the depth of coagulation necrosis. In case of using of the high-frequency electrosurgical device "ERBE ICC 200" the incision of tissues occurred with formation of coagulation necrosis layer, which thickness was 0,113-0,457mm, in case of using high-frequency electrosurgical device "EFA" a layer of coagulation necrosis formed with thickness 0,074-0,434mm, in case of using high-frequency electrosurgical device"KLS Martin" forms a thin layer of coagulation necrosis in the thickness along the edge of the cut 0,053-0,333 mm and using of radio-frequency device "Surgitron" was accompanied with the formation on the cut edge of a thin coagulation necrosis layer with depth 0,037-0,297mm. Application of these modern radio-frequency and high-frequency technologies, due to the minimal and slight influence on tissues, contributes to reducing the operations duration, intensity of the postoperative pain, improving the terms of patients rehabilitation.
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Affiliation(s)
- V Balytskyy
- 1Vinnytsia National M.I. Pyrogov Memorial Medical University; 2Khmel`nyts`kyi regional hospital, Khmel`nyts`kyi; Ukraine
| | - M Zakharash
- 3Bogomolets National Medical University, Kyiv, Ukraine
| | - O Kuryk
- 3Bogomolets National Medical University, Kyiv, Ukraine
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Abdulaziz AM, You X, Liu L, Sun Y, Zhang J, Sun S, Li X, Sun W, Dong Y, Liu H, Zhang Y. Management of high-grade squamous intraepithelial lesion patients with positive margin after LEEP conization: A retrospective study. Medicine (Baltimore) 2021; 100:e26030. [PMID: 34011112 PMCID: PMC8137043 DOI: 10.1097/md.0000000000026030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 05/03/2021] [Indexed: 12/12/2022] Open
Abstract
To explore the optimal way to manage patients with high-grade squamous intraepithelial lesion (HSIL) and positive margin by identifying the risk factors for its recurrence and residue.A retrospective study was conducted on 267 cases of a pathologically confirmed HSIL with positive margin following conization by loop electrosurgical excisional procedure (LEEP) between January 2010 and December 2015. One hundred two cases were selected for regular follow-up every 6 months, and 165 cases were selected for a second surgery (repeat cervical conization or hysterectomy) within 3 months of initial LEEP. We analyzed the association between recurrent or residual diseases and these factors: age, menopausal status, ThinPrep cytologic test (TCT) results, high-risk human papillomavirus (HR-HPV) infection, pathological grades of the margin, number of involved margins, and glandular involvement.The recurrence rate among 102 cases who underwent follow-up was 17.6% (18/102). The factors: atypical squamous cells of undetermined significance cannot exclude HSIL (ASC-H) or higher lesions in the pre-LEEP TCT (P = .038), persistent HR-HPV infection at the 6th month post-LEEP (P = .03), HSIL-positive margin (P = .003), and multifocal-involved margin (P = .002) were significantly associated with recurrent disease, while age, menopause, and pre-LEEP HR-HPV infection were not associated with recurrent disease (P > .05). The residual rate among 165 patients who underwent a second surgery was 45.5% (75/165), of which 15 cases were residual cervical cancer. The factors: menopause (P = .02), ≥ASC-H in pre-LEEP TCT (P = .04), pre-LEEP HR-HPV infection (P = .04), ≥HSIL-positive margin (P < .001), and multifocal-involved margin (P < .001) significantly increased the risk of residual disease. No correlation existed between residual disease and age or glandular involvement (P > .05).For patients with a positive margin after LEEP, regular follow-up or second surgery should be selected according to fertility requirement and pathological characteristics of the positive margin, as well as TCT and HR-HPV infection condition.
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Tashima H, Tomita K, Kurita T, Kubo T. Efficacy of Low Power, Pure Cut Mode of Monopolar Electrosurgery and Quilting Sutures for Preventing Seroma Formation After Latissimus Dorsi Myocutaneous Flap Harvest. Ann Plast Surg 2021; 86:265-267. [PMID: 33555680 DOI: 10.1097/sap.0000000000002545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Latissimus dorsi myocutaneous (LD) flaps are widely used in breast reconstruction surgery. However, seromas often form postoperatively at the donor site as a complication. This study aimed to determine the impact of different electrocautery modes during flap elevation, with or without subsequent quilting sutures, on postoperative seroma formation. METHODS Subjects were 112 patients who underwent immediate breast reconstruction with LD flaps after breast-conserving surgery between April 2015 and January 2019. Group A consisted of 21 patients who underwent LD flap elevation using the fulgurate mode, and group B consisted of 25 patients who underwent flap elevation using the lower power, pure cut mode. Group C consisted of 66 patients who underwent flap elevation with the lower power, pure cut mode combined with quilting sutures for wound closure. RESULTS Mean 1-week postoperative back drain volume and the mean number of days to drain removal in group B were significantly reduced relative to those in group A (group A, 752.3 mL and 16.9 days, respectively; group B, 552.2 mL and 10.6 days, respectively; P < 0.001 for both). Group C, which included quilting sutures, had even lower values than group B (459.7 mL and 7.4 days, respectively; group B vs group C: P = 0.03 and P < 0.001, respectively). Significant differences were observed between groups for postoperative seroma formation at the flap donor site (group A, 16 [76.2%] of 21 patients; group B, 11 [44%] 25 patients; group C, 4 [6.1%] of 66 patients; A vs B: P < 0.001, B vs C: P < 0.001). CONCLUSIONS The use of low power, pure cut mode for LD flap harvest, combined with quilting sutures, effectively shortened the time to drain removal and suppressed seroma formation. Given that specialized devices and materials are not required, this combination may reduce both patient burden and medical costs.
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Affiliation(s)
| | - Koichi Tomita
- From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Osaka University
| | - Tomoyuki Kurita
- Department of Plastic Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Tateki Kubo
- From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Osaka University
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Benn BS, Lum M, Krishna G. Bronchoscopic Treatment of Airway Obstructions With a Novel Electrosurgical Device. J Bronchology Interv Pulmonol 2021; 28:34-41. [PMID: 32265362 DOI: 10.1097/lbr.0000000000000675] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 03/03/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Airway obstructions (AOs) in the central airway or lobar bronchi develop due to malignant or benign disease. Because of the morbidity and mortality associated with AO, it is important to develop additional therapeutic ablative techniques. CoreCath2.7S is a novel monopolar radiofrequency electrosurgical device approved to treat obstructions of the upper airway and tracheobronchial tree by both cutting soft tissue and providing electrosurgical hemostasis. We present a large case series describing its use. METHODS Retrospective chart review was performed of all patients with AO undergoing airway recanalization with CoreCath2.7S at 2 interventional pulmonology practices from October 2017 to May 2019. Demographic information, AO etiology, location, and degree, and therapeutic modalities used were recorded. RESULTS Fifty-three patients underwent 64 procedures for AO due to malignant (n=30, 57%) or benign (n=23, 43%) disease. AOs were treated in the trachea (n=28), mainstem bronchi (n=23), and lobar bronchi (n=17). All AO occluded the airway at least 50%. Adjunctive therapeutic modalities were commonly used (n=60, 94%), including flexible cryoprobe (n=33), balloon dilation (n=23), rigid bronchoscopy (n=19), spray cryotherapy (n=19), argon plasma coagulation (n=14), and stenting (n=5). Restoration of airway patency was achieved in all cases without any periprocedural or immediate postprocedural complications. CONCLUSION CoreCath2.7S was successfully used to treat patients with AO due to malignant or benign disease. Airway patency was restored with no periprocedural or immediate postprocedural complications. It should be considered as another therapeutic modality in the growing field of ablative techniques for the treatment of AO.
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Affiliation(s)
- Bryan S Benn
- Department of Medicine, Division of Pulmonary and Critical Care, University of California, Irvine
| | - Mendy Lum
- Respiratory Care Services, El Camino Hospital, Mountain View
| | - Ganesh Krishna
- Department of Medicine, Division of Pulmonary and Critical Care, University of California, San Francisco
- Department of Medicine, Division of Pulmonary and Critical Care, Palo Alto Medical Foundation, Palo Alto, CA
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Chung MH, De Vuyst H, Greene SA, Topazian HM, Sayed S, Moloo Z, Cagle A, Nyongesa-Malava E, Luchters S, Temmerman M, Sakr SR, Mugo NR, McGrath CJ. Loop electrosurgical excision procedure (LEEP) plus top hat for HIV-infected women with endocervical intraepithelial neoplasia in Kenya. Int J Gynaecol Obstet 2021; 152:118-124. [PMID: 33145753 DOI: 10.1002/ijgo.13466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/15/2020] [Accepted: 11/02/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To determine the utility of detecting endocervical cervical intraepithelial neoplasia (CIN) 2+ with endocervical curettage (ECC) and treating with loop electrosurgical excision procedure (LEEP) plus top hat (+TH) among women with HIV. METHODS Cytology was followed by coloscopy-directed biopsy if participants had HSIL or ASC-H and biopsy plus ECC if there were glandular cells present. CIN2/3 on ECC and/or inadequate colposcopy (ENL) was treated with LEEP+TH, while CIN2/3 on ectocervix (ECL) received LEEP alone. Recurrent CIN2+ were compared over a 2-year follow-up. RESULTS Of 5330 participants, 160 underwent ECC, 98 were CIN2/3 on ECC, and 77 received LEEP+TH. ECC detected 15 (9%) more women with CIN2/3 than biopsy alone. Women were more likely to have ENL if they were older (≥45 vs <35 years) (adjusted relative risk [aRR] 2.14; P = 0.009) and on antiretroviral treatment longer (≥2 vs <2 years) (aRR 3.97; P < 0.001). Over the 2-year follow-up, 35 (29%) ENL had recurrent CIN2+ after TH compared to 19 (24%) ECL after LEEP (hazard ratio 1.32; 95% confidence interval 0.75-2.31; P = 0.338). CONCLUSION Among HIV-infected women, adding ECC did not increase detection of pre-cancerous disease significantly and treatment with LEEP+TH for ENL was comparable to treatment with LEEP for ECL.
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Affiliation(s)
- Michael H Chung
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Department of Medicine, Emory University, Atlanta, GA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Hugo De Vuyst
- Prevention and Implementation Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Sharon A Greene
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Hillary M Topazian
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Shahin Sayed
- Department of Pathology, Aga Khan University, Nairobi, Kenya
| | - Zahir Moloo
- Department of Pathology, Aga Khan University, Nairobi, Kenya
| | - Anthony Cagle
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Stanley Luchters
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Department of Population Health, Aga Khan University, Nairobi, Kenya
| | - Marleen Temmerman
- Department of Obstetrics & Gynecology, Aga Khan University, Nairobi, Kenya
| | - Samah R Sakr
- Department of Surgery, Coptic Hospital, Nairobi, Kenya
| | - Nelly R Mugo
- Department of Global Health, University of Washington, Seattle, WA, USA
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
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Lisko JC, Greenbaum AB, Guyton RA, Kamioka N, Grubb KJ, Gleason PT, Byku I, Condado JF, Jadue A, Paone G, Block PC, Alvarez L, Xie J, Khan JM, Rogers T, Lederman RJ, Babaliaros VC. Electrosurgical Detachment of MitraClips From the Anterior Mitral Leaflet Prior to Transcatheter Mitral Valve Implantation. JACC Cardiovasc Interv 2020; 13:2361-2370. [PMID: 33011144 PMCID: PMC7584767 DOI: 10.1016/j.jcin.2020.06.047] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/20/2020] [Accepted: 06/18/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The aim of this study was to test the hypothesis that transcatheter electrosurgery might allow intentional detachment of previously placed MitraClip(s) from the anterior leaflet to recreate a single mitral orifice for transcatheter mitral valve implantation (TMVI), leaving the retained MitraClip(s) securely fastened to the posterior leaflet and without interfering with the mitral bioprosthesis. BACKGROUND Patients with severe mitral regurgitation or stenosis despite edge-to-edge mitral repair with the MitraClip typically have few therapeutic options because the resultant double orifice precludes TMVI. Transcatheter electrosurgery may allow detachment of failed MitraClip(s) from the anterior leaflet to recreate a single orifice for TMVI. METHODS This was a single-center, 5-patient, consecutive, retrospective observational cohort. Patients underwent transcatheter electrosurgical laceration and stabilization of failed MitraClip(s) to recreate a single orifice, leaving the MitraClip(s) securely fastened to the posterior leaflet. Subsequently, patients underwent TMVI with an investigational device, the Tendyne mitral bioprosthesis, on a compassionate basis. Patients were followed up to 30 days. RESULTS MitraClip detachment from the anterior leaflet and Tendyne implantation were successful in all patients. All patients survived to discharge. All patients were discharged with grade 0 central mitral regurgitation. Two patients had moderate perivalvular mitral regurgitation that did not require reintervention. During the follow-up period of 30 days, there were no deaths, cases of valve dysfunction, or reintervention. There was no evidence of erosion or bioprosthetic valve dysfunction attributable to the retained MitraClip(s) still attached to the posterior leaflet. CONCLUSIONS Transcatheter electrosurgical detachment of failed MitraClips from the anterior leaflet followed by TMVI is technically feasible and safe at 30 days. Longer term study is needed to determine the clinical benefit of this approach and new algorithms for TMVI sizing following electrosurgical laceration and stabilization of a failed MitraClip to avoid perivalvular leak.
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Affiliation(s)
- John C Lisko
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Adam B Greenbaum
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Robert A Guyton
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Norihiko Kamioka
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Kendra J Grubb
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Patrick T Gleason
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Isida Byku
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Jose F Condado
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Andres Jadue
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Gaetano Paone
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Peter C Block
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Lucia Alvarez
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Joe Xie
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Jaffar M Khan
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Toby Rogers
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Vasilis C Babaliaros
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia.
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Lutfallah C, Looi T, Drake J. A Novel Bipolar Cautery Tool for Minimally-Invasive Neuroendoscopic Procedures. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2020:6062-6065. [PMID: 33019353 DOI: 10.1109/embc44109.2020.9176415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Electrosurgery is used in the operating room on a daily basis as a means to cut tissue and maintain hemostasis. The principle of this technology lies in the transfer of electricity from an electrosurgical unit to the operating site on a patient's body and modifying the waveform of that electricity to achieve the desired surgical effect. Bipolar cautery uses two electrodes, an active and a return, both at the surgical site to perform electrosurgery. Bipolar cautery can be very useful in helping surgeons to operate; however, current designs are not well suited to a 2.1 mm working channel in endoscopic procedures due to their rigid structure, limited range of motion, and bulky design. This paper describes a novel approach to designing a minimally- invasive bipolar cautery tool suitable for flexible neuroendoscopy. The system features 1.9 mm diameter bipolar tips which resemble grasping forceps, making it easier for surgeons to hold tissue while performing electrosurgery. The electrode wires also function as the actuating cables used to open and close the tips, which require 2.10 mm to open the tips to 30.9 °. The results show that the tool can safely cauterize a porcine brain specimen at various settings on the electrosurgical unit, and increasing the setting increases the area of tissue affected by the electricity. Repeatability was demonstrated and exhaustion was reached after the tool was opened and closed 73 times. Future work will involve improving the current design to increase the number of cycles the tool can survive before losing function.
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Jagannathan R, Rajendran S, Balaji TM, Varadarajan S, Sridhar LP. Comparative Evaluation of Gingival Depigmentation by Scalpel, Electrosurgery, and Laser: A 14 Months' Follow-up Study. J Contemp Dent Pract 2020; 21:1159-1164. [PMID: 33686040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
AIM AND OBJECTIVE The aim of the study was to compare three different techniques using scalpel, electrosurgery, and laser for gingival depigmentation in terms of pain, discomfort, duration of procedure, wound healing, and repigmentation. MATERIALS AND METHODS Thirty patients in the age range of 24-38 years were briefed about the surgical procedure and an informed consent was obtained and they were randomly allocated into three groups of 10 individuals (5 males and 5 females) each: those undergoing depigmentation with scalpel (group I), electrosurgery (group II), and diode lasers (Biolase) (group III). Individuals of all three groups were asked to describe the level of pain and discomfort by using the visual analog scale (VAS) 2 hours, 24 hours, and 1 week postoperatively. Further, the groups were compared based on duration of procedure, wound healing, and repigmentation at the end of 14 months. RESULTS All the groups showed a decrease in the pain levels, which was statistically highly significant 1 week postoperatively when compared 24 hours postoperatively. There was a statistically significant difference in the pain levels between the scalpel, electrosurgery, and lasers groups after 24 hours (p < 0.001), with the lasers group demonstrating significantly less pain and discomfort. There was significant difference between the groups with respect to the duration of procedure, with less mean time for completion of the procedure observed for group III. Furthermore, less time for wound healing was observed in group III as compared to other groups. Total 8 out 10 patients in group I, 7 out of 10 patients in group II, and 2 out of 10 patients in group III showed repigmentation at the end of 14 months. CONCLUSION The rising concern for esthetic demand of an individual requires the removal of hyperpigmented gingival areas to create a confident and pleasing smile, which could be easily attained by using laser. CLINICAL SIGNIFICANCE Laser is an effective and fast tool that causes less pain, discomfort, faster healing, and delayed repigmentation compared with scalpel or electrosurgery for gingival depigmentation.
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Affiliation(s)
- Raghunathan Jagannathan
- Department of Periodontics, Tagore Dental College and Hospital, Chennai, Tamil Nadu, India, Phone: +91 9884957327, e-mail:
| | | | - Thodur Madapusi Balaji
- Department of Dentistry, Bharathirajaa Hospital and Research Centre, Chennai, Tamil Nadu, India
| | - Saranya Varadarajan
- Department of Oral Pathology and Microbiology, Sri Venkateswara Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Lakshmi Priya Sridhar
- Department of Pedodontics and Preventive Dentistry, Tagore Dental College and Hospital, Chennai, Tamil Nadu, India
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Croke L. Best practices for reporting electrosurgical unit malfunctions. AORN J 2020; 112:P5. [PMID: 32598058 DOI: 10.1002/aorn.13122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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KIYKAÇ ALTINBAŞ Ş, TAPISIZ ÖL, ENGİN ÜSTÜN Y. Gynecological laparoscopic surgery in the shade of COVID-19 pandemic. Turk J Med Sci 2020; 50:659-663. [PMID: 32351102 PMCID: PMC7379405 DOI: 10.3906/sag-2004-272] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 04/29/2020] [Indexed: 11/03/2022] Open
Abstract
A global public health problem with a high rate spread and transmission, Coronavirus outbreak has become the most talked-about matter throughout the world. We are severely affected by the nations with vast numbers of deaths; it was hard to predict such a colossal pandemic with terrifying consequences. Elective surgeries are limited, but situations requiring an urgent gynaecological or obstetric surgical approach must still be performed during the COVID-19 pandemic. Concerns regarding surgical safety and the risk of viral transmission during surgery are of great importance. In this review, we aimed to summarize the concepts related to laparoscopic gynecological surgery during COVID-19 pandemic in the light of current literature.
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Affiliation(s)
- Şadıman KIYKAÇ ALTINBAŞ
- University of Health Sciences, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, AnkaraTurkey
| | - Ömer Lütfi TAPISIZ
- University of Health Sciences, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, AnkaraTurkey
| | - Yaprak ENGİN ÜSTÜN
- University of Health Sciences, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, AnkaraTurkey
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Zhang J, Chauhan S. Fast computation of soft tissue thermal response under deformation based on fast explicit dynamics finite element algorithm for surgical simulation. Comput Methods Programs Biomed 2020; 187:105244. [PMID: 31805458 DOI: 10.1016/j.cmpb.2019.105244] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 11/03/2019] [Accepted: 11/26/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVES During thermal heating surgical procedures such as electrosurgery, thermal ablative treatment and hyperthermia, soft tissue deformation due to surgical tool-tissue interaction and patient movement can affect the distribution of thermal energy induced. Soft tissue temperature must be obtained from the deformed tissue for precise delivery of thermal energy. However, the classical Pennes bio-heat transfer model can handle only the static non-moving state of tissue. In addition, in order to enable a surgeon to visualise the simulated results immediately, the solution procedure must be suitable for real-time thermal applications. METHODS This paper presents a formulation of bio-heat transfer under the effect of soft tissue deformation for fast or near real-time tissue temperature prediction, based on fast explicit dynamics finite element algorithm (FED-FEM) for transient heat transfer. The proposed thermal analysis under deformation is achieved by transformation of the unknown deformed tissue state to the known initial static state via a mapping function. The appropriateness and effectiveness of the proposed formulation are evaluated on a realistic virtual human liver model with blood vessels to demonstrate a clinically relevant scenario of thermal ablation of hepatic cancer. RESULTS For numerical accuracy, the proposed formulation can achieve a typical 10-3 level of normalised relative error at nodes and between 10-4 and 10-5 level of total errors for the simulation, by comparing solutions against the commercial finite element analysis package. For computation time, the proposed formulation under tissue deformation with anisotropic temperature-dependent properties consumes 2.518 × 10-4 ms for one element thermal loads computation, compared to 2.237 × 10-4 ms for the formulation without deformation which is 0.89 times of the former. Comparisons with three other formulations for isotropic and temperature-independent properties are also presented. CONCLUSIONS Compared to conventional methods focusing on numerical accuracy, convergence and stability, the proposed formulation focuses on computational performance for fast tissue thermal analysis. Compared to the classical Pennes model that handles only the static state of tissue, the proposed formulation can achieve fast thermal analysis on deformed states of tissue and can be applied in addition to tissue deformable models for non-linear heating analysis at even large deformation of soft tissue, leading to great translational potential in dynamic tissue temperature analysis and thermal dosimetry computation for computer-integrated medical education and personalised treatment.
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Affiliation(s)
- Jinao Zhang
- Department of Mechanical and Aerospace Engineering, Monash University, Wellington Road, Clayton, VIC 3800, Australia.
| | - Sunita Chauhan
- Department of Mechanical and Aerospace Engineering, Monash University, Wellington Road, Clayton, VIC 3800, Australia
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Bluvshtein V, Lucke L, Widule M. Stabilization of Electrosurgical Cutting Performance Based on Electrode Speed. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2019:166-169. [PMID: 31945870 DOI: 10.1109/embc.2019.8856861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Electrosurgical cutting is used for surgical incisions and resections where hemostasis is important. Much research has been performed on electrosurgical generator control methods that can improve cutting performance. It is also known that speed of the electrode as it is applied to tissue can impact cutting performance. However little work has been done to tie electrode speed to generator improvements. In this paper, the theory of cutting is analyzed, and experiments are performed to determine the impacts of electrode speed combined with generator control methods. This analysis and the experiments demonstrate that 1) voltage control provides improvement to power control for cutting, 2) power factor control may further improve cutting, and 3) speed compensation is even more impactful in improving cutting performance.
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Yang CH, Li W, Chen RK. Determination of Tissue Thermal Conductivity as a Function of Thermal Dose and Its Application in Finite Element Modeling of Electrosurgical Vessel Sealing. IEEE Trans Biomed Eng 2020; 67:2862-2869. [PMID: 32054566 DOI: 10.1109/tbme.2020.2972465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Electrosurgical vessel sealing is a process commonly used to control bleeding during surgical procedures. Finite element (FE) modeling is often performed to obtain a better understanding of thermal spread during this process. The accuracy of the FE model depends on the implemented material properties. Thermal conductivity is one of the most important properties that affect temperature distribution. The goal of this study is to determine the tissue thermal conductivity as a function of thermal dose. Methods: We developed an iterative approach to correlating tissue thermal conductivity to more accurately calculated thermal dose, which cannot be experimentally measured. The resulting regression model was then implemented into an electrosurgical vessel sealing FE model to examine the accuracy of this FE model. Results: The results show that with the regression model, more reasonable temperature and thermal dose prediction can be achieved at the center of the sealed vessel tissue. The resulting electrical current and impedance from the FE model match with the experimental results. Conclusion: The developed approach can be used to determine the correlation between thermal dose and thermal conductivity. Describing the thermal conductivity as a function of thermal dose allows modeling of irreversible changes in tissue properties. Significance: By having a more accurate temperature estimation at the center of the sealed vessel, more insight is provided into how the tissue reacts during the vessel sealing process.
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Valikhnovska KG, Savytska IM, Nataliya PR, Voitiv YY. Experimental studies of the effect of electrosurgical and standard techniques on pancreatic restoration. Wiad Lek 2020; 73:909-913. [PMID: 32386367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The aim: There have been investigated the specific features of pancreatic resection with the use of electrosurgical methods on experimental models of clinical operations. Pancreatic tissue regeneration at the surgical site have been studied when employing monopolar, bipolar, electric welding methods as compared with standard surgical technique. PATIENTS AND METHODS Materials and methods: The study was performed on 40 white laboratory rats. Pancreatic resection was conducted by standard surgical technique or by welding with electrocoagulation device "Patonmed EWD-300", high-energy electrosurgical device in bipolar mode and in monopolar mode. The pancreatic tissue was examined immediately after the surgery and at 3, 7 and 21 days postoperatively. RESULTS Results: In early terms following standard surgery there was seen more severe inflammation and the volume of newly formed connective tissue got increased faster than after the electrosurgical technique. Pancreatic ducts developed in newly formed tissue after the use of each type of electroresection, whereas that event was not observed following standard surgery. When using electrosurgery in monopolar mode, the area of coagulative necrosis was found to be less dense than after resection performed in bipolar mode. CONCLUSION Conclusions: Based on the findings, we can conclude that each of the above types of electroresection reduces surgery time, lowers bleeding risks, contributes to formation of the more adequate sealing on the resection surface with no complications of the recovery process.
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Affiliation(s)
| | - Iryna M Savytska
- State Institute «National Shalimov Institute of Surgery and Transplantation», National Academy of Medical Sciences of Ukrainian, Kyiv, Ukraine
| | - Prysyazhna R Nataliya
- State Institute «National Shalimov Institute of Surgery and Transplantation», National Academy of Medical Sciences of Ukrainian, Kyiv, Ukraine
| | - Yaroslav Y Voitiv
- State Institute «National Shalimov Institute of Surgery and Transplantation», National Academy of Medical Sciences of Ukrainian, Kyiv, Ukraine
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Xiao M, Hu S. [Basic Law of Electrosurgical Cutting and Surface Adhesion Behavior of Stainless Steel Electrode]. Zhongguo Yi Liao Qi Xie Za Zhi 2019; 43:405-409. [PMID: 31854523 DOI: 10.3969/j.issn.1671-7104.2019.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In order to study the performance and surface adhesion behavior of high frequency electrosurgical unit, 304 stainless steel electrode was used for electrical cutting on fresh pork fillet in vitro. The effect of cutting rate on electrode temperature and cutting power on thermal damage and adhesion quality, and the mechanism of tissues adhered on the electrode surface were studied. The results show that the electrode temperature increases with the increase of the cutting power and moving rate. During the cutting process, cells break up to form micron particles and then accumulate on the surface of electrodes to form adhesion layer. The low thermostability of 304 leads to slight melting, which enlarges the bonding area between the adhesive and the matrix. Elements diffusion and enrichment are found at the edge of the adhesives and the electrode, which contributes to higher bonding force.
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Affiliation(s)
- Ming Xiao
- State Key Laboratory of Materials Processing and Die & Mould Technology, Huazhong University of Science & Technology, Wuhan, 430074
| | - Shubing Hu
- State Key Laboratory of Materials Processing and Die & Mould Technology, Huazhong University of Science & Technology, Wuhan, 430074
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Georgesen C, Lipner SR. Comment on "intraoperative electrosurgical smoke during outpatient surgery: a survey of dermatologic surgeon and staff preferences". Cutis 2019; 104:291-294. [PMID: 31886789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Corey Georgesen
- Department of Dermatology, University of Pittsburgh Medical Center, Pennsylvania, USA
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, New York, USA
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Abstract
OBJECTIVE To generate estimates of comparative clinical effectiveness for interventions used in the treatment of anogenital warts (AGWs) through the systematic review, appraisal and synthesis of data from randomised controlled trials (RCTs). DESIGN Systematic review and network meta-analysis of RCTs. Search strategies were developed for MEDLINE, Embase, the Cochrane Library and the Web of Science. For electronic databases, searches were run from inception to March 2018. The systematic review was carried out following the general principles recommended in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. PARTICIPANTS People aged ≥16 years with clinically diagnosed AGWs (irrespective of biopsy confirmation). INTERVENTIONS Topical and ablative treatments recommended by the British Association for Sexual Health and HIV for the treatment of AGWs, either as monotherapy or in combination versus each other. OUTCOME MEASURES Complete clearance of AGWs at the end of treatment and at other scheduled visits, and rate of recurrence. RESULTS Thirty-seven RCTs met inclusion criteria. Twenty studies were assessed as being at unclear risk of bias, with the remaining studies categorised as high risk of bias. Network meta-analysis indicates that, of the treatment options compared, carbon dioxide laser therapy is the most effective treatment for achieving complete clearance of AGWs at the end of treatment. Of patient-applied topical treatments, podophyllotoxin 0.5% solution was found to be the most effective at achieving complete clearance, and was associated with a statistically significant difference compared with imiquimod 5% cream and polyphenon E 10% ointment (p<0.05). Few data were available on recurrence of AGWs after complete clearance. Of the interventions evaluated, surgical excision was the most effective at minimising risk of recurrence. CONCLUSION Of the studies assessed, as a collective, the quality of the evidence is low. Few studies are available that evaluate treatment options versus each other. TRIAL REGISTRATION NUMBER CRD42013005457.
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Affiliation(s)
| | | | - Colm O'Mahony
- Nuffield Health, Chester, UK
- Liverpool Medical Institution, Liverpool, UK
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Affiliation(s)
- Carla J Chibwesha
- Division of Global Women's Health, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill
- Clinical HIV Research Unit, Department of Medicine, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | - Jeffrey S A Stringer
- Division of Global Women's Health, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill
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50
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Greene SA, De Vuyst H, John-Stewart GC, Richardson BA, McGrath CJ, Marson KG, Trinh TT, Yatich N, Kiptinness C, Cagle A, Nyongesa-Malava E, Sakr SR, Mugo NR, Chung MH. Effect of Cryotherapy vs Loop Electrosurgical Excision Procedure on Cervical Disease Recurrence Among Women With HIV and High-Grade Cervical Lesions in Kenya: A Randomized Clinical Trial. JAMA 2019; 322:1570-1579. [PMID: 31638680 PMCID: PMC6806442 DOI: 10.1001/jama.2019.14969] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 08/28/2019] [Indexed: 12/25/2022]
Abstract
Importance The World Health Organization recommends cryotherapy or loop electrosurgical excision procedure (LEEP) for histologically confirmed cervical intraepithelial neoplasia (CIN) grade 2 or higher regardless of HIV status. Cryotherapy is more feasible in resource-limited settings but may be less effective for women living with HIV. Objective To evaluate whether cryotherapy or LEEP is a more effective treatment for high-grade cervical lesions among women with HIV. Design, Setting, and Participants Single-center randomized trial conducted among women with HIV and CIN grade 2 or 3. From June 2011 to September 2016, women with HIV in Kenya underwent cervical screening with Papanicolaou testing and confirmatory biopsy. The final date on which a study procedure was administered was September 7, 2016. Interventions Women with HIV infection and CIN grade 2 or 3 were randomized 1:1 to receive cryotherapy (n = 200) or LEEP (n = 200) and were followed up every 6 months for 24 months with a Papanicolaou test and confirmatory biopsy. Main Outcome and Measures The primary outcome was disease recurrence, defined as CIN grade 2 or higher on cervical biopsy, during the 24-month follow-up period. Results Among 400 women who were randomized (median age, 37.4 [interquartile range, 31.9-43.8] years), 339 (85%) completed the trial. Over 2 years, 60 women (30%) randomized to cryotherapy had recurrent CIN grade 2 or higher vs 37 (19%) in the LEEP group (relative risk, 1.71 [95% CI, 1.12-2.65]; risk difference, 7.9% [95% CI, 1.9%-14.0%]; P = .01). Adverse events occurred in 40 women (45 events, including change in pathology and death due to other causes) in the cryotherapy group and in 30 women (38 events, including change in pathology and unrelated gynecological complications) in the LEEP group. Conclusions and Relevance In this single-center study of women with HIV infection and CIN grade 2 or 3, treatment with LEEP compared with cryotherapy resulted in a significantly lower rate of cervical neoplasia recurrence over 24 months. Cost-effectiveness analysis is necessary to determine whether the additional benefit of LEEP represents an efficient use of the additional resources that would be required. Trial Registration ClinicalTrials.gov Identifier: NCT01298596.
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Affiliation(s)
- Sharon A. Greene
- Department of Global Health, University of Washington, Seattle
- Department of Epidemiology, University of Washington, Seattle
| | - Hugo De Vuyst
- Prevention and Implementation Group, International Agency for Research on Cancer (WHO-IARC), Lyon, France
| | - Grace C. John-Stewart
- Department of Global Health, University of Washington, Seattle
- Department of Epidemiology, University of Washington, Seattle
- Department of Medicine, University of Washington, Seattle
- Department of Pediatrics, University of Washington, Seattle
| | - Barbra A. Richardson
- Department of Global Health, University of Washington, Seattle
- Department of Biostatistics, University of Washington, Seattle
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Kara G. Marson
- Department of Global Health, University of Washington, Seattle
| | - T. Tony Trinh
- Department of Global Health, University of Washington, Seattle
| | - Nelly Yatich
- Department of Global Health, University of Washington, Seattle
| | | | - Anthony Cagle
- Department of Global Health, University of Washington, Seattle
| | | | | | - Nelly R. Mugo
- Department of Global Health, University of Washington, Seattle
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Michael H. Chung
- Department of Global Health, University of Washington, Seattle
- Department of Epidemiology, University of Washington, Seattle
- Department of Medicine, University of Washington, Seattle
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