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Otolaryngologic Clinics of North America Jun 2016Total thyroidectomy has significantly changed over the years from a morbid procedure to one that is performed routinely on an outpatient basis. This article reviews the... (Review)
Review
Total thyroidectomy has significantly changed over the years from a morbid procedure to one that is performed routinely on an outpatient basis. This article reviews the history of thyroid surgery with regard to hemostasis, discusses surgical vascular anatomy, and describes the methods of hemostasis. It compares traditional hemostatic surgical techniques with newer techniques such as the Harmonic Scalpel and LigaSure hand pieces. The use of adjunctive hemostatic agents and indications for a drain in thyroid are discussed.
Topics: Blood Loss, Surgical; Comparative Effectiveness Research; Drainage; Hematoma; Hemostasis, Surgical; Hemostatic Techniques; Humans; Postoperative Hemorrhage; Thyroid Diseases; Thyroid Gland; Thyroidectomy
PubMed: 27267022
DOI: 10.1016/j.otc.2016.03.006 -
Progres En Urologie : Journal de... Nov 2023Contraception is a major global health issue, which is still dominated by female contraception. Developments in male contraception could help redistribute the...
CONTEXT
Contraception is a major global health issue, which is still dominated by female contraception. Developments in male contraception could help redistribute the contraceptive burden.
METHODS
A literature search was carried out to review the existing options and the criteria for optimal contraception, to establish the principles of a male pre-contraception consultation, and to review the various research avenues with their advantages and disadvantages.
RESULTS
The new male contraception options are detailed, whether hormonal (androgen therapy, combination of progestins and testosterone) or non-hormonal, particularly thermal, with current results and avenues for improvement. Condom use and vasectomy remain the only 2 validated options. The recent development of minimally invasive vasectomy without the need for a scalpel and of occlusion techniques has simplified the procedure, minimised the risk of complications (pain, haematomas, post-vasectomy pain syndrome) and improved efficacy. The issues of regret and the possibility of repermeabilisation are also raised.
CONCLUSION
The question of male contraception will become increasingly important in consultations with urologists. The urologist will have to inform the patient, as required by law, before the vasectomy is performed, and provide the best possible advice on the technique, which will often be minimally invasive without the need for a scalpel. New reversible options should also broaden the range of options available on a routine basis, with a view to gradually moving towards contraceptive equity.
Topics: Male; Humans; Female; Contraceptive Agents, Male; Contraception; Vasectomy; Contraceptive Agents; Pain
PubMed: 38012914
DOI: 10.1016/j.purol.2023.09.004 -
Clinical, Cosmetic and Investigational... 2020Rhinophyma is an advanced stage of rosacea affecting the nasal soft tissues and resulting in disruption of the nasal architecture, airway obstruction, and disfigurement... (Review)
Review
Rhinophyma is an advanced stage of rosacea affecting the nasal soft tissues and resulting in disruption of the nasal architecture, airway obstruction, and disfigurement of the nasal aesthetic units. Rhinophyma presents with hypertrophy of the nasal soft tissues, erythema, telangiectasias, nodules, and lobules with a bulbous appearance. Significant psychosocial morbidity is associated with the disease. Understanding of this disease has improved and multiple treatment options exist. The article is a review of the literature to evaluate the pathophysiology, clinical presentation, and epidemiology of keywords "rhinophyma" and "rosacea" using an OVID Medline and PubMed search along with a systematic review of outcomes pertaining to treatment of rhinophyma with laser therapy, scalpel excision, and the subunit method using an OVID Medline search. The subunit method has the highest complication and revision rates followed by carbon dioxide laser therapy. Outcomes between carbon dioxide laser and scalpel therapy and electrocautery are equivalent. Scalpel excision is a more cost-effective treatment modality with less post-operative complications; however, it risks poor hemostasis intraoperatively. Patient satisfaction is common post-therapy regardless of the treatment method. Over 89% of patients would recommend undergoing treatment for rhinophyma irrespective of treatment type. Treatment options vary, and choice of treatment can be dependent on practitioner and patients' treatment goals.
PubMed: 32848439
DOI: 10.2147/CCID.S201290 -
Translational Andrology and Urology Aug 2017According to data from the National Study of Family Growth, vasectomy is utilized by 6-13% of American couples for their form of contraception. Physician surveys have... (Review)
Review
According to data from the National Study of Family Growth, vasectomy is utilized by 6-13% of American couples for their form of contraception. Physician surveys have shown that over 500,000 men undergo vasectomies per year, and more than 75% of vasectomies are performed by urologists. This chapter provides a brief history of vasectomy, as well as recommendations for preoperative counseling, an overview of the modified no-scalpel vasectomy technique, and a brief description of the complications of vasectomy.
PubMed: 28904903
DOI: 10.21037/tau.2017.07.08 -
Biomedicines Nov 2022The plasma scalpel is an application of gas discharges in electrosurgery. This paper introduces the device structure and physicochemical parameters of the two types of... (Review)
Review
The plasma scalpel is an application of gas discharges in electrosurgery. This paper introduces the device structure and physicochemical parameters of the two types of plasma scalpels, namely, a single-electrode Ar discharge device (argon plasma coagulation) and a two-electrode discharge device in normal saline. The diagnostic methods, including the voltage and current characteristics, optical emission spectroscopy, electron spin resonance, and high-speed imaging, are introduced to determine the critical process parameters, such as the plasma power, the gas temperature, the electron density, and the density of active species, and study the ignition dynamics of the plasma discharges in water. The efficacy of the plasma scalpel is mainly based on the physical effects of the electric current and electric field, in addition to the chemical effects of high-density energetic electrons and reactive species. These two effects can be adjusted separately to increase the treatment efficacy of the plasma scalpel. Specific guidance on further improvements of the plasma scalpel devices is also provided.
PubMed: 36428535
DOI: 10.3390/biomedicines10112967 -
The Journal of Craniofacial Surgery May 2021The chin is the most prominent and median sector of the lower third of the face giving harmony to nose and lips. The authors present the application of piezoelectric...
BACKGROUND
The chin is the most prominent and median sector of the lower third of the face giving harmony to nose and lips. The authors present the application of piezoelectric scalpel for the correction of different chin deformities. The distinctive characteristics of this device allow us to avoid or reduce the immediate genioplasty complications.
METHODS
Fifty-five patients with defective chin have been treated from January 2006 to April 2008. Intraoral chinplasty was performed during the correction of dentofacial dysmorphisms or associated with nasal surgery. The authors used a piezoelectric cutting device to perform different osteotomies and if necessary, interpositional graft was used to stabilize bony segments.
RESULTS
Piezosurgery has been associated with a fewer number of postoperative complications, especially as regard intraoperative bleeding, nerve injuries (immediate and late), hematomas and seromas, and asymmetry (immediate and early). The mean time for completing the complete procedure of genioplasty with piezosurgery was almost the same compared with the saw and drill.
CONCLUSIONS
Chinplasty represents one of the most common ancillary procedures and may be associated with corrective surgery of dentofacial dysmorphisms. Mental nerve injuries, asymmetries, intraoperative bleeding are the main immediate complications of genioplasty. Distinctive characteristics of ultrasonic piezoelectric osteotomy are selective cut of mineralized structure with less risk of vascular and nervous damage (microvibrations), intraoperative precision (thin cutting scalpel and no macrovibrations), blood free site (cavitation effect). In our experience, piezoelectric scalpel, compared with saw and drill, enables us to reduce or avoid immediate complications of chin surgery, helping the surgeon to reach patients' satisfaction.
LEVEL OF EVIDENCE
IV.
Topics: Chin; Genioplasty; Humans; Osteotomy; Piezosurgery; Surgical Instruments
PubMed: 29944550
DOI: 10.1097/SCS.0000000000003150 -
Indian Journal of Thoracic and... Apr 2019
PubMed: 33060995
DOI: 10.1007/s12055-018-0747-7 -
Journal of the College of Physicians... May 2020Internal mammary artery (IMA) harvest by using a harmonic scalpel for coronary artery bypass grafting (CABG) have not been sufficiently evaluated. This review aimed to... (Review)
Review
Internal mammary artery (IMA) harvest by using a harmonic scalpel for coronary artery bypass grafting (CABG) have not been sufficiently evaluated. This review aimed to assess the outcomes of IMA harvest by a harmonic scalpel and to compare by conventional electrocautery. The study materials were based on literature retrieval. In total Eight articles describing IMA harvest by a harmonic scalpel for 1,893 patients, and pateints with IMA harvest by electrocautery were taken as controls. IMA harvest by a harmonic scalpel was associated with less thermal injury with potentially better preservation of the endothelial cells, satisfactory intraoperative IMA flow, and promising postoperative IMA patency. Apart from the harvesting merits, the harmonic scalpel had many other advantages in terms of clinical outcomes, such as decreased postoperative mortality and morbidity rates. Nevertheless, IMA harvesting by using a harmonic scalpel is associated with longer harvest time, prolonged operative time, and increased hospitalisation expenses. Therefore, they could be used in selected and non-emergent patients for CABG. Key Words: Coronary artery bypass grafting, Internal mammary artery, Surgical instruments.
Topics: Coronary Artery Bypass; Endothelial Cells; Humans; Internal Mammary-Coronary Artery Anastomosis; Mammary Arteries; Surgical Instruments; Tissue and Organ Harvesting
PubMed: 32580850
DOI: 10.29271/jcpsp.2020.05.516 -
The British Journal of Surgery Sep 2022
Topics: Equipment Design; Humans; Surgical Instruments
PubMed: 35929072
DOI: 10.1093/bjs/znac274 -
JB & JS Open Access 2020The impact of left-handedness on orthopaedic surgeons and trainees has not been well described. We investigated the prevalence and perceived impact of left-handedness... (Review)
Review
BACKGROUND
The impact of left-handedness on orthopaedic surgeons and trainees has not been well described. We investigated the prevalence and perceived impact of left-handedness among orthopaedic surgeons and trainees.
METHODS
We distributed a survey regarding handedness to active members of the American Orthopaedic Association and the Council of Orthopaedic Residency Directors affiliates, including department chairs, program directors, and residency and fellowship program coordinators. Program coordinators were asked to distribute the survey to their current residents and fellows.
RESULTS
Of 510 survey respondents, 78 (15%) were identified as left hand dominant (LHD). Regarding scalpel/cautery use, 64% of LHD respondents reported using their left hand primarily and 10% reported using their right hand primarily; 26% of LHD respondents described themselves as ambidextrous in scalpel/cautery use, compared with 4.7% of right hand dominant (RHD) respondents (p < 0.001). Regarding suturing, 53% of LHD respondents reported using their left hand primarily and 38% reported using their right hand primarily; 9.0% of LHD respondents described themselves as ambidextrous when suturing, compared with 1.9% of RHD respondents (p = 0.012). Only 5.1% of LHD respondents reported having received laterality-specific psychomotor training, whereas 17% perceived a need for such training during residency; RHD respondents reported similar rates. Ambidexterity in scalpel/cautery use or suturing among LHD respondents was not associated with the perception that their left-handedness was advantageous. LHD attending surgeons were more likely than LHD trainees to perceive their handedness as advantageous (p = 0.007).
CONCLUSIONS
Fifteen percent of orthopaedic surgeons and trainees who responded to our survey were LHD. LHD respondents reported significantly higher rates of ambidexterity in both scalpel/cautery use and suturing compared with RHD respondents. Ambidexterity was not associated with a self-perception that left-handedness was advantageous. LHD-attending surgeons were significantly more likely than LHD residents/fellows to perceive their left-handedness as advantageous. There may be benefits to pairing LHD residents with LHD faculty surgeons early in their training to provide mentorship and insight regarding performing surgical procedures left handed.
LEVEL OF EVIDENCE
Level IV.
PubMed: 32832824
DOI: 10.2106/JBJS.OA.20.00019