Review

Authors: Ah Young Lee, Joo Young Cho

Upper gastrointestinal (GI) hemorrhage presents a substantial clinical challenge. Initial management typically involves resuscitation and endoscopy within 24 h, although the benefit of very early endoscopy (< 12 h) for high-risk patients is debated. Treatment goals include stopping acute bleeding, preventing rebleeding, and using a multimodal approach encompassing endoscopic, pharmacological, angiographic, and surgical methods. Pharmacological agents such as vasopressin, prostaglandins, and proton pump inhibitors are effective, but the increase in antithrombotic use has increased GI bleeding morbidity. Endoscopic hemostasis, particularly for nonvariceal bleeding, employs techniques such as electrocoagulation and heater probes, with concerns over tissue injury from monopolar electrocoagulation. Novel methods such as Hemospray and Endoclot show promise in creating mechanical tamponades but have limitations. Currently, the first-line therapy includes thermal probes and hemoclips, with over-the-scope clips emerging for larger ulcer bleeding. The gold probe, combining bipolar electrocoagulation and injection, offers targeted coagulation but has faced device-related issues. Future advancements involve combining techniques and improving endoscopic imaging, with studies exploring combined approaches showing promise. Ongoing research is crucial for developing standardized and effective hemorrhage management strategies.

Topics: Humans; Electrocoagulation; Endoscopy, Gastrointestinal; Gastrointestinal Hemorrhage; Hemostasis, Endoscopic; Hemostatics; Treatment Outcome

PubMed: 38681987
DOI: 10.3748/wjg.v30.i15.2087

Authors: Stephanie Yau

BACKGROUND

Epistaxis is one of the most common ear, nose and throat (ENT) emergencies to present to general practitioners (GPs). The management of epistaxis has evolved significantly in recent years, including the use of nasal cautery and packs. Successful treatment requires knowledge of nasal anatomy, and potential risks and complications of treatment.

OBJECTIVE

Epistaxis is often a simple and readily treatable condition. However, given the potential consequences of a significant bleed, GPs should have an understanding of the causes, potential risks and emergency management.

DISCUSSION

Epistaxis can be classified into anterior or posterior bleeds, the former being the most common. Anterior bleeds can often be treated with cauterisation with silver nitrate sticks, provided there is good preparation, correct equipment and assistance close at hand. If there is a lack in any of these aspects, prompt use of nasal packing and referral to an emergency department or a specialist ENT service is recommended.

Topics: Arteries; Cautery; Embolization, Therapeutic; Epistaxis; First Aid; General Practice; Humans; Ligation; Nose; Patient Education as Topic; Tampons, Surgical

PubMed: 26488045
DOI: No ID Found

Authors: Sameep Kadakia, Arvind Badhey, Sara Ashai...

IMPORTANCE

Multiple techniques may be used to perform bicoronal incisions, and alopecia is a known postoperative complication of this procedure. To date, no large studies exist comparing alopecia outcomes among bicoronal incision techniques with and without the use of Raney clips.

OBJECTIVE

To determine (1) whether postoperative alopecia is more common when bicoronal incisions are performed with monopolar cautery, Colorado microdissection tip cautery, or traditional cold steel and (2) whether this outcome is affected by the use of Raney clips.

DESIGN, SETTING, AND PARTICIPANTS

This retrospective study of postoperative alopecia included 505 patients undergoing bicoronal incisions in a single head and neck surgery practice from 1997 to 2015 with a minimum follow-up of 1 year. Patients with preexisting baldness as well as patients not following up for the minimum period were excluded. All data analysis took place between 1997 and 2015.

MAIN OUTCOMES AND MEASURES

Maximum alopecia width was measured in the postoperative period and compared among the technique groups both with and without Raney clip use. Raney clip duration as a product of surgery length was also compared.

RESULTS

A total of 505 patients (301 male, 204 female) ranging in age from 3 to 97 years were included in the study (median age, 53.9 years). Of these, 236 underwent bicoronal incisions to approach the skull base, 78 to treat chronic frontal sinusitis unresponsive to endoscopic management or frontal sinus mucocele, 143 for trauma, and 48 for craniofacial surgery. For 173 patients, the cold steel technique was used for both skin and subcutaneous incision, 102 of whom needed Raney clips. For 161 patients, cold steel technique was used for skin incisions and monopolar cautery for subcutaneous incision; 81 of these patients required Raney clips. For 171 patients, Colorado tip microdissection cautery was used for both skin and subcutaneous incision, with Raney clips used in 66 of these patients. Incisions made with cold steel for both skin and subcutaneous tissue, regardless of Raney clip use, had lower postoperative alopecia than those made with cautery: for scalpel use for both skin and subcutaneous tissue, average alopecia width was 2.8 mm without Raney clip and 3.5 mm with Raney clip. For scalpel use with skin and monopolar cautery for subcutaneous tissue, average alopecia width was 3.8 mm without Raney clip and 4.3 mm with Raney clip. Colorado tip microdissection cautery used for skin and subcutaneous tissue was associated with the greatest alopecia width: Colorado tip for skin and subcutaneous tissue, average alopecia width, 4.9 mm; with Raney clip, 5.9 mm. Duration of Raney clip use was significantly associated with increased alopecia width: less than 3 hours, 4.1 mm; 3 hours or more, 5.2 mm (P < .001).

CONCLUSIONS AND RELEVANCE

When performing bicoronal incisions, postoperative alopecia can be minimized by preferentially using a cold steel scalpel for skin and subcutaneous incisions. Raney clip use should be avoided when possible or used for only a short time during the procedure.

LEVEL OF EVIDENCE

3.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Alopecia; Cautery; Child; Child, Preschool; Female; Hemostasis, Surgical; Humans; Infant; Male; Middle Aged; Retrospective Studies; Scalp; Surgical Flaps; Surgical Instruments

PubMed: 28056117
DOI: 10.1001/jamafacial.2016.1741

Authors: Christian Thiel, Luca T Frericks, Martin Schenk...

INTRODUCTION

A novel multipurpose bipolar radiofrequency instrument, the Erbe Dissector (EDS), which simultaneously seals and cuts tissue, was developed. sealing rate and time, burst pressure, jaw temperature and thermal spread were studied in porcine renal arteries.

MATERIAL AND METHODS

, 13 surgical tasks were performed in two pigs: beside sealing rate and time, overall performance in sharp and blunt dissection, tissue sticking, hemostasis, precision, etc., were evaluated by four surgeons compared with ENSEAL G2 (EG2) using surveys on a Likert scale (1 = very poor; 5 = very good).

RESULTS

, the EDS sealing rate was 91.7% (33/36 arteries) at an average sealing time of 2.1 s (range 1.7-2.8) and a burst pressure of 1040 ± 350 mmHg. The maximum jaw temperature was 87 ± 4 °C and the mean lateral thermal spread was 0.8 ± 0.2 mm. , the sealing rate for arteries and veins was 92.6% (50/54) and the median seal and cut time was 1.6 s (range: 1.3-2.9). The average EDS performance score across all tasks was 4.4 ± 0.6 Likert points. For five shared tasks, EDS was better than EG2 (4.4 ± 0.5 versus 3.4 ± 0.6 Likert points;  = 0.016).

CONCLUSIONS

EDS seals and cuts arteries and veins rapidly with good safety and user-friendliness.

Topics: Swine; Animals; Renal Artery; Hemostasis, Surgical; Veins; Ligation; Electrocoagulation

PubMed: 36260701
DOI: 10.1080/13645706.2022.2124523

Review

Authors: P P Williams

Topics: Accident Prevention; Anesthesia, Endotracheal; Arrhythmias, Cardiac; Catheterization; Cautery; Female; Fiber Optic Technology; General Surgery; Genital Diseases, Female; Heart Arrest; Humans; Hypercapnia; Laparoscopes; Laparoscopy; Pneumonia; Pneumoperitoneum; Pneumoperitoneum, Artificial; Pneumothorax; Uterus

PubMed: 4273374
DOI: 10.1016/s0015-0282(16)40277-3

Authors: Josh Ehrlich, Amoon Jamzad, Mark Asselin...

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 . 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.

Topics: Breast; Cautery; Electrosurgery; Humans; Robotics; Surgical Wound

PubMed: 35957364
DOI: 10.3390/s22155808

Review

Authors: Takahiro Homma

OBJECTIVES

A clear understanding of energy devices would help achieve high effectiveness and safety and guide the selection of devices. The present review aimed to elucidate the efficacy and adverse events of energy devices in lung cancer to guide the selection of appropriate devices depending on the situation.

METHODS

Four major databases were searched electronically for relevant articles published until 16 April 2021. The reference lists of the identified papers were examined. We excluded (1) irrelevant studies, (2) manuscripts published in languages other than English and Japanese, (3) duplicates, and (4) studies for which the full text was not available in the databases. The results and key information obtained were summarized by means of a narrative approach.

RESULTS

A total of 78 papers were included in the review and these were categorized according to the main topic of investigation as follows: (1) electrosurgery-related injuries, (2) fundamentals of electrosurgery, (3) monopolar devices, (4) bipolar electrosurgical devices, (5) ultrasonic energy devices, (6) energy devices in lung cancer surgery, (7) operating room fire risks, and (8) basic principles of surgery.

CONCLUSIONS

Understanding energy devices could help us use them in a more effective and safer manner. Knowledge of their selection criteria (suitability), merits, risks, and safety precautions relevant to each process of lung cancer surgery could guide appropriate selection.

Topics: Electrocoagulation; Electrosurgery; Fires; Humans; Lung Neoplasms; Operating Rooms

PubMed: 35107778
DOI: 10.1007/s11748-022-01775-w

Review

Authors: Christopher Mallow, Margaret Hayes, Roy Semaan...

Lung cancer is the leading cause of cancer-related deaths in the United States. Nearly 85% of all lung cancers are diagnosed at a late stage, with an associated five-year survival rate of 4%. Malignant central airway obstruction and malignant pleural effusions occur in upwards of 30% of these patients. Many of these patients are in need of palliative interventions for symptom control and to help improve their quality of life. Areas covered: This review covers the treatment modalities of malignant central airway obstruction and malignant pleural effusion. PubMed was used to search for the most up to date and clinically relevant articles that guide current treatment strategies. This review focuses on rigid bronchoscopy and the tools used for the relief of central airway obstruction, as well as intra-pleural catheter use and pleurodesis for the management of malignant pleural effusions. Expert commentary: There are multiple treatment modalities that may be used to help alleviate the symptoms of malignant central airway obstruction and pleural effusion. The modality used depends on the urgency of the situation, and specific patient's goals. An open dialog to understand the patient's end of life goals is an important factor when choosing the appropriate treatment strategy.

Topics: Airway Obstruction; Argon Plasma Coagulation; Bronchoscopy; Catheters, Indwelling; Cryosurgery; Dilatation; Dyspnea; Electrocoagulation; Humans; Laser Therapy; Lung Neoplasms; Palliative Care; Photochemotherapy; Pleural Effusion, Malignant; Pleurodesis; Radiotherapy; Stents; Thoracentesis

PubMed: 29883216
DOI: 10.1080/17476348.2018.1486709

Authors: Emily K Funk, Philip Weissbrod, Santiago Horgan...

BACKGROUND

We investigated a novel minimally invasive surgical platform for use in the oropharynx, hypopharynx, and larynx for single-port transoral surgery used in concert with standard transoral laryngeal and pharyngeal instrumentation.

METHODS

The preclinical investigational device by Fortimedix Surgical B.V. (Netherlands) features two channels for manually controlled flexible articulating surgical instruments. A third central channel accepts both rigid and flexible endoscopes. The system is coupled to a standard laryngoscope for transoral access. In three cadaver models, we evaluated the surgical capabilities using wristed grasping instruments, microlaryngeal scissors, monopolar cautery, and a laser fiber sheath. Procedures were performed within the oropharynx, supraglottis, glottis, subglottis, and hypopharynx.

RESULTS

Within the oropharynx, we found adequate strength, range of motion, and dexterity to perform lateral oropharyngectomy and tongue base resection. Within the larynx, visualization was achieved with a variety of instruments including a flexible, 0° and 30° rigid endoscope. The glottis, supraglottis, pyriform sinuses, post-cricoid space, and esophageal inlet were readily accessible. Visualization and manipulation of grasping, laser, and monopolar cautery instruments were also possible within the subglottis. Instrument reach and accuracy facilitated completion of a delicate micro-flap on the true vocal fold. Other procedures included vocal fold resection, cricopharyngeal myotomy, and resection of subglottic mucosa.

CONCLUSIONS

From this initial proof of concept experience with this novel platform, we found a wide range of procedures within the oropharynx, larynx, and hypopharynx to be feasible. Further work is needed to evaluate its applicability to the clinical setting. The ability of this platform to be used with conventional instrumentation may provide an opportunity for complex transoral surgery to be performed in a facile manner at greatly reduced cost.

Topics: Endoscopes; Humans; Hypopharynx; Laryngoscopes; Microsurgery; Minimally Invasive Surgical Procedures; Robotic Surgical Procedures

PubMed: 33712940
DOI: 10.1007/s00464-021-08420-2

Randomized Controlled Trial Comparative Study

A comparison of novel electrocautery-enhanced lumen-apposing metal stents and plastic stents in endoscopic ultrasound-guided drainage of infected walled-off necrosis: a multicenter randomized study.

Authors: Jong Ho Moon, Se Woo Park, Yun Nah Lee...

BACKGROUND

Although lumen-apposing metal stents (LAMSs) have been increasingly used for walled-off necrosis (WON), their advantages over plastic stents in infected WON are unclear. We investigated the safety and efficacy of a novel electrocautery-enhanced LAMS for managing infected WON.

METHODS

Patients who required endoscopic ultrasound-guided WON drainage were randomly assigned to LAMS or plastic stent groups. The primary outcome was total number of direct endoscopic necrosectomy (DEN) procedures required to achieve clinical success. Secondary outcomes included rates of technical success, clinical success, and adverse events.

RESULTS

46 patients were included in the LAMS (n = 23) and plastic stent (n = 23) groups. The median total number of DEN procedures did not differ significantly between the plastic stent group (4 procedures, interquartile range [IQR] 2.5-5.0) and LAMS group (9 procedures, IQR 8.0-9.0) ( = 0.07). The LAMS group demonstrated a significantly higher clinical success rate than the plastic stent group based on intention-to-treat analysis (100% vs. 73.9%, =0.03) at 8 weeks but not at 4 weeks. Significant bleeding occurred in one patient in the plastic stent group and no patients in the LAMS group.

CONCLUSIONS

We found no significant difference in the total number of DEN procedures between LAMSs and plastic stents for managing infected WON. The only statistically significant finding was a higher clinical success rate at 8 weeks for patients treated with LAMS. The use of LAMS did not result in any adverse events, such as bleeding or buried LAMS syndrome, within the study duration.

Topics: Humans; Male; Female; Middle Aged; Drainage; Stents; Endosonography; Pancreatitis, Acute Necrotizing; Electrocoagulation; Plastics; Adult; Aged; Treatment Outcome; Metals; Ultrasonography, Interventional

PubMed: 38857618
DOI: 10.1055/a-2342-1140