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Anesthesiology Mar 2019Operating room fires are rare but devastating events. Guidelines are available for the prevention and management of surgical fires; however, these recommendations are... (Review)
Review
Operating room fires are rare but devastating events. Guidelines are available for the prevention and management of surgical fires; however, these recommendations are based on expert opinion and case series. The three components of an operating room fire are present in virtually all surgical procedures: an oxidizer (oxygen, nitrous oxide), an ignition source (i.e., laser, "Bovie"), and a fuel. This review analyzes each fire ingredient to determine the optimal clinical strategy to reduce the risk of fire. Surgical checklists, team training, and the specific management of an operating room fire are also reviewed.
Topics: Electrocoagulation; Fires; Gas Scavengers; Humans; Operating Rooms; Oxygen; Plastic Surgery Procedures
PubMed: 30664060
DOI: 10.1097/ALN.0000000000002598 -
Sensors (Basel, Switzerland) Aug 2022In 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 ....
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 -
JAMA Facial Plastic Surgery May 2017Multiple techniques may be used to perform bicoronal incisions, and alopecia is a known postoperative complication of this procedure. To date, no large studies exist...
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 -
Australian Family Physician Sep 2015Epistaxis is one of the most common ear, nose and throat (ENT) emergencies to present to general practitioners (GPs). The management of epistaxis has evolved...
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 -
Optometry and Vision Science : Official... Mar 2021Hemolacria (bloody tears) is a rare clinical presentation with varied underlying etiologies. Thorough clinical evaluation is essential to diagnosis and management. (Review)
Review
SIGNIFICANCE
Hemolacria (bloody tears) is a rare clinical presentation with varied underlying etiologies. Thorough clinical evaluation is essential to diagnosis and management.
PURPOSE
This study aimed to report unilateral hemolacria in a known contact lens wearer with an occult, palpebral, conjunctival pyogenic granuloma and review the literature.
CASE REPORT
A 21-year-old female contact lens wearer presented to the clinic after three episodes of sudden painless bloody tears from the right eye. She was referred to the oculoplastic clinic for evaluation. On everting her right upper lid, a fleshy, nontender, ovoid, pedunculated mass was found attached to the palpebral conjunctiva of the right, nasal, upper tarsus. Surgical excision was performed in the office, and pathological examination of the lesion was consistent with pyogenic granuloma.
CONCLUSIONS
Unilateral hemolacria should raise clinical suspicion for a hidden conjunctival lesion such as pyogenic granuloma, although other more sinister causes of hemolacria must also be considered. Thorough evaluation including eyelid eversion is critical in identifying and managing occult conjunctival lesions.
Topics: Blood; Cautery; Conjunctival Diseases; Contact Lenses; Crying; Female; Granuloma, Pyogenic; Humans; Lacrimal Apparatus Diseases; Tears; Young Adult
PubMed: 33633021
DOI: 10.1097/OPX.0000000000001653 -
Canadian Respiratory Journal 2017Hemoptysis is a frequent manifestation of a wide variety of diseases, with mild to life-threatening presentations. The diagnostic workup and the management of severe... (Review)
Review
Hemoptysis is a frequent manifestation of a wide variety of diseases, with mild to life-threatening presentations. The diagnostic workup and the management of severe hemoptysis are often challenging. Advances in endoscopic techniques have led to different new therapeutic approaches. Cold saline, vasoconstrictive and antifibrinolytic agents, oxidized regenerated cellulose, biocompatible glue, laser photocoagulation, argon plasma coagulation, and endobronchial stents and valves are amongst the tools available to the bronchoscopist. In this article, we review the evidence regarding the definition, etiology, diagnostic modalities, and treatment of severe hemoptysis in the modern era with emphasis on bronchoscopic techniques.
Topics: Adhesives; Antifibrinolytic Agents; Argon Plasma Coagulation; Biocompatible Materials; Bronchoscopy; Cellulose; Cryotherapy; Hemoptysis; Hemostasis, Surgical; Humans; Laser Coagulation; Stents; Vasoconstrictor Agents
PubMed: 29430203
DOI: 10.1155/2017/1565030 -
General Thoracic and Cardiovascular... Mar 2022A 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... (Review)
Review
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 -
Surgical Endoscopy Aug 2021We investigated a novel minimally invasive surgical platform for use in the oropharynx, hypopharynx, and larynx for single-port transoral surgery used in concert with...
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 -
Expert Review of Respiratory Medicine Jul 2018Lung 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... (Review)
Review
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 -
British Medical Journal Aug 1970
Topics: Anesthesia; Electrocoagulation; Hemorrhage; Humans; Lighting; Male; Methods; Postoperative Complications; Posture; Prostate; Prostatectomy; Prostatic Hyperplasia; Sterilization; Surgical Instruments; Urethra; Urinary Bladder; Urinary Bladder Diseases; Urinary Bladder Neck Obstruction; Urinary Bladder Neoplasms; Urologic Diseases
PubMed: 4194560
DOI: 10.1136/bmj.3.5717.241