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General Surgery
Published in Kelvin Yan, Surgical and Anaesthetic Instruments for OSCEs, 2021
There are many indications. Electrosurgery may be used in procedures that require cutting and coagulation. These can range from eye, dental, dermatological to general surgical, endoscopic and laparoscopic procedures.
How Long Does it Take Uterine Scar(s) to Heal?
Published in John C. Petrozza, Uterine Fibroids, 2020
Multiple factors impact uterine healing including type of energy source, volume of tissue treated, number of incisions or lesions treated, etc. Although not definitively studied, many surgeons advocate minimizing the use of electrosurgery and attention to careful surgical technique. No surgical adjuvants have been shown to improve uterine healing (as opposed to bleeding, adhesion formation, etc.). It appears, and makes sense clinically, that hysteroscopic techniques lead to faster healing than an abdominal approach but there are no data comparing open and endoscopic abdominal routes. All myomectomy studies are limited by variations in technique, number of fibroids and location of fibroids and other variables limiting the ability to make comparisons and draw definitive conclusions.
Laparoscopic and Robotic-Assisted Myomectomy
Published in Botros R.M.B. Rizk, Yakoub Khalaf, Mostafa A. Borahay, Fibroids and Reproduction, 2020
Harold Wu, Anja Frost, Mostafa A. Borahay
The standard laparoscopy instrument set contains most of the instruments required for LM. Few studies have assessed various energy sources used for LM. The harmonic scalpel has been found to have a lower total operative time (mean 17 minutes) and EBL (mean 47 cc) when compared to conventional electrosurgery [29]. Also, the pulsed bipolar system has been associated with a lower EBL (mean 53 cc) compared to conventional electrosurgery [30]. Ultimately, the surgeon's preference and comfort level with the various energy sources should take precedence in choosing the instrumentation for the case. Additional instruments that should be prepared include a laparoscopic tenaculum to aid in providing tissue traction and countertraction for enucleation of the fibroids, a laparoscopic injection needle for vasopressin, and endoscopic bags or morcellators (see further discussion in next section) for tissue extraction. It is critical to have an operating room setup that includes all necessary instruments and devices and allows for efficient team movement (Figure 11.1).
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
Published in Journal of Medical Economics, 2023
Alessandra Piemontese, Lucas Cohen, George W. J. Wright, Natalia Robledinos-Antón, Nadine Jamous, Giovanni A. Tommaselli, Thibaut Galvain
The comparative efficacy of advanced energy devices sourced from Ethicon versus other manufacturers was based on a previously published systematic literature review and network meta-analysis (NMA) of randomized or observational studies16. The model inputs sourced from the systematic review and NMA are included in Supplementary Appendix A. The systematic review was performed to identify comparative studies of electrosurgery techniques and conventional techniques across several surgical specialties including general surgery, gynecology, thoracic, bariatric, and colorectal procedures. All studies included were on adult human patients and compared different advanced energy devices to each other (e.g. Harmonic™, Sonicision™, LigaSure™, Enseal™, and Thunderbeat™) or to conventional techniques such as bipolar or monopolar electrosurgery16. Study designs included were RCTs, and both retrospective and prospective observational studies from all regions16. Studies were excluded if they compared two different surgeries or approaches, combined advanced energy device use with another device, or were conference abstracts or narrative reviews16.
A survey on the current practice of indicating an elective cesarean after a previous myomectomy
Published in Annals of Medicine, 2023
Giovanni Delli Carpini, Valeria Verdecchia, Luca Giannella, Jacopo Di Giuseppe, Barbara Gardella, Pantaleo Greco, Ettore Cicinelli, Andrea Ciavattini
The global importance of monopolar electrosurgery resulted in 88.3%. In comparison, the use of bipolar electrosurgery presented a global importance of 30.8%, and none or minimal use of electrosurgery had a global importance of 5% (Table 2). Excessive use of electrosurgery, particularly monopolar electrosurgery [19,26], is a risk factor for uterine rupture [5–7,21,27–29]. It has also been associated with the weakening of the myometrium, adhesions, poor vascularization, tissue necrosis, thermal damage, tissue hardening, delay in wound healing, increase in collagen deposition, and reduction in smooth muscle fibers, with the formation of an abnormal uterine scar with suboptimal tension, which cannot undergo remodeling during pregnancy, and is less resistant to uterine distension [5–7,10,28]. Thus, several authors indicate that hemostasis during myomectomy should be achieved to avoid excessive electrosurgery, which should be reserved only for single big vessels [6,7,10]. Alternative energy sources are also preferred [5,22], and adjunctive hemostatic techniques (e.g. temporary uterine artery clipping or injection of vasoconstrictors) [30] may be adopted to reduce intraoperative bleeding [6]. However, it is necessary to obtain adequate hemostasis since excessive bleeding in the surgical site may promote hematoma formation and abnormal healing [6,8,21,31].
Complications associated with PEAK PlasmaBlade from 2010 to 2020 from MAUDE
Published in Baylor University Medical Center Proceedings, 2022
Esther Lee, Amir Elzomor, Sameh Boulos, Olivia Silva, Luke J. Pasick, Daniel A. Benito, Jane Tong, Philip Zapanta, Arjun S. Joshi, Joseph F. Goodman, Punam G. Thakkar
Electromagnetic interference (EMI) was the most common cause of adverse events leading to patient injury (10, 26.3%). Pacemakers were found to be the most common cause of electromagnetic interference (22, 57.9%). The Medtronic manual warned of potential hazards during the use of electrosurgery in the presence of internal or external electrically conductive implants due to the concentration of redirection of current.8 Thus, EMI may adversely influence the operation of other electronic equipment such as pacemakers, leading to serious adverse events in patients (e.g., arrhythmias).13 Paniccia et al found that the PlasmaBlade emitted the most electromagnetic energy and is considered high risk for EMI in implanted defibrillators.13 Thus, they recommended use of either bipolar or electromagnetic shears instead of PlasmaBlade in patients at risk for EMI. Lin et al also found that electrosurgical device usage was associated with an increased risk of pacemaker output failure for prolonged periods.14 St. Jude Medical released an advisory warning of temporary decreases in pacemaker device output voltage and failure associated with PlasmaBlade use.15