Surgery
John Melford in Pocket Guide to Cancer, 2017
A standard electrical current at a frequency of 60 c/s is unsuitable for electrosurgery because it stimulates body tissue, causes injury, and can cause death by electrocution. High‑frequency currents above 100,000 c/s do not stimulate nerves and muscles and therefore, are more suitable for electrosurgery. Special generators are used to take normal current as input and ramp up its frequency to over 200,000 c/s. At this frequency, electrosurgical energy passes through the body with minimal neuromuscular stimulation and no risk of electrocution. Benign growths are often treated with electrosurgery or curettage. Curettage involves the physical scraping of affected tissue. When combined, electrosurgery, and curettage provide an effective means of treating legions and a margin of surrounding tissue.
Surgical treatment of skin disorders
Ronald Marks, Richard Motley in Common Skin Diseases, 2019
Curettage is a useful technique for separating softer lesion tissue, such as basal cell carcinoma or seborrhoeic keratoses, from surrounding skin. It may be used in combination with electrosurgery or electrocautery to soften the lesional tissue and for haemostasis. Traditionally curettage and cautery or electrodessication has been used to treat small, well-circumscribed basal and squamous cell carcinomas. In many instances these tumours are so well circumscribed that they are entirely removed by curettage. The base of the wound is then heated to destroy remaining tumour cells. The procedure may be repeated. Cure rates of more than 80 per cent can be achieved with careful lesion selection but there is no way of detecting residual tumour in cases which fail, so this technique should be reserved for locations and instances where recurrence of the tumour would not be a cause for concern. Curettage to define tumour extent prior to excision of the curetted wound with a margin of normal skin is a very useful surgical technique.
Management of fetal anomalies
David M. Luesley, Mark D. Kilby in Obstetrics & Gynaecology, 2016
Surgical termination may be performed by vacuum aspiration or dilatation and evacuation. Vacuum aspiration or suction curettage is the method used until the end of the first trimester. Dilatation of the cervix prior to surgery is achieved by passing graduated metal dilators or inserting vaginal prostaglandin preparations. Abortion is then performed by the use of a Perspex suction tube connected to vacuum apparatus. The inherent risk associated with abortion relates to the use of general anaesthesia and the invasive nature of the procedure – with complications of haemorrhage, uterine perforation and infection. The incidence of haemorrhage is 1.5/1000, uterine perforation 1–4/1000 and of cervical trauma 1 percent. Post-abortion infection occurs in up to 10 percent of cases and is significantly reduced if prophylactic antibiotics are given [B]. Suction curettage has been shown to produce lower risks of these complications than sharp curettage.2 Complications are lessened the earlier the gestation.11 Couples should also be informed of the risk of failed abortion, which occurs in 2.3/1000 surgical terminations.
Risk factors of retained products of conception after miscarriage or termination with gemeprost in the second trimester of pregnancy: a retrospective case-controlled study in Japanese population
Published in Journal of Obstetrics and Gynaecology, 2022
Tomoko Noguchi, Michihisa Shiro, Sakiko Nanjo, Mika Mizoguchi, Nami Ota, Yasushi Mabuchi, Shigetaka Yagi, Sawako Minami, Kazuhiko Ino
Surgical curettage after delivery was not routinely performed in our hospital in order to avoid uterine rupture and subsequent intrauterine adhesions. Routine curettage after delivery in the second trimester abortion was not recommended in Royal College of Obstetricians and Gyanecologists (RCOG) guidelines (RCOG 2004). Previous reports (Hooker et al. 2016) indicated that surgical curettage was associated with a higher incidence of uterine adhesion and infertility. Moreover, surgical curettage for RPOC is reported to be associated with an increase risk factor of recurrence in subsequent pregnancies (Smorgick et al. 2018). Capmas et al. reported that hysteroscopic resection of RPOC was an efficient procedure and alternative therapy compared to surgical curettage. In this study, only 7.5% of women who were diagnosed with RPOC and received hysteroscopic resection caused intrauterine adhesion, and 83% of them had subsequent pregnancy (Capmas et al. 2019).
Animal models in intrauterine adhesion research
Published in Journal of Obstetrics and Gynaecology, 2022
Shanshan Liang, Yanlan Huang, Yanfen Xia, Shuang Liang, Qiaoling Wu, Zhifu Zhi
In addition to factors such as surgery, infection, and trauma, low levels of oestradiol after endometrial injury can also lead to the formation of adhesions (Yang et al. 2022). However, a current view also supports using oestrogen before surgery to prevent the formation of adhesions (Zhang et al. 2019). Some studies have shown that oestrogen combined with other treatments can reduce the AFS score, reduce endometrial adhesions, improve the capability of endometrial regeneration, and improve the reproductive outcome of patients with IUA (Cai et al. 2016; Ebrahim et al. 2018). Bazoobandi et al. (2016) increased the intervention conditions with oestrogen on the basis of the above experiments (Bazoobandi et al. 2016). They improved the method of the above model by combining it with the polyoestrous characteristic of rabbits, allowing the uterine endometrium to be restored shortly after the traumatic curettage of the uterus. Under the same experimental conditions as those of Khrouf et al.(2012), lowering the oestrogen level by deletion or fixation of ovarian hormone effects reduced endometrial proliferation. The histological examination of uterine sections showed that curettage was effective in endometrial destruction. These workers thus successfully established an IUA model and proved the potential effects of hormone levels on endometrial structure, regeneration, and fertility after uterine curettage. Their study also provided a model reference for follow-up study with oestrogen and progesterone for preventing adhesions (Khrouf et al. 2012).
Medical management of first trimester missed miscarriage: the efficacy and complication rate
Published in Journal of Obstetrics and Gynaecology, 2019
Tamara Serdinšek, Milan Reljič, Vilma Kovač
The complications of medical management are one of the main concerns, especially those requiring immediate therapeutic measures (e.g. heavy bleeding, severe pain). We performed a curettage in the first 48 hours after the procedure in only 7.4% of the women (29.2% in HGA and 2.2% in LGA protocol). Our results are comparable to the results of studies conducted in an outpatient setting in which surgical evacuation of the uterus (emergency and elective) was performed in 9.4 – 22% of the women (Ngai et al. 2001; Sifakis et al. 2005; Niinimäki et al. 2006; Barceló et al. 2012; Torre et al. 2012; Petersen et al. 2013). Only 9% of the patients returned to our clinic because of different complications (mostly vaginal bleeding or RPOC). This could be due to inpatient management of these patients, which enabled us to detect early complications during hospitalisation and, therefore, reduce the rate of subsequent visits. If we transform from inpatient to outpatient management, the number of these unscheduled visits would be expected to rise. The current literature reports 18–23% of unscheduled visits, mostly because of pain and/or vaginal bleeding (Torre et al. 2012). However, most studies describe the outpatient management of missed miscarriage as safe and effective (Zhang et al. 2005; Shankar et al. 2007; Torre et al. 2012), while offering women more privacy, control, and choice (Sifakis et al. 2005).
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