Background
Lead damage is a complication caused by lead manipulation or heating damage from conventional electrocautery (EC) after cardiovascular implantable electronic device (CIED) replacement. ...Application of electrical plasma (PEAK PlasmaBlade) is a new technology that reportedly reduces this risk.
Objectives
This study was designed to compare the effect of EC versus PEAK PlasmaBlade on lead parameters and complications after generator replacement procedures.
Methods
We retrospectively studied 410 consecutive patients (840 leads) who underwent CIED replacement using EC (EC group) and 410 consecutive patients (824 leads) using PEAK PlasmaBlade (PlamaBlade group). Pacing lead impedance, incidence of lead damage, and complications were compared between both groups.
Results
Lead impedance increased in 393 leads (46.8%) in the EC group versus 282 leads (34.2%) in the PlasmaBlade group (p < .01) with average percent changes of 6.7% and 4.0% (p < .01), respectively. Lead impedance decreased in 438 leads (52.1%) in the EC group versus 507 leads (61.5%) in the PlasmaBlade group (p < .01) with average percent changes of −5.7% and −7.1% (p < .01), respectively. Lead damage requiring lead revision occurred in five leads (0.6%) or after five procedures (1.2%) in the EC group compared to three leads (0.4%, p = .50) or after three procedures (0.7%, p = .48) in the PlasmaBlade group. There were no significant differences in the procedural‐related complications between the EC group (nine patients, 2.2%) and the PlasmaBlade group (five patients, 1.2%, p = .28).
Conclusion
Conventional electrocautery can potentially damage lead insulations. However, this study shows that when used carefully electrocautery is as safe as the PEAK PlasmaBlade™.
Aims
In cases of malignant distal biliary obstruction, ERCP is the preferred technique for bile duct drainage. In case of failure, the alternative techniques are percutaneous transhepatic biliary ...drainage (PTBD) and more recently endoscopic ultrasound-guided biliary drainage. A new type of stent called the electrocautery-enhanced lumen-apposing metal stent (EC-LAMS) has been developed to enable the performance of biliary-enteric anastomosis under EUS-guidance in a single step, without prior bile duct puncture or the need for a guidewire. The aim of our study was to compare the real-life efficacies of PTBD and EUS-BD with the EC-LAMS for cases of ERCP failure in patients with malignant biliary obstruction.
Methods
We performed a monocentric retrospective study comparing PTBD and EUS-BD with the use of electrocautery-enhanced lumen-apposing metal stent in the context of a malignant distal biliary obstruction after ERCP failure.
Results
95 patients were included (50 in EUS-BD group and 45 in PTBD group). The main etiology of malignant obstruction was adenocarcinoma of the head of pancreas (85%). There was a significant difference in favor of endoscopic ultrasound-guided biliary drainage using electrocautery-enhanced lumen-apposing metal stent for the following criteria: clinical success: 89.3% vs. 45.5%;
p
< 0.0001; procedure-related adverse event rate: 2.12% vs. 22.7%;
p
= 0.003; duration of post-drainage hospitalization: 3.5 vs. 8.2 days;
p
< 0.0001, overall survival (median survival): 118.2 vs. 42 days;
p
= 0.012, overall cost of the strategy per patient: 5098 vs. 9363 euros;
p
< 0.001.
Conclusion
Our results are in favor of EUS-BD using electrocautery-enhanced lumen-apposing metal stent in case of ERCP failure for a distal tumor biliary obstruction. Operators performing ERCP for distal tumor biliary obstruction must learn this backup procedure because of its superiority over percutaneous transhepatic biliary drainage in terms of clinical success, safety, cost, and overall survival.
The aim of this study was to investigate the clinical effectiveness of patella rim electrocautery “denervation” versus no denervation in patients undergoing total knee arthroplasty (TKA).
We ...conducted a single-center, double-blind randomized controlled trial. Patients aged 40 years or older, due to undergo a TKA who did not have patella resurfacing (usual care) were randomized with or without circumferential patella electrocautery. This was undertaken according to a randomly generated sequence of treatment allocation that was placed into numbered, sealed opaque envelopes. Participants were blinded to treatment allocation. There was no crossover. The primary outcome was Oxford Knee Score at 1 year postoperatively. Secondary outcomes were Bartlett Patella Score, Western Ontario and McMaster Universities Arthritis Index (WOMAC), and 12-Item Short Form Survey. Linear regression analyses were performed with adjustments by age, sex, and baseline (preoperative) scores. There were 142 participants recruited, of which 49 (35%) were allocated to the denervation intervention. Recruitment was stopped early when interim statistical analyses confirmed adequate numbers in both groups despite an imbalance in early treatment allocation rates due to the randomization method. The mean patient age was 71 years (range, 50 to 85) and 51% (n = 74) were women.
No difference in Oxford Knee Score was detected at 1 year (mean difference MD 1.87; 95% confidence interval CI −1.28 to 5.03). No difference was detected in Bartlett Patella Score (MD 0.490; 95% CI −1.61 to 2.59) or 12-Item Short Form Survey (MD 0.196; 95% CI −2.54 to 2.93). A statistically significant difference in WOMAC was detected, but at a level less than the minimal clinically important difference for WOMAC (MD 4.79; 95% CI 1.05 to 8.52).
No clinically relevant benefit was detected from patella rim electrocautery in patients undergoing TKA who did not have patella resurfacing (including no benefit in terms of anterior knee pain). This treatment is therefore not recommended for clinical practice.
Level 1.
Background
Basal cell carcinoma (BCC) is the commonest cancer affecting white‐skinned individuals, and worldwide incidence is increasing. Although rarely fatal, BCC is associated with significant ...morbidity and costs. First‐line treatment is usually surgical excision, but alternatives are available. New published studies and the development of non‐surgical treatments meant an update of our Cochrane Review (first published in 2003, and previously updated in 2007) was timely.
Objectives
To assess the effects of interventions for BCC in immunocompetent adults.
Search methods
We updated our searches of the following databases to November 2019: Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, and LILACS.
Selection criteria
Randomised controlled trials (RCTs) of interventions for BCC in immunocompetent adults with histologically‐proven, primary BCC. Eligible comparators were placebo, active treatment, other treatments, or no treatment.
Data collection and analysis
We used standard methodological procedures expected by Cochrane. Primary outcome measures were recurrence at three years and five years (measured clinically) (we included recurrence data outside of these time points if there was no measurement at three or five years) and participant‐ and observer‐rated good/excellent cosmetic outcome. Secondary outcomes included pain during and after treatment, early treatment failure within six months, and adverse effects (AEs). We used GRADE to assess evidence certainty for each outcome.
Main results
We included 52 RCTs (26 new) involving 6690 participants (median 89) in this update. All studies recruited from secondary care outpatient clinics. More males than females were included. Study duration ranged from six weeks to 10 years (average 13 months). Most studies (48/52) included only low‐risk BCC (superficial (sBCC) and nodular (nBCC) histological subtypes). The majority of studies were at low or unclear risk of bias for most domains. Twenty‐two studies were industry‐funded: commercial sponsors conducted most of the studies assessing imiquimod, and just under half of the photodynamic therapy (PDT) studies.
Overall, surgical interventions have the lowest recurrence rates. For high‐risk facial BCC (high‐risk histological subtype or located in the facial 'H‐zone' or both), there may be slightly fewer recurrences with Mohs micrographic surgery (MMS) compared to surgical excision (SE) at three years (1.9% versus 2.9%, respectively) (risk ratio (RR) 0.64, 95% confidence interval (CI) 0.16 to 2.64; 1 study, 331 participants; low‐certainty evidence) and at five years (3.2% versus 5.2%, respectively) (RR 0.61, 95% CI 0.18 to 2.04; 1 study, 259 participants; low‐certainty evidence). However, the 95% CI also includes the possibility of increased risk of recurrence and no difference between treatments. There may be little to no difference regarding improvement of cosmetic outcomes between MMS and SE, judged by participants and observers 18 months post‐operatively (one study; low‐certainty evidence); however, no raw data were available for this outcome.
When comparing imiquimod and SE for nBCC or sBCC at low‐risk sites, imiquimod probably results in more recurrences than SE at three years (16.4% versus 1.6%, respectively) (RR 10.30, 95% CI 3.22 to 32.94; 1 study, 401 participants; moderate‐certainty evidence) and five years (17.5% versus 2.3%, respectively) (RR 7.73, 95% CI 2.81 to 21.3; 1 study, 383 participants; moderate‐certainty evidence). There may be little to no difference in the number of participant‐rated good/excellent cosmetic outcomes (RR 1.00, 95% CI 0.94 to 1.06; 1 study, 326 participants; low‐certainty evidence). However, imiquimod may result in greater numbers of good/excellent cosmetic outcomes compared to SE when observer‐rated (60.6% versus 35.6%, respectively) (RR 1.70, 95% CI 1.35 to 2.15; 1 study, 344 participants; low‐certainty evidence). Both cosmetic outcomes were measured at three years.
Based on one study of 347 participants with high‐ and low‐risk primary BCC of the face, radiotherapy may result in more recurrences compared to SE under frozen section margin control at three years (5.2% versus 0%, respectively) (RR 19.11, 95% CI 1.12 to 325.78; low‐certainty evidence) and at four years (6.4% versus 0.6%, respectively) (RR 11.06, 95% CI 1.44 to 84.77; low‐certainty evidence). Radiotherapy probably results in a smaller number of participant‐ (RR 0.76, 95% CI 0.63 to 0.91; 50.3% versus 66.1%, respectively) or observer‐rated (RR 0.48, 95% CI 0.37 to 0.62; 28.9% versus 60.3%, respectively) good/excellent cosmetic outcomes compared to SE, when measured at four years, where dyspigmentation and telangiectasia can occur (both moderate‐certainty evidence).
Methyl‐aminolevulinate (MAL)‐PDT may result in more recurrences compared to SE at three years (36.4% versus 0%, respectively) (RR 26.47, 95% CI 1.63 to 429.92; 1 study; 68 participants with low‐risk nBCC in the head and neck area; low‐certainty evidence). There were no useable data for measurement at five years. MAL‐PDT probably results in greater numbers of participant‐ (RR 1.18, 95% CI 1.09 to 1.27; 97.3% versus 82.5%) or observer‐rated (RR 1.87, 95% CI 1.54 to 2.26; 87.1% versus 46.6%) good/excellent cosmetic outcomes at one year compared to SE (2 studies, 309 participants with low‐risk nBCC and sBCC; moderate‐certainty evidence).
Based on moderate‐certainty evidence (single low‐risk sBCC), imiquimod probably results in fewer recurrences at three years compared to MAL‐PDT (22.8% versus 51.6%, respectively) (RR 0.44, 95% CI 0.32 to 0.62; 277 participants) and five years (28.6% versus 68.6%, respectively) (RR 0.42, 95% CI 0.31 to 0.57; 228 participants). There is probably little to no difference in numbers of observer‐rated good/excellent cosmetic outcomes at one year (RR 0.98, 95% CI 0.84 to 1.16; 370 participants). Participant‐rated cosmetic outcomes were not measured for this comparison.
AEs with surgical interventions include wound infections, graft necrosis and post‐operative bleeding. Local AEs such as itching, weeping, pain and redness occur frequently with non‐surgical interventions. Treatment‐related AEs resulting in study modification or withdrawal occurred with imiquimod and MAL‐PDT.
Authors' conclusions
Surgical interventions have the lowest recurrence rates, and there may be slightly fewer recurrences with MMS over SE for high‐risk facial primary BCC (low‐certainty evidence). Non‐surgical treatments, when used for low‐risk BCC, are less effective than surgical treatments, but recurrence rates are acceptable and cosmetic outcomes are probably superior. Of the non‐surgical treatments, imiquimod has the best evidence to support its efficacy.
Overall, evidence certainty was low to moderate. Priorities for future research include core outcome measures and studies with longer‐term follow‐up.
Since its introduction, electrocautery has served as a valuable surgical tool, enabling precise tissue cutting and effective hemostasis in spine surgery. While there have been numerous efforts to ...elucidate the possible hazardous effects of surgical smoke in various surgical fields, there has been very little discussion in the context of spine surgery. The objective of this study was to measure and conduct a quantitative analysis of the particulate matter (PM) of different sizes and of formaldehyde (HCHO) generated by smoke during spine surgeries.
This study included a consecutive series of patients who underwent 1- or 2-level lumbar spinal fusion surgery between June and November 2021. Particle counts were measured using a particle counter, specifically focusing on six different sizes of PM (0.3, 0.5, 1, 2.5, 5, and 10 µm). Additionally, measurements were taken for HCHO in parts per million (ppm). Monopolar cautery was used in the surgical setting. Systematic measurements were conducted at specific time points during the surgical procedures to assess the levels of PM and HCHO. Furthermore, the efficacy of surgical smoke suction was evaluated by comparing the PM levels with and without adjacent placement of suction.
This study involved 35 patients, with measurements of both PM and HCHO taken in 27 cases. The remaining 8 cases had measurements only for PM. In this study, statistically significant quantitative changes in various PM sizes were observed when electrocautery was used during spine surgery (12.3 ± 1.7 vs 1975.7 ± 422.8, 3.4 ± 0.5 vs 250.1 ± 45.7, and 1.9 ± 0.2 vs 78.1 ± 13.3, respectively, for 2.5-, 5-, and 10-µm PM; p < 0.05). The level of HCHO was also significantly higher (0.085 ± 0.006 vs 0.131 ± 0.014 ppm, p < 0.05) with electrocautery use. Utilization of adjacent suction of surgical smoke during electrocautery demonstrated a statistically significant reduction in PM levels.
The findings of this study highlight the potential surgical smoke-related hazards that spine surgeons may be exposed to in the operating room. Implementing simple interventions, such as utilizing nearby suction, can effectively minimize the amount of toxic surgical smoke and mitigate these risks.
Study Design.
A laboratory study performed in a self-controlled fashion.
Objective.
The aim of this study was to examine whether “surgical smoke” generated by using the electrocautery on porcine ...spinal tissues could contain viable bacteria.
Summary of Background Data.
The year 2020 has seen a surge in legislation regarding surgical smoke evacuation in the operating room across the United States. Surgical smoke contains numerous toxic and carcinogenic substances, which spine surgeons and operating room staff are regularly exposed to. Although the smoke's chemical toxicity has been extensively studied, little is known about its biohazard level.
Methods.
The electrocautery was used to “operate on” 20 segments of porcine spinal tissues on a clean bench. In each operation, the generated smoke was captured with a swab, which was positioned above the surgical site and within the smoke, to obtain bacteria cultures. Two other swabs—a tissue swab (swabbing the porcine tissue itself) and a blank swab (swabbing an empty sterile bowl)—were collected as controls. The culture results were compared among the three groups. An additional experiment was conducted to see whether using a mask can reduce the “infection rate” of the swab.
Results.
Although all blank swabs tested negative, 95% (19/20) of the smoke swabs tested positive, with a total of nine bacteria species identified. The most prevalent species observed in the smoke swabs included
Serratia liquefaciens
,
Lactococcus garvieae
, and
Hafnia alvei
, and so on. Among the positive smoke swabs, 84% (16/19) had one or more bacteria species that were consistent with the cultures of their corresponding tissue swabs. Using a surgical or N95 mask reduced the “infection rate” of the swab.
Conclusion.
“Surgical smoke” generated by electrocauterization of porcine spinal tissues contains viable bacteria. Further research in actual spine surgery is needed next.
Level of Evidence:
N/A
The use of electrocautery to facilitate passage of a suture needle through bone without the aid of a drill or burr is a novel technique that has potential utility in orthopedic procedures, but there ...is a scarcity of research to support its utility. The specific aims of this cadaveric biomechanical study were to evaluate (1) the axial force reduction during suture passage using electrocautery when applied to rotator cuff repair, (2) the temperature change caused while using electrocautery, and (3) the failure loads and failure modes of this technique.
Five matched pairs of fresh frozen humeri were used, classified into 2 groups: with electrocautery on needle (study group) and without electrocautery on needle (control group). Four individual osseous tunnels were made on the greater tuberosity around the insertion of the supraspinatus tendon. Each specimen was sequentially tested in 2 parts: a needle penetration test (part I) to measure the peak axial force and temperature change and a single load-to-failure test (part II) to measure the maximum load to failure as well as the mechanism of failure. A No. 2 FiberWire suture with a straight needle was used.
In part I, the mean peak axial force was lower in the study group compared with the control group for all osseous tunnels but was not statistically significant for individual tunnels. However, there was a significant decrease in peak axial force in the study group of 36% compared with the control group overall (P = .033). There was no significant change in temperature of the tunnel site with the use of electrocautery (mean: 0.2 ± 0.3°C, P = .435). In part II, 100% of the samples from each study group experienced bone tunnel failure. Forty percent of the trials in the study group found lower ultimate failure loads compared with the control group (reduction range: 7%-38%). There was no statistically significant difference in the ultimate failure load between either the loop tested or between the 2 study groups (loop 1: P = .352; loop 2: P = .270).
Suture passage using electrocautery does significantly decrease the peak force needed to pass a needle directly through the greater tuberosity. This technique does not appear to burn the bone or weaken the bone tunnels. This technique may be useful during open rotator cuff repair or shoulder arthroplasty, although clinicians should be cautious when using this technique as its utility depends on bone quality and cortical thickness, and in vivo results may differ.
To describe the effect of monopolar electrocautery (EC) settings on surgical plume particulate concentration during pediatric tonsillectomy.
Cross-sectional study.
Tertiary medical center.
During ...total tonsillectomy exclusively performed with EC, air was sampled with a surgeon-worn portable particle counter. The airborne mean and maximum particle concentrations were compared for tonsillectomy performed with EC at 12 W vs 20 W, with smoke evacuation system (SES) and no smoke evacuation (NS).
A total of 36 children were included in this analysis: 9 cases with EC at 12 W and SES (12SES), 9 cases with EC at 20 W and SES (20SES), 9 cases with EC at 12 W without SES (12NS), and 9 cases with EC at 20 W without SES (20NS). Mean particle number concentration in the breathing zone during tonsillectomy was 1661 particles/cm
for 12SES, 5515 particles/cm
for 20SES, 8208 particles/cm
for 12NS, and 78,506 particles/cm
for 20NS. There was a statistically significant difference in the particle number concentrations among the 4 groups. The correlation between the particle number concentration and EC time was either moderate (for 12SES) or negative (for remaining groups).
Airborne particle concentrations during tonsillectomy are over 9.5 times higher when EC is set at 20 W vs 12 W with NS, which is mitigated to 3.3 times with SES. Applying lower EC settings with SES during pediatric tonsillectomy significantly reduces surgical plume exposure for patients, surgeons, and operating room personnel, which is a well-known occupational health hazard.
Ingrown toenail is a common condition that results in chronic pain, recurrent infections, and difficulty in performing daily activities. Our aim is to compare two surgical methods for the treatment ...of ingrown toenails: wedge resection with curetting versus wedge resection curetting followed by electrocauterization of the nail bed.
A prospective, comparative study that included 130 patients with ingrown toenails. All patients had stage II or III disease. We divided the participants into two groups according to the type of surgery and all patients were followed up for 6 months. The outcomes measured were the incidence of postoperative bleeding and infection, recovery time, patient satisfaction, and recurrence rate 6 months after surgery.
Of the 130 patients included, 59 (45.4%) underwent excision and curetting of the nail matrix (group 1) and 71 (54.6%) underwent excision, curetting, and electrocauterization of the nail matrix (group 2). The postoperative infection rates were 20.3 and 4.2% in the first and second groups, respectively (
= 0.004). Patient satisfaction was 76.3% among the first group, while 91.5% of patients in the second group were satisfied with the results of surgery. Six months postoperatively, recurrence rates were 25.4 and 4.2% in the first and second groups, respectively (
= 0.001).
Wedge excision and curettage, followed by electrocauterization of the ingrown toenail is a safe treatment modality with a high success rate, that is evident by a lower recurrence rate, and greater patient satisfaction, with no effect on postoperative pain score or recovery time.
Background and Aim Inferior turbinate hypertrophy is one of the most common causes of nasal obstruction after nasal septal deviation. Enlargement of the turbinate is the result of the position of ...turbinate bone or swelling of turbinate submucosal. This study aimed to evaluate the effectiveness of the SubMucosal Resection (SMR) method with electrocautery method in the treatment of inferior turbinate hypertrophy. Methods and Materials A total of 140 patients with inferior turbinate hypertrophy complicated with nasal congestion and rhinorrhea and candidate of surgery were randomly divided into two groups. In the first group, after induction of anesthesia, we performed SMR of inferior turbinate hypertrophy. In the second group, after induction of anesthesia, we performed monopolar cauterization with 20-gauge angiocath in three anterior, middle, and posterior regions and crests of the inferior turbinate. Ethical Considerations This study was approved by the Ethics Committee of Arak University of Medical Sciences (Code: 91.133.3). Results In the electrocautery group, a significant improvement was observed in nasal congestion after 6 months (P=0.017). In the SMR group, a satisfactory headache improvement was reported (P=0.034), one month after the operation. Also, the electrocautery group reported less pain and burning in the site of surgery, sneezing, coughing, and itching (P=0.013). Conclusion Electrocautery can be superior over SMR because of its less bleeding, shorter time of surgery, the availability of primary equipment, and relative improvement in decreasing the rhinorrhea. However, if the patient suffers from isolated inferior turbinate hypertrophy, SMR as a suitable method is recommended.
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