The hospital environment is both unique and unusual in that electrical equipment is directly applied to the human body. From this application either capacitive or resistive coupling may lead to ...current flow and harm. Surgical diathermy, patient monitoring and imaging, although universal, are often misunderstood, and many clinicians are ignorant of their principles and hazards. Electrical equipment in hospital therefore has the potential to lead to serious injury or death. This article outlines the basic physics of electricity, in particular the principles behind diathermy, the hazards posed by it and by other devices and the various measures available to reduce the risk of these.
Objectives/Hypothesis
The effects of different electrocautery power settings on mucosal contraction and margin status in the oral cavity have not been well established. The aim of this study was to ...examine how different levels of electrocautery energy outputs affect oral mucosal tissue margins.
Study Design
Animal model.
Methods
A model of 23 adult rats was used (two specimens per rat). After anesthetizing the animals, a 6‐mm biopsy punch marked the resection margin on the buccal mucosa (one per cheek). The specimens were excised by means of three energy levels, a cold knife, and monopolar diathermy that was set on either 20 W or 30 W cut modes. The specimens were evaluated for extent of contraction.
Results
A total of 45 samples were obtained and measured, including 15 specimens in the cold‐knife group, 15 specimens in the 20 W group, and 15 specimens in the 30 W group. The median diameters of the specimens after resection were 4.5 mm for the cold‐knife group (interquartile range IQR = 4.0–5.0), 3.5 mm for the 20 W group (IQR = 3.5–4.0), and 2.8 mm for the 30 W group (IQR = 2.5–3.0). Specimen contraction was 25.0%, 41.7%, and 53.3%, respectively. The difference in shrinkage between each pair was statistically significant: cold knife versus 20 W, P = .001; cold knife versus 30 W, P < .0001; and 20 W versus 30 W, P < .001.
Conclusions
Diathermy power settings result in a significant difference of mucosal tissue contraction, with higher outputs resulting in a narrower mucosal margin. It is imperative that the surgical team take into consideration the diathermy settings during initial resection planning. Laryngoscope, 131:E1514–E1518, 2021
Surgical smoke produced by electrosurgery contains various chemical substances such as volatile organic compounds (VOCs) and polycyclic aromatic hydrocarbons (PAHs). The aim of this study is to ...investigate airborne concentrations of VOCs and PAHs during electrosurgery in an operating room, in relation to metabolites in urine in order to assess the absorbed dose.
A 5-day exposure study was set up in a general surgery operation room including surgeons, scrub assistants and circulation nurses (n = 15). Stationary and personal air sampling for VOCs and PAHs were carried out. Pre-, mid- and end-shift analysis of urinary S-phenylmercapturic acid (SPMA), o-cresol, mandelic acid and 1-hydroxypyrene was performed to assess the internal exposure to respectively benzene, toluene, styrene and PAHs.
Several VOCs (styrene, ethyl benzene, benzene and toluene), ranging from 0.7 to 3.27 μg/m3 were detected in the air samples, along with one PAH (naphthalene, ranging from 0.012 to 0.39 μg/m3). There was no significant correlation between air monitoring and urinary biomonitoring. O-cresol levels were increased, especially among assistants and nurses at mid- and end-shift, exceeding current biological exposure indices several times. External and internal exposure for assistants and nurses was substantially more, compared to surgeons.
This study confirms the presence of VOCs and PAHs in surgical smoke and shows the presence of their metabolites in urine, but the association is unclear. Urinary biomonitoring shows especially high concentrations of o-cresol.
To verify that the TiO
nanofilm dip-coated by sol-gel can reduce titanium alloy implants (TAI)'s heat production after microwave diathermy (MD).
The effect of 40 W and 60 W MD on the titanium alloy ...substrate coated with TiO
nanofilm (Experimental Group) and the titanium alloy substrate without film (Control Group) were analyzed
and
. Changes in the skeletal muscle around the implant were evaluated in
by histology.
After 20 min of MD,
the temperature rise of the titanium substrate was less in the Experimental Group than in the Control Group (40 W: 1.4 °C vs. 2.6 °C,
< .01, 60 W: 2.5 °C vs. 3.7 °C,
< .01) and
, the temperature rise of the muscle tissue adjacent to TAI was lower in the Experimental Group than in the Control Group (40 W: 3.29 °C vs. 4.8 °C,
< .01, 60 W: 4.16 °C vs. 6.52 °C,
< .01). Skeletal muscle thermal injury can be found in the Control Group but not in the Experimental Group.
Sol-gel dip-coated TiO
nanofilm can reduce the heat production of TAIs under single 40～60 W and continuous 40 W MD and protect the muscle tissue adjacent to the implants against thermal injury caused by irradiation.
Objective
To compare different tonsillectomy techniques in terms of postoperative bleeding incidence and postoperative pain.
Methods
An arm‐based network analysis was conducted using a Bayesian ...hierarchical model. The primary and secondary outcomes were postoperative bleeding incidence and mean postoperative pain score.
Results
A total of 6464 patients were included for five different interventions (cold dissection tonsillectomy; extracapsular coblation tonsillectomy; intracapsular coblation tonsillectomy ICT; bipolar diathermy tonsillectomy BDT; monopolar diathermy tonsillectomy). ICT showed the lowest absolute risk (4.44%) of postoperative bleeding incidence (73.31% chance of ranking first) and the lowest mean postoperative pain score (1.74 ± 0.68) with a 94.0% chance of ranking first, whereas BDT showed both the highest absolute risk of bleeding incidence (10.75%) and the highest mean postoperative pain score (5.67 ± 1.43).
Conclusions
ICT seems to offer better postoperative outcomes, in terms of reduced risk of bleeding and reduced pain. Further prospective studies are advised to confirm these findings.
Level of Evidence
NA Laryngoscope, 134:1696–1704, 2024
The aim of this study was to perform a systematic review and network meta‐analysis to compare different tonsillectomy techniques in terms of postoperative bleeding incidence and postoperative pain. A total of 6464 patients were included for five different interventions. Intracapsular coblation tonsillectomy showed the lowest absolute risk (4.44%) of postoperative bleeding incidence (73.31% chance of ranking first) and the lowest mean post‐operative pain score (1.74 ± 0.68) with a 94.0% chance of ranking first.
Objective
To compare the postoperative pain following bipolar diathermy scissors tonsillectomy (higher temperature dissection) with harmonic scalpel tonsillectomy (lower temperature dissection).
...Methods
Sixty patients aged 7–40 years planned for tonsillectomy with no other concurrent surgery were randomised to either bipolar diathermy scissors or harmonic scalpel as surgical technique. Blinded to the surgical technique, the patients recorded their pain scores (VAS, 0–10) at awakening and the worst pain level of the day in the postoperative period. All intake of pain medication was also recorded.
Results
No statistically significant differences were found between the two groups regarding postoperative pain levels or consumption of pain medication.
Conclusion
Usage of the harmonic scalpel does not render less postoperative pain following tonsillectomy when compared with usage of the bipolar diathermy scissors.
Objective
This study was performed to review the current evidence for the efficacy of shortwave and microwave diathermy in promoting nerve regeneration after peripheral nerve injuries in both animal ...models and human patients.
Methods
An extensive literature search was conducted without publication data restrictions. Studies including the intervention and outcome in animal or human models were selected. Non-English studies, reviews, letters, and case reports were excluded.
Results
Eleven articles were included in this study. Shortwave diathermy at the frequency of 27.12 or 40.68 MHz was used in six of seven animal studies, while only one study utilized microwave diathermy at 915 MHz. Seven animal experiments demonstrated that shortwave or microwave diathermy produces an increased myelinated nerve fiber number, myelin sheath thickness, and axon diameter as well as improved electrophysiological parameters and locomotion. A total of 128 patients (207 wrists) were enrolled in four clinical studies. The clinical use of diathermy in human patients with carpal tunnel syndrome showed positive effects on pain, hand function, and electrophysiological findings.
Conclusions
Shortwave or microwave diathermy can improve the electrophysiological parameters, myelinated fiber number, and axon diameter of the injured nerve.
Background
The purpose of this study was to determine whether there is any difference in cosmetic outcome between using cutting diathermy and using a scalpel to make abdominal skin incisions.
Method
...This was a prospective, randomized, double‐blind crossover study. The primary end point was wound cosmesis as judged by the patient. In each case, one‐half of the skin incision was made using diathermy, and one‐half using a scalpel blade. Patients were contacted at 6 months post‐operatively, and were asked which half of the wound looked better to them. A panel of 18 surgeons was also shown photographs of the wounds taken after 6 months, and were asked the same question.
Results
Of the 31 patients with complete follow‐up, 11 (35%) reported no difference between the two halves of the wound. Nine (29%) preferred the half incised with diathermy, and 11 (35%) preferred the half incised with the scalpel (P = 0.82, chi‐squared test). Twenty‐four patients consented to having their wound photographed. There was no difference in the surgeons' preference between the diathermy and scalpel halves of the incision (P = 0.35, signed‐rank test).
Conclusion
We found the use of cutting diathermy to make abdominal skin incisions to be cosmetically equivalent to cutting with the scalpel. As previous studies have not shown adverse wound outcomes using this technique, and considering the safety concerns for theatre staff when the scalpel is used, the routine use of cutting diathermy for skin incisions in abdominal surgery is justified.
Management of rotator cuff disease may include use of electrotherapy modalities (also known as electrophysical agents), which aim to reduce pain and improve function via an increase in energy ...(electrical, sound, light, or thermal) into the body. Examples include therapeutic ultrasound, low-level laser therapy (LLLT), transcutaneous electrical nerve stimulation (TENS), and pulsed electromagnetic field therapy (PEMF). These modalities are usually delivered as components of a physical therapy intervention. This review is one of a series of reviews that form an update of the Cochrane review, 'Physiotherapy interventions for shoulder pain'.
To synthesise available evidence regarding the benefits and harms of electrotherapy modalities for the treatment of people with rotator cuff disease.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 3), Ovid MEDLINE (January 1966 to March 2015), Ovid EMBASE (January 1980 to March 2015), CINAHL Plus (EBSCOhost, January 1937 to March 2015), ClinicalTrials.gov and the WHO ICTRP clinical trials registries up to March 2015, unrestricted by language, and reviewed the reference lists of review articles and retrieved trials, to identify potentially relevant trials.
We included randomised controlled trials (RCTs) and quasi-randomised trials, including adults with rotator cuff disease (e.g. subacromial impingement syndrome, rotator cuff tendinitis, calcific tendinitis), and comparing any electrotherapy modality with placebo, no intervention, a different electrotherapy modality or any other intervention (e.g. glucocorticoid injection). Trials investigating whether electrotherapy modalities were more effective than placebo or no treatment, or were an effective addition to another physical therapy intervention (e.g. manual therapy or exercise) were the main comparisons of interest. Main outcomes of interest were overall pain, function, pain on motion, patient-reported global assessment of treatment success, quality of life and the number of participants experiencing adverse events.
Two review authors independently selected trials for inclusion, extracted the data, performed a risk of bias assessment and assessed the quality of the body of evidence for the main outcomes using the GRADE approach.
We included 47 trials (2388 participants). Most trials (n = 43) included participants with rotator cuff disease without calcification (four trials included people with calcific tendinitis). Sixteen (34%) trials investigated the effect of an electrotherapy modality delivered in isolation. Only 23% were rated at low risk of allocation bias, and 49% were rated at low risk of both performance and detection bias (for self-reported outcomes). The trials were heterogeneous in terms of population, intervention and comparator, so none of the data could be combined in a meta-analysis.In one trial (61 participants; low quality evidence), pulsed therapeutic ultrasound (three to five times a week for six weeks) was compared with placebo (inactive ultrasound therapy) for calcific tendinitis. At six weeks, the mean reduction in overall pain with placebo was -6.3 points on a 52-point scale, and -14.9 points with ultrasound (MD -8.60 points, 95% CI -13.48 to -3.72 points; absolute risk difference 17%, 7% to 26% more). Mean improvement in function with placebo was 3.7 points on a 100-point scale, and 17.8 points with ultrasound (mean difference (MD) 14.10 points, 95% confidence interval (CI) 5.39 to 22.81 points; absolute risk difference 14%, 5% to 23% more). Ninety-one per cent (29/32) of participants reported treatment success with ultrasound compared with 52% (15/29) of participants receiving placebo (risk ratio (RR) 1.75, 95% CI 1.21 to 2.53; absolute risk difference 39%, 18% to 60% more). Mean improvement in quality of life with placebo was 0.40 points on a 10-point scale, and 2.60 points with ultrasound (MD 2.20 points, 95% CI 0.91 points to 3.49 points; absolute risk difference 22%, 9% to 35% more). Between-group differences were not important at nine months. No participant reported adverse events.Therapeutic ultrasound produced no clinically important additional benefits when combined with other physical therapy interventions (eight clinically heterogeneous trials, low quality evidence). We are uncertain whether there are differences in patient-important outcomes between ultrasound and other active interventions (manual therapy, acupuncture, glucocorticoid injection, glucocorticoid injection plus oral tolmetin sodium, or exercise) because the quality of evidence is very low. Two placebo-controlled trials reported results favouring LLLT up to three weeks (low quality evidence), however combining LLLT with other physical therapy interventions produced few additional benefits (10 clinically heterogeneous trials, low quality evidence). We are uncertain whether transcutaneous electrical nerve stimulation (TENS) is more or less effective than glucocorticoid injection with respect to pain, function, global treatment success and active range of motion because of the very low quality evidence from a single trial. In other single, small trials, no clinically important benefits of pulsed electromagnetic field therapy (PEMF), microcurrent electrical stimulation (MENS), acetic acid iontophoresis and microwave diathermy were observed (low or very low quality evidence).No adverse events of therapeutic ultrasound, LLLT, TENS or microwave diathermy were reported by any participants. Adverse events were not measured in any trials investigating the effects of PEMF, MENS or acetic acid iontophoresis.
Based on low quality evidence, therapeutic ultrasound may have short-term benefits over placebo in people with calcific tendinitis, and LLLT may have short-term benefits over placebo in people with rotator cuff disease. Further high quality placebo-controlled trials are needed to confirm these results. In contrast, based on low quality evidence, PEMF may not provide clinically relevant benefits over placebo, and therapeutic ultrasound, LLLT and PEMF may not provide additional benefits when combined with other physical therapy interventions. We are uncertain whether TENS is superior to placebo, and whether any electrotherapy modality provides benefits over other active interventions (e.g. glucocorticoid injection) because of the very low quality of the evidence. Practitioners should communicate the uncertainty of these effects and consider other approaches or combinations of treatment. Further trials of electrotherapy modalities for rotator cuff disease should be based upon a strong rationale and consideration of whether or not they would alter the conclusions of this review.
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