Loop Diathermy to Replace Conization in the Conservative Treatment of In Situ Cancer of the Uterine Cervix
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Retrospective data are analyzed from 217 patients conservatively treated for in situ cervical cancer, as diagnosed by colposcopically directed biopsies. One hundred twenty-four patients were treated by diathermy loop (57%), 43 patients were submitted to laser vaporization or diathermocoagulation (19.9%), and 50 patients (23%) had a surgical cone. The outpatient treatment never had to be stopped for pain or hemorrhage. After treatment, every patient had a periodic colposcopic and cytologic follow-up (mean follow-up 48 months). The cure rates were similar for the three therapy methods (94% overall, 93% diathermy loop, 96% surgical cone, and 95.4% laser or diathermocoagulation). Relapses were successfully treated, again with conservative therapy. Histologic examination of the surgical specimen was always possible for both the diathermy loop treatment and the surgical cone. The discordance between the preoperative biopsy and the postsurgical examination was 27% and 18% for diathermy loop and conization, respectively (not statistically significant). In 3 cases, a microinvasion was detectable in the specimen, and 1 patient had an associated cervical adenocarcinoma. The diathermy loop appears to be a reliable therapy for almost all patients with CIN 3. (J GYNECOL SURG 10:235, 1994)Keywords:
Diathermy
Electrosurgery
Electrocoagulation
Cervical canal
Electromagnetic interference problems associated with electrosurgery (also known as diathermy, surgical diathermy or high frequency surgical equipment) and other medical equipment are discussed with an emphasis an practical methods of minimizing problems. >
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This report presents further experience in the use of electrocoagulation diathermy for the treatment of patients with cervical intraepithelial disease. By means of the colposcope it was possible to select a group of nonpregnant patients, in whom a proven noninvasive lesion was located entirely within range of the colposcope. This group, comprising 450 patients, has been treated by means of electrocoagulation diathermy, and with followup, only 28 patients have shown evidence of a residual lesion; in 8 of these the residual lesion has been eradicated subsequently by repeat diathermy treatment. Significant complications following electrocoagulation diathermy occurred in 13 patients (3%). The overall apparent cure rate for electrocoagulation diathermy was 95.4%.
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Plume generated by electrosurgical techniques is a health hazard to patients and dermatologists.To compare the particle concentration generated by various energy devices used in dermatologic surgery.Five surgical techniques were tested on human tissue samples in a closed chamber. A particle counter, positioned at a fixed point 20 cm away from the sample, recorded the concentrations of aerosolized particles generated over 7 particle sizes (0.3, 0.5, 0.7, 1, 2.5, 5, and 10 μm).Monopolar electrocoagulation created the greatest concentration of particles followed by electrocautery, electrodesiccation, electrofulguration, and bipolar electrocoagulation. Bipolar electrocoagulation created 80 times fewer 0.3 μm particles and 98 times fewer 0.5 μm particles than monopolar electrocoagulation. Across all electrosurgical techniques, the greatest concentrations of particles generated were of the 0.3 and 0.5 μm particle size.Bipolar electrocoagulation created the lowest concentration of particulate matter. Given the noxious and hazardous nature of surgical plume, the bipolar forceps offer surgeons a safer method of performing electrical surgery for both the surgical staff and the patient.
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Electrodesiccation and electrocoagulation are commonly used to control bleeding and destroy tissue. In certain outpatient settings, the clinician routinely uses one of these electrosurgical modalities on successive patients without sterilization or antisepsis of the treatment electrode tip. In controlled laboratory experiments using electrodesiccation and electrocoagulation, we investigated bacterial transference of Staphylococcus aureus from inoculated tissue to sterile electrode tips and from inoculated electrode tips to sterile tissue. With use on inoculated tissue, sterile electrode tips remained sterile after electrocoagulation but not after electrodesiccation. Bacterial transference from inoculated electrode tips to sterile tissue occurred with electrodesiccation but not with electrocoagulation. These results are consistent with bacterial destruction by electric current and suggest that bacterial transference via the treatment electrosurgery electrode from one patient to another is possible but much more probable during electrodesiccation than during electrocoagulation.
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• Electrodesiccation and electrocoagulation are commonly used to control bleeding and destroy tissue. In certain outpatient settings, the clinician routinely uses one of these electrosurgical modalities on successive patients without sterilization or antisepsis of the treatment electrode tip. In controlled laboratory experiments using electrodesiccation and electrocoagulation, we investigated bacterial transference ofStaphylococcus aureusfrom inoculated tissue to sterile electrode tips and from inoculated electrode tips to sterile tissue. With use on inoculated tissue, sterile electrode tips remained sterile after electrocoagulation but not after electrodesiccation. Bacterial transference from inoculated electrode tips to sterile tissue occurred with electrodesiccation but not with electrocoagulation. These results are consistent with bacterial destruction by electric current and suggest that bacterial transference via the treatment electrosurgery electrode from one patient to another is possible but much more probable during electrodesiccation than during electrocoagulation. (Arch Dermatol. 1990;126:751-755)
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Although there are other physical methods of destruction which may be effective for small areas of dysplastic change, the author believes that D&C and electrocoagulation diathermy under general anesthesia is a more reliable and more effective method of destruction of abnormal T-Zone. It has the distinct advantage of being able to eliminate large areas, and in particular, changes of major atypia extending into the gland crypts. To date, no patient treated in this fashion has developed invasive carcinoma of the cervix.
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Management of periorbital syringomas is problematic and avoided by many inexperienced physicians. The medical literature presently prefers CO(2) laser resurfacing to many other modalities, but the subject of electrosurgery has not been well explored.To evaluate the clinical efficacy of electrocoagulation at low voltages in treating periorbital syringomas.Twenty cases were collected during the period of 2002 through 2005. All cases were photographed before treatment with a dual-frequency 4-MHz radiofrequency device (Surgitron, Ellman International, Inc., Hewlett, NY) at a power of 1 to 2 in electrocoagulation mode. Six-week follow-up visits were scheduled to discuss occurrences and expectations, observe treatment effects, and apply further electrosurgery if needed.Clinical improvement increased with each subsequent treatment session. All patients scored either moderate or marked clinical improvement by their final visits, with 60% (11/18) revealing a marked clinical improvement (i.e., >70% clearance). The most common encountered adverse effects consisted of periorbital burning, swelling, redness, and pigmentary changes.Low-voltage electrocoagulation is an effective therapy for periorbital syringoma and should be considered when treating this difficult condition. To our knowledge, this is the first study utilizing electrocoagulation for removal of syringomas.
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Electrosurgery (diathermy) uses a high-frequency (2-3 MHz) alternating electrical current to heat tissues. Several settings are available for monopolar diathermy: cutting, coagulation, blend (combining coagulation and cutting) and fulguration. A number of potential hazards are linked to the use of diathermy. Smoke plume has been shown to be a biological and chemical hazard to both staff and patients; it has been found to incorporate toxic gases and vapours, blood fragments and viruses, and in high intensities it can cause ocular and respiratory tract infections. Due to the number of instruments in a secluded space, and a limited visibility outside of direct surgical vision, minimal access surgery (MAS) provides healthcare professionals with a new set of challenges relating to electrosurgery. Insulation failure is said to be the most dangerous as the full strength of current can be reassigned to non-targeted tissue.
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