Cryosurgery and electrosurgery compared in the treatment of experimentally induced oral carcinoma
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Aims: This study is to compare the outcome of diathermy incisions versus steel scalpel incisions in abdominal surgeries with regard to incision time, incision related blood loss, post-operative pain and post-operative wound infection / complication. Materials and methods: This is a prospective randomized comparative clinical study involving 116 patients. 58 patients were randomly assigned to undergo incision either with scalpel or electrocautery. Results were analysed based on the findings. Results: Incision time and incisional blood loss is lesser in electrocautery incisions when compared to scalpel incisions. This is an encouraging fact in view of routine use of electrocautery for taking abdominal incisions after observing all necessary aseptic precautions. There was no significant difference in terms of post-operative pain and wound complications according to the data. Conclusion: Electrosurgical instruments can be used as an alternate safer option for surgical incisions.
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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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Cryosurgery
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Cryotherapy
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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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Although still controversial, the use of diathermy instead of scalpel for skin incision and underlying tissue dissection is gradually gaining wide acceptance. This is due to the observation that no change in wound complication rates or postoperative pain are reported with the use of electrocautery. However, these studies include operations without the use of prosthetic materials during abdominal wall closure. The purpose of this study was to investigate the hypothesis that a) application of extreme heat may result in significant postoperative pain and poor wound healing because of excessive tissue damage and scarring respectively, and b) skin incision with the use of diathermy entails increased risk of wound infection in the presence of an underlying prosthetic material. One hundred twenty-five consecutive patients submitted to inguinal hernioplasty using the tension-free technique and fulfilling the inclusion criteria for the study were allocated alternately to either scalpel (n = 60), or diathermy (n = 57) groups. Eight patients had bilateral hernias. Five of them were allocated to the scalpel group and three to the diathermy group. According to the study protocol, they received both approaches for skin and underlying tissues incision, thus resulting in a total of 68 scalpel and 65 diathermy individual hernioplasties. Parameters measured included blood loss during the skin incision and underlying tissue dissection, postoperative pain and requirements for analgesics, the presence of wound dehiscence in the absence of infection, and postoperative wound infection on the day of discharge, on the day staples were removed, and 1 month after surgery. The two groups of patients were similar in relation to patient demographics, type of hernias, and operation details. Blood loss was minimal, and the amount of blood lost did not differ between the two groups. Diathermy group patients required less parenteral analgesics on the first postoperative day. A higher proportion of patients in the scalpel group continued to need oral analgesics on the second postoperative day compared to patients in the diathermy group. There was no difference between the two groups in terms of wound strength. Infectious complications were totally absent. The use of diathermy for skin incision during inguinal hernioplasty is as safe as the use of scalpel in terms of wound healing and reduces the analgesics requirements in the postoperative period.
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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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Summary A new method of low heat electrocautery (cold coagulation) treatment of cervical erosion has been assessed. It has the advantages of being odourless, smokeless and relatively pain free when compared with hot wire cautery or diathermy treatment. It has been found to compare favourably with a matched series of patients treated by cryosurgery.
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Cauterization
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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)
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