共查询到20条相似文献,搜索用时 31 毫秒
1.
THOMAS J. MATZKE MD LESLIE J. CHRISTENSON MD STUART D. CHRISTENSON MD NATASHA ATANASHOVA BS CLARK C. OTLEY MD 《Dermatologic surgery》2006,32(9):1155-1162
BACKGROUND: Electrosurgery used during dermatologic surgical procedures can cause malfunction of pacemakers and implantable cardiac defibrillators (ICDs), producing problems with rhythm detection, proper function, or alteration of the device. Well-documented safety data on electrosurgery in patients with cardiac devices are limited. At Mayo Clinic in Rochester, Minnesota, the Pacemaker Clinic manages all patients with pacemakers and ICDs undergoing dermatologic surgery. The preoperative and postoperative evaluations provide a unique opportunity to evaluate the safety of dermatologic surgery with electrosurgery in such patients. OBJECTIVES: The objective was to review the evaluation and management, by an experienced cardiology team, of patients with cardiac devices undergoing dermatologic surgery and to characterize perioperative complications. METHODS: A retrospective chart review of all patients identified with pacemakers or ICDs undergoing Mohs micrographic or dermatologic excisional surgery with electrosurgery at Mayo Clinic 2001 through 2004 were identified. Data were abstracted to identify any possible complications. RESULTS: The 173 patients with pacemakers and 13 with ICDs undergoing dermatologic surgery had no documented complications from electrosurgery. CONCLUSION: The lack of complications associated with pacemakers and ICDs with electrosurgery is reassuring. The authors support published recommendations about techniques and precautions to optimize safety during electrosurgery in patients with cardiac devices. The care of patients with ICDs in particular requires special consideration. 相似文献
2.
Background and Objective. As the number of patients with implantable cardiac devices escalates, inadvertent electromagnetic interference (EMI) by electrosurgery carries increasing concern for patient safety. Given the trend for dermatologic care delivery by nonphysician providers, supervising physicians must carefully consider the adequacy of perioperative evaluation in elective or cosmetic settings. Rapidly evolving technology also calls into question potential EMI of new therapeutic modalities (radiofrequency resurfacing, electrochemotherapy, and endovenous ablation). The most recently published recommendations (1998) for care of dermatologic patients with cardiac devices do not differ significantly from guidelines proposed in 1975. These recommendations, based on complications experienced during noncutaneous surgery, are exceedingly conservative and do not take into consideration the different electrosurgical modalities and varying degrees of EMI risk. In addition, modern cardiac devices have evolved significantly with increased sophistication in protection from EMI. A survey of dermatologic surgeons demonstrated low compliance with these existing guidelines.
Methods, Results, and Conclusions. Based on a review of the literature and current electrosurgical and cardiac devices, we discuss the potential impact of conventional dermatologic electrosurgery and new technologies. We propose that new perioperative guidelines are needed to provide appropriate safety, facile implementation, and cost-effective care for patients with modern implantable cardiac devices. 相似文献
Methods, Results, and Conclusions. Based on a review of the literature and current electrosurgical and cardiac devices, we discuss the potential impact of conventional dermatologic electrosurgery and new technologies. We propose that new perioperative guidelines are needed to provide appropriate safety, facile implementation, and cost-effective care for patients with modern implantable cardiac devices. 相似文献
3.
BACKGROUND: Electrosurgery is one of the most commonly used energy systems in laparoscopic surgery. Two major categories of potential complications related to electrosurgery in laparoscopy are mechanical trauma and electrothermal injury. The latter can result from unrecognized energy transfer in the operational field or, less commonly, to unnoticed stray current outside the laparoscopic field of view. Stray current can result from insulation failure, direct coupling, or capacitive coupling. METHODS: We reviewed the literature concerning essential biophysics of electrosurgery, including electrosurgical waveform differentiation, tissue effect, and variables that determine tissue effect. The incidence of electrosurgical injuries and possible mechanisms responsible for the injuries are discussed. Different types of injuries may result in different clinical manifestations and histopathological findings. Gross and microscopic pathological check-ups of the injury sites may distinguish between different mechanisms, and thus provide further clues postoperatively. RESULTS: Several recommended practices are proposed to avoid electrosurgical injury laparoscopically. To achieve electrosurgical safety and to prevent electrosurgical injuries, the surgical team should have a good understanding of the biophysics of electrosurgery, the basis of equipment and general tissue effects, as well as the surgeon's spatial orientation and hand-eye coordination. Some intraoperative adjuvant procedures and newly developed safety devices have become available may aid to improve electrosurgical safety. CONCLUSIONS: Knowledge of the biophysics of electrosurgery and the mechanisms of electrosurgical injury is important in recognizing potential complications of electrosurgery in laparoscopy. Procedures for prevention, intraoperative adjuvant maneuvers, early recognition of the injury with in-time salvage treatment, and alertness to postoperative warning signs can help reduce such complications. 相似文献
4.
BACKGROUND: Deep brain stimulators are implantable devices with electrical activity used to treat certain movement disorders such as essential tremor and Parkinson's disease. Similar to implantable cardiac devices, use of electrosurgery on patients with these devices may produce adverse effects. CASE REPORT: We describe the effects of electrosurgery on a patient with essential tremor and an implantable deep brain stimulator who required Mohs micrographic surgery to excise a basal cell carcinoma. The patient experienced immediate lancinating "electrical shock" using electrosurgery in the monopolar mode. The patient experienced no discomfort when a bipolar electrosurgical device was used or when his deep brain stimulator was "turned off." Appropriate positioning of the dispersive plate also reduced adverse effects. CONCLUSION: Dermatologic surgeons should be aware of patients with devices implanted in the CNS with electrical activity and proceed with caution when using electrosurgery. Different approaches can be utilized to help reduce adverse effects. 相似文献
5.
T. G. Vancaillie 《Surgical endoscopy》1998,12(8):1009-1012
Background: In recent years, the use of minimally invasive surgery (MIS) has expanded to a wide variety of surgical specialties. The
increased popularity of the procedure, however, has been accompanied by its share of complications, including trocar lacerations
and inadvertent thermal injuries to nontargeted tissues during monopolar electrosurgery.
Methods: A survey on electrosurgical thermal injuries and three case studies are presented. The new technology of active electrode
monitoring (AEM) is described.
Results: AEM eliminates stray currents generated by insulation failure and capacitive coupling.
Conclusions: To reduce the incidence of injury by monopolar electrosurgery at laparoscopy, there is a need for advanced technology, such
as AEM. In addition, laparoscopic surgeons should be encouraged to study the basic concepts of the biophysics of electrosurgery.
Received: 26 June 1997/Accepted: 10 December 1997 相似文献
6.
The article is devoted to topical problem of modern urology, one of the lines of surgical treatment of benign prostatic hyperplasia (BPH)--transurethral electrosurgery. Physical principles which are the basis of transurethral electrosurgical interventions and influence of transurethral electrosurgery on prostatic tissue are described. Methods of necessary preoperative examination of patients with BPH are presented. The most often used transurethral electrosurgical technique for destruction of hyperplastic prostatic tissue is described. The results of 5-year use of combination of transurethral electroresection and electrovaporisation in the treatment of BPH and its complications are presented. Ways of prophylaxis of possible complications are proposed. 相似文献
7.
Paul J. Weber MD Brent R. Moody MD Robert M. Dryden MD Jill A. Foster MD 《Dermatologic surgery》2001,27(11):960-962
BACKGROUND: Tissue redundancy manifesting as a standing cutaneous cone is a common surgical problem. OBJECTIVE: To describe the use of electrosurgery to modify standing cutaneous cones. METHODS: Electrical current is applied via an electrosurgical needle to deep dermis and subcutaneous fat. The superficial dermis and epidermis are left undisturbed. In properly selected standing cones, correction of the standing cone is achieved without scar lengthening. RESULTS: Use of the technique can provide standing cone correction without lengthening the surgical scar. There has been no increase in wound failure or infection with the described technique. CONCLUSION: Electrosurgical modification complements existing surgical techniques for standing cutaneous cone repair. 相似文献
8.
Based on experience in treating 64 patients with chronic hemorrhoid a comparative clinical evaluation of efficiency of electrosurgical methods is carried out hemorrhoidectomy. Compared with traditional Milligan-Morgan surgery, electrosurgical method demonstrates the absence of intraoperative blood loss, a reduction in the algetic syndrome after surgery, a decrease in postoperative complications rates by 4.8 times. Physiological and physical activity, stool are also recovered by electrosurgery. 相似文献
9.
D J Zinder 《Otolaryngology--head and neck surgery》2000,123(4):450-455
The electrosurgery device market is lucrative and highly competitive. Several device manufacturers exist, and many creative techniques are used to differentiate products. Some device manufacturers make claims in marketing campaigns that are difficult to reconcile with the laws of physics or basic physiology. The variety of claims may be confusing to surgeons desiring to purchase new electrosurgical products. Understanding a few basic principles of electrosurgery physics can allow a surgeon to be a more informed consumer of electrosurgical products. This article discusses the basic physics of electrosurgery and then addresses several common misconceptions about electrosurgery and electrosurgical devices. 相似文献
10.
《Arthroscopy》2000,16(8):813-821
Purpose: To outline the development of electrosurgical (radiofrequency) devices, explain the basic principles, and review the current orthopaedic literature regarding the application of electrosurgery to arthroscopic partial meniscectomy. Materials and Methods: The history and principles of electrosurgery were obtained from various pertinent texts and journal articles. A literature search was performed using MEDLINE; reviewed articles consisted of articles in the English language cataloged between 1966 and January 1999. Results: The history and principles of electrosurgery are reviewed. The articles pertaining to arthroscopic electrosurgical meniscectomy are discussed with a separate discussion on the potential complications of using radiofrequency energy for meniscal ablation, including articular cartilage damage, osteonecrosis, and damage caused by irrigant. Conclusion: Electrosurgery has been shown to be an effective tool in arthroscopic meniscectomy. Further research and refinement is warranted because it may show superiority to other methods in certain situations.Arthroscopy: The Journal of Arthroscopic and Related surgery, Vol 16, No 8 (November-December), 2000: pp 813–821 相似文献
11.
Background: Direct and capacitive coupling of diathermy current have been reported as causes of occult injury during surgical laparoscopy.
Methods: In order to determine the incidence of electrosurgical injury adjacent to metal and plastic cannulas, skin biopsies at 19
port sites used for monopolar electrosurgery were analyzed for coagulative necrosis. Prior to surgery the cannulas were randomized
to either metal or plastic.
Results: Coagulative necrosis was observed at nine electrosurgery port sites compared to only one control (χ2= 4.872; df= 1; 0.05 > p > 0.02). Plastic cannulas afforded no greater protection from skin burns than metal cannulas.
Conclusions: Burns may be the result of direct or capacitive coupling to metal cannulas or capacitive coupling to the skin edge across
plastic cannulas. The potential exists for burns to other tissues also in close proximity to a cannula used for electrosurgery.
Received: 12 August 1996/Accepted 26 November 1996 相似文献
12.
Clarke JR 《Surgical endoscopy》2009,23(1):216-220
Surgical errors with minimally invasive surgery differ from those in open surgery. Perforations are typically the result of
trocar introduction or electrosurgery. Infections include bioburdens, notably enteric viruses, on complex instruments. Retained
foreign objects are primarily unretrieved device fragments and lost gallstones or other specimens. Fires and burns come from
illuminated ends of fiber-optic cables and from electrosurgery. Pressure ischemia is more likely with longer endoscopic surgical
procedures. Gas emboli can occur.
Minimally invasive surgery is more dependent on complex equipment, with high likelihood of failures. Standardization, checklists,
and problem reporting are solutions for minimizing failures. The necessity of electrosurgery makes education about best electrosurgical
practices important.
The recording of minimally invasive surgical procedures is an opportunity to debrief in a way that improves the reliability
of future procedures. Safety depends on reliability, designing systems to withstand inevitable human errors. Safe systems
are characterized by a commitment to safety, formal protocols for communications, teamwork, standardization around best practice,
and reporting of problems for improvement of the system.
Teamwork requires shared goals, mental models, and situational awareness in order to facilitate mutual monitoring and backup.
An effective team has a flat hierarchy; team members are empowered to speak up if they are concerned about problems. Effective
teams plan, rehearse, distribute the workload, and debrief.
Surgeons doing minimally invasive surgery have a unique opportunity to incorporate the principles of safety into the development
of their discipline. 相似文献
13.
《Surgery (Oxford)》2023,41(2):81-88
This article reviews the principles of electricity with its applications in electrosurgery. The basic concepts of current, voltage, wattage, impedance and energy are described. Thermal tissue effects are discussed with relation to modes of current application. The hazards of electrosurgery, their mechanisms and preventative measures are outlined. The clinical application and evolution of electrosurgical devices, including the standard monopolar and bipolar circuits, newer ultrasonic energy devices, advanced tissue energisers is also summarized. Special considerations in robotic surgery and gastrointestinal endosurgery are highlighted. 相似文献
14.
H Kawasaki H Egawa M Takasaki K Yokoyama 《Masui. The Japanese journal of anesthesiology》1991,40(6):997-1002
We observed the incidence of pump errors by the interference from the electrosurgical unit (Vallylab, Force 4B) set at coagulation or cut mode, with three infusion pumps: Terumo STC-523, STC-525 and STC-525-01. The STC-525-01 painted with electrically conductive paint inside was used during electrosurgery on experimental basis. Malfunctioning of the STC-523 pump occurred frequently by using electrosurgical unit set at coagulation mode and placed close to the pump. The STC-525-01 showed markedly lower incidence of malfunctioning. Therefore, the STC-252-01 pump can be used safely during electrosurgery. Additionally, we discovered, through an estimation of radiated electrical field around the electrosurgical unit, the cable of an active electrode was important as an interference source. To minimize electrosurgical interferences, we propose the following recommendations; 1) keeping the infusion pump and its AC line as far as possible from the active electrode cable, 2) keeping the output of electrosurgical unit as low as possible, 3) operating the pump with its internal battery power supply, and 4) monitoring the operation of the pump while using electrosurgery. 相似文献
15.
Targarona EM Balague C Marin J Neto RB Martinez C Garriga J Trias M 《Surgical innovation》2005,12(4):339-344
The development of operative laparoscopic surgery is linked to advances in ancillary surgical instrumentation. Ultrasonic energy devices avoid the use of electricity and provide effective control of small- to medium-sized vessels. Bipolar computer-controlled electrosurgical technology eliminates the disadvantages of electrical energy, and a mechanical blade adds a cutting action. This instrument can provide effective hemostasis of large vessels up to 7 mm. Such devices significantly increase the cost of laparoscopic procedures, however, and the amount of evidence-based information on this topic is surprisingly scarce. This study compared the effectiveness of three different energy sources on the laparoscopic performance of a left colectomy. The trial included 38 nonselected patients with a disease of the colon requiring an elective segmental left-sided colon resection. Patients were preoperatively randomized into three groups. Group I had electrosurgery; vascular dissection was performed entirely with an electrosurgery generator, and vessels were controlled with clips. Group II underwent computer-controlled bipolar electrosurgery; vascular and mesocolon section was completed by using the 10-mm Ligasure device alone. In group III, 5-mm ultrasonic shears (Harmonic Scalpel) were used for bowel dissection, vascular pedicle dissection, and mesocolon transection. The mesenteric vessel pedicle was controlled with an endostapler. Demographics (age, sex, body mass index, comorbidity, previous surgery and diagnoses requiring surgery) were recorded, as were surgical details (operative time, conversion, blood loss), additional disposable instruments (number of trocars, EndoGIA charges, and clip appliers), and clinical outcome. Intraoperative economic costs were also evaluated. End points of the trial were operative time and intraoperative blood loss, and an intention-to-treat principle was followed. The three groups were well matched for demographic and pathologic features. Surgical time was significantly longer in patients operated on with conventional electrosurgery vs the Harmonic Scalpel or computed-based bipolar energy devices. This finding correlated with a significant reduction in intraoperative blood loss. Conversion to other endoscopic techniques was more frequent in Group I; however, conversion to open surgery was similar in all three groups. No intraoperative accident related to the use of the specific device was observed in any group. Immediate outcome was similar in the three groups, without differences in morbidity, mortality, or hospital stay. Analysis of operative costs showed no significant differences between the three groups. High-energy power sources specifically adapted for endoscopic surgery reduce operative time and blood loss and may be considered cost-effective when left colectomy is used as a model. 相似文献
16.
Maragh Sherry L. MD Otley Clark C. MD Roenigk Randall K. MD Phillips P. Kim MD 《Dermatologic surgery》2005,31(1):83-93
BACKGROUND: Antibiotic prophylaxis in dermatologic surgery is poorly understood, and data on its use are lacking. Prophylaxis is indicated for the prevention of endocarditis and prosthesis infection, as well as surgical site infection. OBJECTIVE: We review essential considerations for the use of antibiotic prophylaxis in dermatologic surgery and provide clear guidelines for practical implementation. METHODS: Guidelines were developed after review of the literature and consultation with infectious disease specialists and subspecialists in the areas of cardiac, orthopedic, and neurosurgical infectious disease at Mayo Clinic. RESULTS: Three factors affect the decision to use prophylactic antibiotics in dermatologic surgery: (1) the underlying indication for prophylaxis (patient risk stratification), (2) the condition of the skin, and (3) the specific procedure planned. Thorough preoperative evaluation and surgical planning are critical in identifying and optimizing patient and environmental risk factors that may increase the risk of infection. Appropriate antibiotic selections with site-specific consideration and appropriate timing of antibiotic administration are key factors in providing effective prophylaxis. CONCLUSIONS: Low rates of infection associated with dermatologic surgical procedures warrant selective use of antibiotic prophylaxis. The proposed guidelines reflect current standards of practice. 相似文献
17.
Background: The influence of surgical operations on the systemic immune response is
proportional to the degree of trauma. Ultrasonic surgery can dissect structures and divide
vessels by the effect produced by vibrations in the tissues. It is believed to
be less traumatic than the more commonly used monopolar electrosurgery. This randomized study
compares the systemic immune response after laparoscopic cholecystectomy performed using
either ultrasonic energy or monopolar electrosurgery.
Methods: Eighteen patients scheduled for elective laparoscopic cholecystectomy were
randomly assigned to treatment using either a harmonic scalpel and clips or monopolar
electrosurgery and clips. Postoperative inflammatory response was assessed via changes in the
white blood cell count and levels of C-reactive protein. Postoperative immune function was assessed
by measuring monocyte HLA-DR expression.
Results: Both the harmonic scalpel and the use of monopolar electrosurgery resulted in
activation of the systemic immune response. No significant differences between the two
groups were observed.
Conclusion: The harmonic scalpel and monopolar electrosurgery are equally traumatic in
terms of activation of the systemic immune response. 相似文献
18.
Hazem M. El-Gamal MD Raymond G. Dufresne Jr. MD Kirk Saddler MD 《Dermatologic surgery》2001,27(4):385-390
BACKGROUND: Minimal information is available in the literature regarding the precautions implemented or complications experienced by cutaneous surgeons when electrosurgery is used in patients with pacemakers or implantable cardioverter-defibrillators (ICDs). The literature pertinent to dermatologists is primarily based on experiences of other surgical specialties and a generally recommended thorough perioperative evaluation. OBJECTIVE: To determine what precautions are currently taken by cutaneous surgeons in patients with pacemakers or ICDs, and what types of complications have occurred due to electrosurgery in a dermatologic setting. METHODS: In the winter of 2000, a survey was mailed to 419 U.S.-based members of the American College of Mohs Micrographic Surgery and Cutaneous Oncology (ACMMSCO). RESULTS: A total of 166 (40%) surveys were returned. Routine precautions included utilizing short bursts of less than 5 seconds (71%), use of minimal power (61%), and avoiding use around the pacemaker or ICD (57%). The types of interference reported were skipped beats (eight patients), reprogramming of a pacemaker (six patients), firing of an ICD (four patients), asystole (three patients), bradycardia (two patients), depleted battery life of a pacemaker (one patient), and an unspecified tachyarrhythmia (one patient). Overall there was a low rate of complications (0.8 cases/100 years of surgical practice), with no reported significant morbidity or mortality. Bipolar forceps were utilized by 19% of respondents and were not associated with any incidences of interference. CONCLUSIONS: Significant interference to pacemakers or ICDs rarely results from office-based electrosurgery. No clear community practice standards regarding precautions was evident from this survey. The use of bipolar forceps or true electrocautery are the better options when electrosurgey is required. These two modalities may necessitate fewer perioperative precautions than generally recommended, without compromising patient safety. 相似文献
19.
John D. Polousky M.D. Thomas P. Hedman Ph.D. C. Thomas Vangsness Jr. M.D. 《Arthroscopy》2000,16(8):813
Purpose: To outline the development of electrosurgical (radiofrequency) devices, explain the basic principles, and review the current orthopaedic literature regarding the application of electrosurgery to arthroscopic partial meniscectomy. Materials and Methods: The history and principles of electrosurgery were obtained from various pertinent texts and journal articles. A literature search was performed using MEDLINE; reviewed articles consisted of articles in the English language cataloged between 1966 and January 1999. Results: The history and principles of electrosurgery are reviewed. The articles pertaining to arthroscopic electrosurgical meniscectomy are discussed with a separate discussion on the potential complications of using radiofrequency energy for meniscal ablation, including articular cartilage damage, osteonecrosis, and damage caused by irrigant. Conclusion: Electrosurgery has been shown to be an effective tool in arthroscopic meniscectomy. Further research and refinement is warranted because it may show superiority to other methods in certain situations. 相似文献
20.
Hye-Chun Hur Isabel Green Anna Merport Modest Magdy Milad Edwin Huang Hope Ricciotti 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2014,18(3)