Electrosurgery in Otolaryngology–Head and Neck Surgery: Principles, Advances, and Complications

Smith, Timothy L.; Smith, James M.

doi:10.1097/00005537-200105000-00004

Cited by 122 publications

(118 citation statements)

References 46 publications

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“…Some RF-based devices provide electrical current to the vessel followed by an actuated mechanical knife which separates the coagulum into two sealed segments. These devices expedite normally labor-intensive surgical procedures such as lobectomy, 1,2 nephrectomy, 3 gastric bypass, 4-6 splenectomy, 7,8 thyroidectomy, [9][10][11][12][13][14] hysterectomy, 15 and colectomy. [16][17][18][19] However, both electrosurgical and ultrasonic devices have limitations, including the potential for undesirable charring and unnecessarily large collateral thermal damage zones.…”

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confidence: 99%

Infrared laser thermal fusion of blood vessels: preliminaryex vivotissue studies

et al. 2013

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Abstract. Suture ligation of blood vessels during surgery can be time-consuming and skill-intensive. Energy-based, electrosurgical, and ultrasonic devices have recently replaced the use of sutures and mechanical clips (which leave foreign objects in the body) for many surgical procedures, providing rapid hemostasis during surgery. However, these devices have the potential to create an undesirably large collateral zone of thermal damage and tissue necrosis. We explore an alternative energy-based technology, infrared lasers, for rapid and precise thermal coagulation and fusion of the blood vessel walls. Seven near-infrared lasers (808, 980, 1075, 1470, 1550, 1850 to 1880, and 1908 nm) were tested during preliminary tissue studies. Studies were performed using fresh porcine renal vessels, ex vivo, with native diameters of 1 to 6 mm, and vessel walls flattened to a total thickness of 0.4 mm. A linear beam profile was applied normal to the vessel for narrow, full-width thermal coagulation. The laser irradiation time was 5 s. Vessel burst pressure measurements were used to determine seal strength. The 1470 nm laser wavelength demonstrated the capability of sealing a wide range of blood vessels from 1 to 6 mm diameter with burst strengths of 578 AE 154, 530 AE 171, and 426 AE 174 mmHg for small, medium, and large vessel diameters, respectively. Lateral thermal coagulation zones (including the seal) measured 1.0 AE 0.4 mm on vessels sealed at this wavelength. Other laser wavelengths (1550, 1850 to 1880, and 1908 nm) were also capable of sealing vessels, but were limited by lower vessel seal pressures, excessive charring, and/or limited power output preventing treatment of large vessels (>4 mm outer diameter). © The Authors. Published by SPIE under a Creative Commons Attribution 3.0 Unported License. Distribution or reproduction of this work in whole or in part requires full attribution of the original publication, including its DOI.

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confidence: 99%

Infrared laser thermal fusion of blood vessels: preliminaryex vivotissue studies

et al. 2013

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“…Ideally and for future study, patient data including severity of snoring symptoms and presence or absence of OSA should be incorporated to try and correlate local tissue effects with preoperative symptoms. If snoring and OSA are, as has been suggested, the results of a failure of neurological control of the palatal tissues [26] and that local heating effects are altered by the ultrastructural characteristics of the target tissue [28], then one would expect different tissue effects depending on the severity of patients symptoms. However, the results of our study have shown minimal tissue effect in all specimens and as such any effect may be so small as to be of no consequence.…”

Section: Discussionmentioning

confidence: 99%

Histopathological and ultrastructural effects of cutting radiofrequency energy on palatal soft tissues: a prospective study

Stimpson

Kotecha

2011

Eur Arch Otorhinolaryngol

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Radiofrequency (RF) surgery has gained popularity as a safe and effective method for treating patients with snoring and mild obstructive sleep apnoea (OSA). Both interstitial and cutting radiofrequency energy may be used for multi-segmental management of the upper airway. Little is known about the effect of cutting radiofrequency energy on human soft palate. Excessive collateral injury may have an impact on tissue healing and functional outcomes. A histological analysis of specimens of human soft palate and uvula following resection with cutting RF energy was performed. In addition, ultrastructural analysis using scanning electron microscopy of excision margins was performed and compared with CO(2) LASER. Twelve patients were included. In ten patients, specimens of redundant uvula and faucial pillars were collected and underwent formal histological analysis. The maximum depth of tissue injury was 1 mm in two specimens and overall average depth of injury was 0.15 mm. Injury depth was independent of tissue subtype at the resection margin. Ultrastructural analysis demonstrated accurate incision when compared to CO(2) LASER. Cutting RF energy causes minimal collateral injury to the soft palate during resection for the treatment of snoring and mild OSA. A detailed knowledge of local effects on resection specimens allows accurate inference of in vivo tissue injury at the resection margin and may enable more precise prediction of healing patterns and repair.

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“…Controlled hypothermia impacts a range of biochemical, histologic, and physiologic effects that include a temperature dependent reduction in cellular metabolism leading to reduced energy demands, decreased free radical production, interruption of the apoptotic cascade, and decreased inflammation. 1,[10][11][12][13][14][15][16][17] The protective effects of hypothermia have been demonstrated in the nervous system, cardiac system, shock, transplantation, and partial nephrectomy. 9,13,18,19 We have previously reported our results in applying this technique to radical prostatectomy to prevent inflammatory damage allowing improved preservation of continence and potency.…”

Section: Conceptmentioning

confidence: 99%

The Application of Regional Hypothermia Using Transrectal Cooling During Radical Prostatectomy: Mitigation of Surgical Inflammatory Damage to Preserve Continence

Liss

Skarecky

Morales

et al. 2012

Journal of Endourology

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Preservation of continence and sexual function continues to be a formidable quality-of-life issue regarding outcomes after radical prostatectomy. There is little argument that physical preservation of the nerves and sphincters is a critical component to achieving success in these domains. Previously demonstrated factors such as advancing age, deteriorating physical health status, and subnormal baseline potency negatively impact outcomes. Our hypothesis, however, has been that inflammatory response to surgery has a large impact on surgical outcomes of prostatectomy.Trauma-induced inflammation could account for variation in recovery despite nearly identical surgery on many patients, especially in high-volume surgeons. In other words, we suggest and maintain that younger and healthier patients tolerate and/or recover better from the trauma/inflammation of surgery. Those who do not recover as well may have altered inflammatory response to injury. A common response to decrease inflammation in response to physical injury would be as simple as to cool the injury with ice. Previous neurologic studies have suggested that using ice during surgical intervention can reduce the inflammatory damage. Therefore, we applied this concept that preemptive hypothermia could reduce inflammation to the robotassisted prostatectomy procedure to potentially lead to improved continence and potency outcomes.In 2009, we introduced the concept of regional hypothermia via an endorectal cooling balloon during robotassisted radical prostatectomy (RARP). We have published our single institution data demonstrating a significant reduction of overall incontinence. Defining continence as zero-pads, our overall 1-year incontinence has been reduced by 70% (from 13% to 4%). Severe incontinence, defined as two or more pads, was likewise reduced by 70% (from 2.9% to 0.9%). Regional hypothermia used during the time of surgery represents a novel strategy for minimizing inflammation and subsequent muscle and nerve damage in RARP.

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Electrosurgery in Otolaryngology–Head and Neck Surgery: Principles, Advances, and Complications

Cited by 122 publications

References 46 publications

Infrared laser thermal fusion of blood vessels: preliminaryex vivotissue studies

Infrared laser thermal fusion of blood vessels: preliminaryex vivotissue studies

Histopathological and ultrastructural effects of cutting radiofrequency energy on palatal soft tissues: a prospective study

The Application of Regional Hypothermia Using Transrectal Cooling During Radical Prostatectomy: Mitigation of Surgical Inflammatory Damage to Preserve Continence

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