Injury and adhesion formation following ovarian wedge resection with different thermal surgical modalities

Abstract

The purpose of this study is to determine the role of bleeding, acute thermal damage, and charring in adhesion formation. Postoperative adhesions were compared following ovarian wedge resection in 48 rabbits using different lasers, electrosurgery, and scalpel. Twelve ovaries were sectioned per modality, in randomized pairs. Acute thermal injury as assessed by histology, bleeding, and charring differed among the modalities used. Adhesions were assessed 4 weeks later, by an investigator completely blinded of the treatment protocol. The adhesion scores were 11.6 +/- 8.0 with pulsed Er:YAG laser; 11.9 +/- 7.5 with scalpel; 8.3 +/- 9.3 with electrocautery; 6.7 +/- 8.8 with a continuous (c.w.) Nd:YAG laser; 5.3 +/- 4.8 with c.w. CO2 laser; 3.1 +/- 2.7 with pulsed CO2 laser; 1.7 +/- 1.8 with pulsed Ho:YAG laser; and 0.8 +/- 1.5 in the control (no resection) group. Ho:YAG, Nd:YAG, and electrocautery were completely hemostatic. Bleeding was minimal with the CO2 lasers. Er:YAG and scalpel caused maximum bleeding, requiring hemostatic measures to prevent exsanguination. Charring occurred with electrocautery, CO2 laser, and Nd:YAG laser. Bleeding and charring correlated with adhesion formation, but the histological depth of thermal damage did not. The Ho:YAG laser is a hemostatic, fiber-optic compatible laser causing significantly fewer adhesions (P < 0.04) than scalpel, electrocautery, Nd:YAG, Er:YAG, and c.w. CO2 lasers. Clinical use of the Ho:YAG laser, and the role of carbonization in promoting adhesions, deserve further study.

A Prospective Randomized Experimental Study to Investigate the Eradication Rate of Endometriosis after Surgical Resection versus Aerosol Plasma Coagulation in a Rat Model

“…This can be explained by the fact that in the SR group the thermal effect of radiofrequency coagulation was only applied to achieve haemostasis of minor bleeding of the resection area. According to Bhatta et al 28 the histological depth of thermal lesions did not correlate with the formation of adhesions in contrast to carbonization and charring. The onset of the inflammatory adhesion cascade by thermal effects and local peritoneal conditions is under investigation 29 - 32 .…”

Lasers in urology

“…This laser normally operates in the pulsed mode with pulses of -200 ms. Er:YAG laser radiation is usually transmitted using reflecting mirrors, but it can be transmitted using reflecting mirrors, but it can be transmitted via low-OH silica fibers. In a study examining Er:YAG laser cutting effect upon rabbit ovaries, explosive effects, bleeding, and poor coagulation were observed [15]. Er:YAG lasers may be developed in ophthalmology for corneal surgery, due to its minimal thermal damage property.…”

Use of a novel haemostatic agent: ankaferd blood stopper in conjunctival incisions

“…Electrocauterization, in particular, involves heating the tissue, enabling quick bleeding control. However, because electrocauterization causes more severe postoperative pain, ischaemic tissue damage and adhesion between tissues, it is recommended to limit its use in surgery 3 . Prevention of bleeding at the incision site reduces both the need for electrocautery and complications, increasing the success rate of surgery.…”

“…However, because electrocauterization causes more severe postoperative pain, ischaemic tissue damage and adhesion between tissues, it is recommended to limit its use in surgery. 3 Prevention of bleeding at the incision site reduces both the need for electrocautery and complications, increasing the success rate of surgery. Ankaferd blood stopper (ABS; Ankaferd Health Products Ltd, Istanbul, Turkey) is a novel haemostatic agent used successfully to control bleeding.…”