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Introducción. La nueva era de la cirugía es cada vez más dependiente de la tecnología, y un ejemplo de ello es el uso generalizado de electrocauterio como parte primordial de la práctica quirúrgica. El humo quirúrgico es un subproducto de la disección y la coagulación de los tejidos producidas por los equipos de energía, que representa múltiples riesgos potenciales para la salud del grupo quirúrgico, sin embargo, se han minimizado los peligros causados por la exposición de manera frecuente y acumulativa a este aerosol. Métodos. Se realizó un análisis crítico, desde una posición reflexiva de la información disponible, estableciendo los posibles riesgos relacionados con la exposición al humo quirúrgico. Discusión. Es visible la necesidad imperativa de establecer directrices nacionales, pautas normativas y recomendaciones estandarizadas para cumplir con las exigencias dadas por los sistemas de gestión en salud ocupacional y seguridad del trabajo, cuyo objetivo principal es hacer efectivo el uso de mascarillas quirúrgicas apropiadas, la implementación de programa de vigilancia epidemiológica ambiental en sala de cirugía, la priorización del uso constante de aspiradores y sistemas de evacuación, y la ejecución de programas educativos de sensibilización dirigidos al personal implicado. De igual manera, se abre la inquietud de la necesidad de nuevos estudios para definir con mayor precisión el peligro de este aerosol. Conclusión. Se recomienda de manera responsable utilizar todas las estrategias preventivas existentes para intervenir en salas de cirugía los riesgos minimizados y olvidados del humo quirúrgico.
Introduction. The new era of surgery is increasingly dependent on technology, and an example of this is the widespread use of electrocautery as a primary part of surgical practice. Surgical smoke is a byproduct of the dissection and coagulation of tissues produced by energy equipment, which represents multiple potential health risks for the surgical group; however, the dangers caused by cumulative exposure have been minimized. Methods. A critical analysis was carried out from a reflective position of the available information, establishing the possible risks related to exposure to surgical smoke. Discussion. The imperative need to establish national normative guidelines and standardized recommendations to comply with the demands given by the occupational health and work safety management systems, whose main objective is to make effective the use of appropriate surgical masks, implementation of environmental epidemiological surveillance program in the operating room, prioritizing the constant use of vacuum cleaners and evacuation systems, and carrying out educational awareness programs aimed at the personnel involved. Likewise, there is concern about the need for new studies to more precisely define the danger of this aerosol. Conclusion. It is recommended to responsibly use all existing preventive strategies to intervene in operating rooms to minimize the forgotten risks of surgical smoke.
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Humans , Smoke Inhalation Injury , Occupational Exposure , Electrocoagulation , Operating Rooms , Health Risk , N95 RespiratorsABSTRACT
Objective To investigate the relevant risk factors for endoscopic electrocoagulation hemostasis in elderly patients with acute epistaxis,and establish and validate a nomogram prediction model to facilitate early selection of appropriate hemostasis methods in clinical practice.Methods Clinical data of 228 elderly patients with unilateral acute epistaxis from January 2018 to December 2022 were collected.There were two groups,the electrocoagulation group(n = 112)and the conservative packing group(n = 116),based on whether they received endoscopic electrocoagulation hemostasis.Analysis was performed to explore the independent risk factors for requiring endoscopic electrocoagulation hemostasis.A nomogram prediction model was established based on the multivariate results,and receiver operator characteristic curve(ROC curve),calibration curve and clinical decision curve analysis(DCA)were used to evaluate the predictive performance and consistency of the model.Results According to the research results,the univariate analysis showed that age,hypertension,cardiovascular disease,anticoagulant use,and bleeding site were associated with endoscopic electrocoagulation hemostasis(P<0.05).The multivariate binary Logistic regression analysis revealed that older age,the presence of hypertension,long-term use of anticoagulants,and bleeding sites located in the posterior nasal region or unknown location were associated with a higher likelihood of undergoing endoscopic electrocoagulation hemostasis(P<0.05).Based on these independent risk factors,a nomogram model for predicting endoscopic electrocoagulation hemostasis for acute epistaxis in elderly patients was established,the area under the curve(AUC)was 0.856(95%CI:0.805～0.907).The calibration curve and DCA showed that the use of the nomogram model could benefit patients over a wide range of diagnostic threshold probabilities.Conclusion A nomogram model based on age,hypertension,anticoagulant use,and bleeding site to predict the risk of endoscopic electrocoagulation hemostasis in elderly patients with acute epistaxis has a good predicted performance.
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RESUMEN Objetivo: Comparar dos técnicas quirúrgicas para extirpar el pterigión, mediante la evaluación de la sintomatología postoperatoria y la incidencia de la recidiva. Métodos: Ensayo clínico controlado aleatorizado con dos grupos paralelos y diseño simple ciego en 80 pacientes con pterigión primario de la Clínica Oftalmológica de la Selva. El primer grupo consideró la técnica de autoplastia fijada con cauterio bipolar (n=40) y el segundo la técnica convencional de autoplastia fijada con puntos (n=40). Se evaluaron los síntomas a las 72 horas postoperatorias y la recidiva a los seis meses. Resultados: A las 72 horas postcirugía el 6 % de los operados con la técnica electrocauterio presentaron sintomatología en comparación a un 41 % de los operados con sutura (p<0,05). Se evidenció recurrencia de 1 caso en el grupo de electrocauterio y 4 en el grupo de sutura (2,5 % vs. 10 %, p<0,05). Conclusiones: La técnica con cauterio demostró una recuperación más favorable, con menor sintomatología y recurrencia en comparación a la técnica convencional. Estos hallazgos sugieren que la técnica con cauterio puede ser más efectiva y mejor tolerada en pacientes de este estudio.
ABSTRACT Objective: To compare two surgical techniques for excising pterygium, by evaluating postoperative symptoms and the incidence of recurrence. Methods: Randomized controlled clinical trial with two parallel groups and a single-blind design involving eighty patients with primary pterygium from the Ophthalmological Clinic of the Jungle. The first group considered the autograft fixation technique with bipolar cautery (n=40), and the second group considered the conventional autograft fixation technique with sutures (n=40). Symptoms were assessed at 72 hours postoperatively, and recurrence was evaluated at six months. Results: At 72 hours post-surgery, 6% of patients operated with the electrocautery technique exhibited symptoms, compared to 41% of those operated with sutures (p < 0.05). Recurrence was observed in 1 case in the electrocautery group and 4 in the suture group (2.5% vs. 10%, p < 0.05). Conclusions: The cautery technique demonstrated a more favorable recovery, with fewer symptoms and recurrence compared to the conventional technique. These findings suggest that the cautery technique may be more effective and better tolerated in patients in this study.
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OBJECTIVES@#Surgical robot system has broken the limitation of traditional surgery and shown excellent performance in surgery, and has been widely used in minimally invasive treatment in most areas of surgery. This study aims to verify the basic performance of the domestic surgical robot system and the safety and effectiveness of the integrated bipolar electrocoagulation and ultrasonic knife.@*METHODS@#The basic performance of the domestic surgical robot system was evaluated by completing the square knot and surgical knot, vertical and horizontal perforation and right ring perforation and suture, as well as picking up beans. Compared with laparoscopy, the safety and effectiveness of the domestic surgical robot after integrated interconnection bipolar electrocoagulation and ultrasonic scalpel were evaluated by detecting the vascular closure performance and the degree of histopathological damage in animals.@*RESULTS@#Compared with freehand knotting, domestic robot knotting speed and circumference were slightly worse, but better than laparoscopic knotting. There was no statistical significance in the tension difference of the surgical knots among the 3 methods (P>0.05), but the tension of the square knots made by the freehand and the domestic surgical robot was greater than that of the laparoscopy (P<0.05). The space required for both the left and right forceps heads of knots was smaller than that of laparoscopy (P<0.001), which successfully completed the 4 quadrant suture tasks, and the time of picking up beans was significantly less than that of laparoscopy (P<0.05). There was no significant difference in the temperature of the liver tissue after the bipolar electrocoagulation between the interconnected domestic surgical robot and the laparoscopy (P>0.05), and the acute thermal injury was observed under the light microscope. The temperature of the liver tissue treated by the domestic robotic ultrasound knife was higher than that of the laparoscopic ultrasound knife (P<0.05).@*CONCLUSIONS@#Domestic surgical robots are obviously superior to laparoscopy in suturing, knotting, and moving objects, and domestic surgical robots' interconnect bipolar electrocoagulation and ultrasonic knife have achieved success in animal experiments, and hemostasis is considered to be safe and effective.
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Animals , Robotics , Laparoscopy/methods , UltrasonographyABSTRACT
Objective:To study the effect of different hemostasis methods on postoperative pain and sex hormone levels in patients undergoing laparoscopic ovarian cystectomy.Methods:A total of 118 patients with ovarian cysts admitted to our hospital from Jun. 2018.6 to Aug. 2020 were collected and grouped by digital table method into electrocoagulation hemostasis group (59 cases, electrocoagulation hemostasis) and suture hemostasis group (59 cases, suture hemostasis). Pain at time points, serum inflammatory factors and sex hormone levels in the two groups were measured, and the incidence of complications was counted 12 weeks after surgery.Results:The VAS scores of suture hemostasis group at 6, 12 and 24 h after operation (3.33±0.93, 3.63±1.02, 3.01±0.94) were significantly lower than those of the electrocoagulation hemostasis group (4.16±1.05, 4.61±1.17, 3.72±1.05) ; there was no significant difference in serum interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) levels between the preoperative suture hemostasis group and the electrocoagulation hemostasis group. The serum levels of IL-6 and TNF-α in the group (37.64±4.82ng/L, 39.67±4.71ng/L) were lower than those in the electrocoagulation hemostasis group (45.96±5.25ng/L, 48.96±5.14ng/L) ( P<0.05) .) ; there was no significant difference in serum follicle-stimulating hormone (FSH), estradiol (E 2) or luteinizing hormone (LH) levels between preoperative electrocoagulation hemostasis group and suture hemostasis group ( P>0.05) ; There was no significant difference in the three indexes in the suture hemostasis group 3 months after operation compared with those before treatment ( P>0.05). The serum FSH and LH [ (6.59±0.91) mIU/ml, (5.24±0.77) mIU/ml] in the suture hemostasis group were lower than those in the electrocoagulation hemostasis group [ (7.39±1.02) mIU/m, (5.97±0.89) mIU/m], E 2 in suture hemostasis group [ (51.08±6.09) pg/ml] was higher than that in electrocoagulation hemostasis group [ (46.88±5.59) pg/ml] ( P<0.05). In terms of the complication rate at 3 months after operation, the suture hemostasis group (32.20%) was significantly lower than electrocoagulation hemostasis (13.56%) ( P<0.05). After 1 year of follow-up, the pregnancy success rate of the suture hemostasis group (72.88%) was significantly higher than that of the electrocoagulation hemostasis group (52.54%) ( P<0.05). There was no significant difference in pregnancy outcomes ( P>0.05) . Conclusions:Suture hemostasis in patients undergoing laparoscopic ovarian cystectomy is beneficial to relieve postoperative pain, improve postoperative inflammatory response, protect their ovarian function, avoid complications such as abnormal ovulation and excessive menstrual flow, and improve the success rate of pregnancy. The overall application effect is better than electrocoagulation hemostasis.
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Abstract Objective: To compare recurrence rates and symptomatic relief in symptomatic maxillary sinus Retention Cysts (RCs) between Middle Meatus Antrostomy (MMA) alone and Inferior Meatus Antrostomy (IMA) with basal mucosa electrocoagulation. Methods: Patients with symptomatic unilateral maxillary RCs were randomly allocated to MMA (n = 54) and IMA combined with mucosa electrocoagulation (n = 53) groups. Symptomatic relief, cyst recurrence, and closure of the antrostomy opening were compared at 12-months postoperatively. Results: Symptomatic failure occurred in 13 (12.1%) patients, including 9 (16.7%) MMA and 4 (7.5%) IMA patients; this difference was not statistically significant (p = 0.251). Postoperative cyst recurrence occurred in 16 (29.7%) and 1 (1.9%) patient in the MMA and IMA groups, respectively (p<0.0001). Closure of the opening occurred in 7 (13.0%) and 17 (32.1%) patients in the MMA and IMA groups, respectively (p = 0.032). However, there were no significant pairwise correlations between closure of the opening and symptomatic failure or cyst recurrence. Conclusion: IMA combined with basal mucosa electrocoagulation and MMA alone provided similar symptomatic relief for symptomatic maxillary RCs, but IMA had shorter operation times and lower postoperative recurrence rates of RCs. Level of evidence: Level 1b.
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ABSTRACT The high consumption of water and the generation of greywater in laundromats underscore the need to investigate advanced treatment techniques to reuse this effluent. Based on the estimated growth figures of the laundromat sector in Brazil, this study looked into the efficiency of electrocoagulation to treat laundromat greywater. Electrodes were connected to an EC reactor on a monopolar parallel connection mode, with electric current of 6 A and current density of 400 A.m2. The highest efficiency to treat laundromat greywater was observed at a distance of 15 mm between electrodes, voltage of 17.14 V, and operation time of 30 min, when the removal values of apparent color, true color, turbidity, biochemical oxygen demand, chemical oxygen demand, and surfactants were 92, 97, 88, 91, 98, and 96%, respectively. Electrode consumption was measured at 1.82 g.h, while energy consumption was 20.54 kWh.m3 and the total cost was US$ 4.10 per cubic meter of treated effluent. However, despite the high efficiency of the treatment, reuse of treated laundromat effluent requires polishing in order to meet the standards defined by Brazilian regulations.
RESUMO O elevado consumo de água potável e a consequente geração de efluentes associados ao segmento de lavanderias domésticas justificam o estudo de tratamentos avançados que proporcionem o reuso dessas águas. Considerando-se uma perspectiva de crescimento desse setor em nível nacional, esta pesquisa avaliou a eletrocoagulação como tecnologia de tratamento de tais efluentes. Foram executados testes de bancada utilizando eletrodos em alumínio, arranjados como monopolar paralelo. A corrente elétrica e a densidade de corrente foram fixadas em 6A e 400A.m², respectivamente. Entre as variáveis avaliadas estão a distância entre eletrodos, o tempo de operação, o tipo de roupa, a utilização de alvejante e o suporte para eletrólise. O melhor tratamento foi obtido sem a utilização do suporte para eletrólise, para uma distância entre eletrodos de 15 mm, tensão elétrica aplicada no sistema de 17,14 V e tempo de operação igual a 30 min. Nessas condições, as eficiências do tratamento obtidas foram de 92% para cor aparente, 97% para cor verdadeira, 88% para turbidez, 91% para demanda bioquímica de oxigênio, 98% para demanda química de oxigênio e 96% para surfactantes. O sistema resultou no consumo de eletrodo de 1,83 g.h e no consumo de energia elétrica igual a 20,57 kWh.m³. O custo final do tratamento foi calculado em US$ 4,10.m³ de efluente tratado. Embora tenham sido obtidas elevadas remoções nas concentrações dos poluentes, para o reuso do efluente ainda é necessário um tratamento adicional.
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Objective:To determine the oxygen concentration threshold for explosion induced by high-frequency electric knife or argon knife at different energies.Methods:① In vivo experiment The smooth muscle tissue or adipose-rich tissue in 10 pairs of isolated porcine lungs and trachea was electrocauterized at 30 and 50 W with high-frequency electroknife or argon knife at different oxygen concentrations.The initial oxygen concentration was 20%, the oxygen concentration was gradually increased in increments of 5% until the oxygen concentration reached 80%.Each sample was electrocauterized 10 times at each concentration, and the number of explosion was recorded.As long as one explosion occurred, it could be considered that the concentration could induce explosion, and the minimum oxygen concentration inducing explosion was considered as the threshold.② Measurement of oxygen concentration in the airway of patients received bronchoscopic intervention Thirty patients scheduled for elective bronchoscopy with cryotherapy were selected, the oxygen concentration inhaled was reduced from 100% until 50% in decrements of 10%, and the oxygen concentration in airway was measured with the AIRVO 2 transnasal high-flow oxygen inhalation device.ICC consistency analysis was performed between the oxygen concentration in airway and oxygen concentration inhaled. Results:In adipose-rich tissues, the threshold of the oxygen concentration for explosion was 70% at 30 W and 65% at 50 W when using the high-frequency electric knife; the threshold of the oxygen concentration for explosion was 35% at 30 W and 30% at 50 W when using the high-frequency argon knife.In smooth muscle tissues, no explosion occurred at each oxygen concentration when using the high-frequency electric knife and argon knife at 30 or 50 W, and the threshold value was above 80%.There was moderate consistency (ICC value 0.722, 95% CI 0.537-0.850, P<0.001) between the oxygen concentration in airway and oxygen concentration inhaled. Conclusions:In smooth muscle tissues, explosion is not easy to occur at oxygen concentrations below 80% when using the high-frequency electric knife or argon knife.In adipose-rich tissues, explosion is not easy to occur at oxygen concentrations less than 70% at 30 W and at oxygen concentrations less than 65% at 50 W when using the high-frequency electric knife; explosion is not easy to occur at oxygen concentrations less than 35% at 30 W and at oxygen concentrations less than 30% at 50 W when using the high-frequency argon knife.The threshold of oxygen concentrations in airway can be determined using the oxygen concentration inhaled.
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Objective:To explore the efficacy and safety of intraarterial microguidewire electrocoagulation in arterial aneurysms.Methods:(1) SilverSpeed, a kind of microguidewire used in clinical intravascular treatment for intracranial aneurysms, was used to conduct in vitro electrolysis gas generation experiment with isolated arterial blood of anticoagulant New Zealand white rabbits as medium, and thrombus attachment on the surface of microguidewire was observed under scanning electron microscope. (2) Rabbit common carotid artery aneurysm models were established by using vein bag transplantation method, and divided into microguidewire electrocoagulation treatment groups ( n=40) and blank control group ( n=10). The number of closured tumor cavity and the quality of formed thrombus were observed after electrocoagulation simulation treatment with SilverSpeed microguidewire (charging at 6, 9, 12, 15, and 18 V voltage, respectively for 1, 3, 6, 9, 12, and 15 min). DSA was used to observe whether there was ruptured aneurysms or thrombosis of parent artery. Twelve h later, head MRI diffusion weighted sequence scan was performed to detect whether there were new cerebral ischemia foci in the distal cerebral blood supply area of the parent artery. DSA was performed again 6 months after surgery to observe whether the aneurysms recurred. Results:(1) Electrolytic gas generation experiment results showed that bubbles were generated after electrification of SilverSpeed microguidewire; the higher the voltage, the more severe the reaction. Scanning electron microscope showed that thrombus attached to the surface of the microguidewire after electrification in isolated blood; and the higher the voltage, the denser the thrombus. (2) Under the same charging time, the higher the voltage, the larger the number of closured tumor cavity in rabbits of the microguidewire electrocoagulation treatment groups. Under the same voltage, the longer the charging time, the better the quality of thrombosis. Ischemic events occurred only in the microguidewire electrocoagulation treatment group with voltage>9 V, and the charging duration was not associated with the incidence of embolic events. When the voltage was 15 V, 2 experimental rabbits died due to aneurysm rupture 3 min after electrification. When the voltage was 18 V, 4 experimental rabbits died of cardiac arrest 9 min after electrification, and another 2 rabbits died of aneurysm rupture 6 min after electrification.Conclusions:High voltage is the main cause of adverse events in the microguidewire electrocoagulation treatment of aneurysms. After setting the appropriate voltage, prolonging the electrification time can improve the electrocoagulation effect without increasing the safety risk.
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Objetivo: Analisar as evidências científicas disponíveis na literatura sobre os sinais e sintomas relacionados à exposição à fumaça cirúrgica em trabalhadores do bloco operatório. Método: Revisão integrativa da literatura, com busca nas seguintes bases de dados: Medline, Cumulative Index to Nursing and Allied Health Literature, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Web Of Science e SCOPUS. Resultados: Foram 1.351 estudos pré-selecionados, sendo 4 por busca manual. Ao fim, obtiveram-se cinco artigos para análise. Os sinais e sintomas encontrados foram: tosse, ardência de faringe, espirros, rinite, lesão nasofaringe, sensação de corpo estranho na garganta, congestão nasal, inflamação das vias aéreas, lacrimejamento dos olhos, náuseas, vômitos, dor abdominal, fraqueza, cãibra, cefaleia, sonolência, tonturas, irritabilidade, desconforto (como mau cheiro na roupa). Conclusão: Observaram-se grandes avanços nas pesquisas propostas, estudos que embasam a intensidade dos sinais e sintomas e orientação dos riscos nocivos que proporcionem aos gestores conhecimento e fundamentação científica para futuras intervenções tanto contra a proteção ao trabalhador como para prevenção de risco no ambiente de trabalho.
Objective: To analyze the scientific evidence available in the literature on signs and symptoms related to surgical smoke exposure among surgical block workers. Method: This integrative literature review searched the following databases: MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Latin American and Caribbean Health Sciences Literature, Web of Science, and Scopus. Results: A total of 1,351 studies were pre-selected, 4 of which were found by manual search. In the end, five articles were analyzed. The signs and symptoms identified were: cough, burning sensation in the pharynx, sneezing, rhinitis, nasopharyngeal lesion, foreign body sensation in the throat, nasal congestion, airway inflammation, lacrimation, nausea, vomiting, abdominal pain, weakness, muscle cramp, headache, drowsiness, lightheadedness, irritability, discomfort (such as unpleasant smell in clothes). Conclusion: Great advances have been detected in the studies proposed. These investigations lay the foundation for the intensity of signs and symptoms and the orientation regarding harmful risks, providing managers with the knowledge and scientific basis for future interventions, both to protect the team and to prevent risks in the work environment.
Objetivo: Analizar la evidencia científica disponible en la literatura sobre signos y síntomas relacionados con la exposición al humo quirúrgico en trabajadores de quirófano. Método: Revisión integrativa de la literatura, buscando en las siguientes bases de datos: Medline, Cumulative Index to Nursing and Allied Health Literature, Latin American and Caribbean Literature in Health Sciences, Web Of Science y SCOPUS. Resultados: Hubo 1.351 estudios preseleccionados, cuatro por búsqueda manual. Al final, se obtuvieron cinco artículos para su análisis. Los signos y síntomas encontrados fueron: tos, ardor faríngeo, estornudos, rinitis, lesión nasofaríngea, sensación de cuerpo extraño en la garganta, congestión nasal, inflamación de las vías respiratorias, lagrimeo de los ojos, náuseas, vómitos, dolor abdominal, debilidad, calambres, dolor de cabeza, somnolencia, mareos, irritabilidad, malestar como mal olor en la ropa. Conclusión: Hubo grandes avances en la investigación propuesta, estudios que apoyan la intensidad de los signos y síntomas y orientaciones sobre riesgos nocivos que brinden a los gestores conocimiento y fundamento científico para futuras intervenciones, tanto contra la protección del trabajador como para la prevención de riesgos en el entorno laboral.