Outcomes of coblation tonsillectomy versus bipolar electrocautery tonsillectomy in pediatric population

Background: Bipolar electrocautery tonsillectomy has been the preferred technique for many otolaryngologists, yet coblation tonsillectomy is gaining popularity in the current practice. This study aims at comparing both techniques in terms of pain, bleeding, and healing. Result(s): A total of 120 patients were randomly divided into two equal groups. Overall mean pain score associated with coblation tonsillectomy was statistically less than that caused by bipolar electrocautery throughout the follow-up period (p < 0.001). The difference in pain duration was statistically longer for the bipolar group. The incidence of postoperative hemorrhage-both reactionary and secondary-was statistically higher in the bipolar group. Coblation tonsillectomy showed statistically shorter duration of healing (p < 0.001). Conclusion(s): Coblation tonsillectomy is associated with less pain severity and shorter pain duration, fewer bleeding incidents, and more prompt healing.Copyright © 2022, The Author(s).

The use of monopolar diathermy in laparoscopic appendectomy, Is it really safe?

Background: There have been numerous techniques used in laparoscopic appendectomy (LA) to divide the mesoappendix, including LigaSure, Harmonic scalpel, clips, endoloop ligatures, Endo GIA staplers, and bipolar coagulation. However, few studies have investigated monopolar diathermy for mesoappendix division. Therefore, this study aimed to assess both its safety and efficacy in LA. Method(s): In this prospective non-randomized study, patients (n = 87) who underwent LA for acute appendicitis were included. The bipolar electrocautery was used for mesoappendix division in the first 33 patients (BC group), while the monopolar electrocautery was used in the next 54 patients (MC group). Result(s): The median operative time was significantly shorter in the MC group (42 min. vs 47 min. in BE group, p = 0.01). One patient converted to open surgery in the MC group due to uncontrollable bleeding. There were no significant differences between both groups regarding postoperative complications and hospital stay (p = 0.91, p = 0.13, respectively). Conclusion(s): Monopolar electrocautery is safe and effective for mesoappendix division in LP in comparison to bipolar electrocautery. However, larger and multicentric studies are required to validate our results.Copyright © 2023 The Authors

Comparison of aerosol generation between electrocautery and cold dissection tonsillectomy.

OBJECTIVE: Coronavirus disease 2019 can spread through aerosols produced by surgical procedures, but knowledge of the extent of aerosol production and the risk posed by many common procedures does not exist. This study analysed aerosol generation during tonsillectomy and how it differs between distinct surgical techniques and instruments. The results can be used in risk assessment during current and future pandemics and epidemics. METHOD: An optical particle sizer was used to measure particle concentrations generated during tonsillectomy from the perspectives of the surgeon and other staff. Coughing is commonly used as a reference for high-risk aerosol generation; therefore, coughing and the operating theatre's background concentration were chosen as reference values. Different instruments were also compared to find the safest way to perform the tonsillectomy from the perspective of airborne transmission. RESULTS: Eighteen tonsillectomies were evaluated; all techniques mostly generated less than 1 µm particles. For the surgeon, bipolar electrocautery significantly exceeded the particle generation of coughing in both total and less than 1 µm particles and was found to produce significantly higher total and less than 1 µm aerosol concentrations than cold dissection and BiZact. No technique exposed other staff to a greater aerosol concentration than is generated by a cough. CONCLUSION: Bipolar electrocautery generated high aerosol concentrations during tonsillectomy; cold dissection generated significantly less. The results support cold dissection as the primary tonsillectomy technique, particularly during the epidemics of airborne diseases.

A systematic review of the harmful effects of surgical smoke inhalation on operating room personnel

Background Surgical smoke refers to the plume produced by usage of energy-generating surgical equipment on tissues. This review aimed to assess the potential of this smoke to be a serious occupational hazard to theatre staff due to its composition, particularly during the COVID-19 pandemic. Method A search of Ovid MEDLINE, EMBASE, and PubMed databases was undertaken for publications reporting plume composition, presence of infectious material, carcinogenic potential and comparisons between production in laparoscopic versus open surgery. All human in-vivo and ex-vivo primary studies were included, provided English language translation was available. A narrative synthesis was conducted due to the methodologic heterogeneity of the studies. Results 25 studies resulted from the primary search, and an additional 3 from cross-referencing, leading to 28 included studies. Studies addressing particle size found that smoke particles were respirable in size. Viral DNA was present in 3 studies, while 2 studies demonstrated the ability for surgical smoke to produce infection of nasal epithelial cells. Chemical composition was explored in 8 studies, revealing the presence of carcinogenic compounds in concentrations above occupational safety limits. These chemicals are recognised as carcinogenic to humans by the International Agency for Research on Cancer criteria. Open surgery was found to generally produce less smoke than laparoscopic, however, both surgical methods resulted in particulate counts higher than Air Quality Index standards. Conclusion Surgical smoke contains a myriad of hazardous constituents, such as carcinogenic compounds and infectious materials, however, more research surrounding the implications of inhalation of surgical smoke is required to grasp the true extent to which these plumes may be harmful. Safety measures such as extraction of plumes using local exhaust ventilation, and usage of protective equipment such as N95 masks, should be instilled due to the components of this plume.

Comparison of the Effects of High-Power Diode Laser and Electrocautery for Lingual Frenectomy in Infants: A Blinded Randomized Controlled Clinical Trial.

The aim of the study was to evaluate the release of the lingual frenulum through frenectomy in newborns zero to 90 days of age who breastfed and had diagnosis of ankyloglossia with an indication for surgery, comparing two methods: electrocautery and a high-power diode laser. Fifty-seven patients were randomly allocated to two groups (23 submitted to electrocautery and 34 submitted to a high power diode laser). Tongue movements were evaluated based on a clinical assessment and using the Bristol Tongue Assessment Tool (BTAT) before and 15 days after the surgical procedures. The visual analog scale was administered to the mothers on the same occasions for the measurement of pain during breastfeeding. Both groups had an increased BTAT score (favorable outcome) at the post-surgical evaluation, but the anterior third of the tongue was not always free to enable the movements necessary for lingual functions. It is fundamental for surgeons to have skill and in-depth knowledge of the equipment used to avoid accidents and complications in the region of important structures. Both techniques employed in this study were safe and effective, causing little bleeding and few postoperative complications. The group submitted to a high-power diode laser exhibited less post-surgical bleeding compared to the group submitted to electrocautery and no inflammation at the edges of the surgical cut.

Particle aerosolization with energy devices: A comparative study.

OBJECTIVE: To compare the degree of particle aerosolization with the use of several energy devices used in tonsillectomy and other common upper airway procedures. METHODS: Three different energy devices were measured. These included (a) monopolar electrocautery, (b) bipolar electrocautery, and (c) thermal welding device (TWD). Each device was applied to fresh cadaveric cow tongue and porcine nose. Aerosolized particles produced by these devices were measured using a calibrated electronic particle counter. Measurements were recorded over the course of 3 minutes. Particle sizes were measured at 0.3, 0.5, 1.0, 5, and 10 µm. RESULTS: In comparing types of tissues and particle sizes, TWD had the lowest aerosolizing burden among the three devices. By analyzing the highest particle value of TWD against both monopolar and bipolar, monopolar electrocautery proved to have the highest aerosolization exposure with statistical significance at 0.5 and 10 µm. No statistical significance was found when comparing TWD against monopolar electrocautery. DISCUSSION: Our study demonstrates there is a difference in aerosolization burden dependent on the type of device utilized. TWD proved to have the lowest burden whereas monopolar electrocautery had the highest. CONCLUSION: TWD produces less aerosolization than conventional monopolar electrocautery when cauterizing or ablating tissue in an experimental setting. The degree of aerosolization was comparable to bipolar electrocautery. LEVEL OF EVIDENCE: 2.

Clearing the air on surgical plume.

BACKGROUND: Surgical smoke or plume is produced by a variety of surgical coagulators and dissectors. A number of jurisdictions have recently introduced policies to reduce the associated occupational health risks including WorkSafe Victoria and New South Wales Health. METHOD: This paper is a narrative review of potential risks, including any associated with COVID-19, and options for mitigation. RESULTS: Surgical smoke or plume contains potentially toxic chemicals, some of which are carcinogens. Plume may also contain live virus, notably Human Papilloma and Hepatitis B, though any possible viral transmission is limited to a few case reports. Despite identifying COVID-19 ribonucleic acid fragments in various body tissues and fluids there are no current reports of COVID-19 transmission. Although plume is rapidly removed from the atmosphere in modern operating rooms, it is still inhaled by the operative team. Mitigation should include ensuring diathermy devices have evacuators while plume extraction should be standard for laparoscopic procedures. Consideration needs to be given to the potential to compromise the operating field of view, or the noise of the extractor impairing communication. There is an increasing range of suitable products on the market. The future includes pendant systems built into the operating room. CONCLUSION: The potential risks associated with surgical plume cannot be ignored. Health services should invest in plume extraction devices with a view to protecting their staff. The conduct of the operation should not be compromised by the devices chosen. Future operating theatres need to be designed to minimize exposure to plume.

Radiofrequency Ablation vs Electrocautery Blinded Randomized Trial: Impact on Clinically Meaningful Outcomes.

OBJECTIVE: To analyze patients' return to normal activity, pain scores, narcotic use, and adverse events after undergoing tonsillectomy or adenotonsillectomy with monopolar electrocautery or radiofrequency ablation. STUDY DESIGN: Randomized double-blinded clinical trial based on prospective parallel design. SETTING: Academic medical center and tertiary children's hospital between March 2018 and July 2019. METHODS: Inclusion criteria included patients aged ≥3 years with surgical indication of recurrent tonsillitis or airway obstruction/sleep-disordered breathing. Patients were randomly assigned to monopolar electrocautery or radiofrequency ablation. Patients were blinded to treatment assignment. Survey questions answered via text or email were collected daily until postoperative day 15. The primary outcome was the patient's return to normal activity. Secondary outcomes included daily pain score, total amount of postoperative narcotic use, and adverse events. RESULTS: Of the 236 patients who met inclusion criteria and were randomly assigned to radiofrequency ablation or monopolar electrocautery, 230 completed the study (radiofrequency ablation, n = 112; monopolar electrocautery, n = 118). There was no statistically significant difference between the groups in the number of days for return to normal activity (P = .89), daily pain scores over 15 postoperative days (P = .46), postoperative narcotic use (P = .61), or return to hospital for any reason (P = .60), including bleeding as an adverse event (P = .13). CONCLUSIONS: As one of the largest randomized controlled trials examining instrumentation in tonsillectomy, our data do not show a difference between monopolar electrocautery and radiofrequency ablation with regard to return to normal activity, daily pain scores, total postoperative narcotic use, or adverse events.

Easy-to-use electrocautery smoke evacuation device for open surgery under the risk of the COVID-19 pandemic.

OBJECTIVE: This study was performed to introduce an easy method of surgical smoke evacuation for patients with confirmed or suspected COVID-19 undergoing emergency surgery. METHODS: An easy, inexpensive, protective, and practical surgical smoke evacuation device/system was developed and is herein described. RESULTS: The use of this surgical smoke evacuation device/system in open surgery is convenient and effective. It allows for easy, economic, useful, and protective surgical smoke evacuation. CONCLUSIONS: COVID-19 infection causes direct mortality and morbidity, and its incidence has recently increased. Protection from electrosurgery-related smoke is recommended particularly during the current pandemic. This surgical smoke evacuation device/system is easy to use and provides a convenient and effective method of smoke evacuation during both open surgery and all cauterization interventions.

Transforming laparoendoscopic surgical protocols during the COVID-19 pandemic; big data analytics, resource allocation and operational considerations.

The current dreadful pandemic of coronavirus disease (COVID-19) is playing havoc with humanity, socio-communal systems and economic reserves worldwide. Certain countries have managed to curtail COVID-19 crisis to some extent, however, a great majority still remains helpless in containing this outbreak. Rapidly evolving disease patterns and complex epidemiology of the COVID-19 necessitate a tailored approach by medical experts in dealing with this devastating outbreak. Similar to other medical disciplines, surgical associations and societies have developed a tailored approach of patients' selection and management plans with improvised endolaparoscopic practice during the COVID-19 pandemic. Non-essential and non-urgent surgical procedures are deferred till this outbreak is abated. Benefits of delaying elective and non-urgent surgery outweighs the risk of performing surgical procedures on patients with asymptomatic or active COVID-19 disease. Laparoendoscopic procedures increase the risk of aerosol exposure, disease transmission and contamination. Limiting the number of operating room personnel, use of disposable instruments, small trocar incisions, negative pressure environment, and setting energy devices at low modes can help reduce disease transmission during laparoendocsopic procedures. This write up sheds lights on the impact of the COVID-19, big data analytics of response of medical personnel in understanding and curtailing the disease process and the consensus guidelines for carrying out laparoscoendoscopic procedures.