Search Results (44)

Background: HPV infections with high-risk subtypes are a risk factor for developing cervical and anal cancer. Despite HPV vaccination, the incidence of cervical and anal cancer is increasing. There has been substantial research regarding the benefits of screening men who have sex with men (MSM) and those diagnosed with HIV for anal HPV and dysplasia, but little data exists for women diagnosed with cervical cancer. Methods: We constructed a Markov model in Python 3.13 to simulate the outcomes and financial impact of screening women newly diagnosed with cervical cancer for anal HPV and dysplasia. Two matrices were used to represent the screened group and the unscreened group. In the screening group, all women received initial anal HPV screening and high-resolution anoscopy with biopsy. If biopsy results confirmed HSIL, each would receive treatment with electrocautery. The screening group would also undergo annual surveillance and follow-up treatment as necessary. In the unscreened group, women did not receive screening or treatment, and the disease process was allowed to progress naturally. Results: The initial cohort consisted of 5555 women diagnosed with cervical cancer and concurrent anal HPV. The incidence of anal cancer in the screening group was 271 vs. 375 in the unscreened group after three years, 642 vs. 1236 after ten years, and 863 vs. 2039 after twenty years. Moreover, anal cancer deaths were 1236 in the screening group vs. 9041 in the unscreened group after 10 years and 31,118 vs. 51,553 after twenty years. The screened group saved 330.1 million dollars after ten years and 1.33 billion dollars after twenty years when compared to the unscreened group. Over the life of the study, the screened group would also accrue 102,000 discounted QALYs when compared to the unscreened group. Conclusions: Our model strongly suggests that screening women diagnosed with cervical cancer for anal HPV and treating anal dysplasia leads to less anal cancer, less deaths from anal cancer, less economic impact on the healthcare system, and more QALYs for patients. Full article

Background and Objectives: Modified radical mastectomy (MRM) is a common surgical procedure, with outcomes that are influenced by the instruments used in the operation. This meta-analysis aimed to compare “cold cutting” or “traditional” techniques and monopolar or bipolar electrocautery. Materials and Methods: A comprehensive search of five databases was conducted, with only studies of adult patients undergoing MRM in clearly defined groups selected. Data from 12 RCTs and 3 cohort studies summarizing 1372 participants was extracted and then synthesized using random-effects models. Risk of Bias was assessed for each of the included studies using the RoB-2 or ROBINS-I tool. Results: Scalpel or scissor use in dissection and flap raising was associated with a significantly lower risk of seroma formation (LogOR = −0.90, 95% CI: −1.26 to −0.54, p < 0.01). Conversely, electrocautery demonstrated advantages including reduced operative time (MD = −13.14 min, 95% CI: −19.58 to −6.70, p < 0.01) and decreased intraoperative blood loss (MD = −171.60 mL, 95% CI: −259.35 to −84.41, p < 0.01). No statistically significant differences were observed in total drain output (MD = −16.45 mL, 95% CI: −170.96 to 138.06, p = 0.83) or duration of drainage (MD = 0.41 days, 95% CI: −0.41 to 1.23, p = 0.32). Similarly, rates of infection, ecchymosis, and flap necrosis did not differ significantly between techniques. Conclusions: Electrocautery should be employed in patients who benefit from a shorter operative time and lower blood loss, while patients in better clinical condition should benefit from cold cutting techniques. Data on patient-reported outcomes and wound cytokine levels were sparse and inconsistent. This meta-analysis was registered in PROSPERO (ID: CRD420251059886). Full article

Background and Objectives: Although cyanoacrylate–polylactic acid (CA + PLA) patches shorten the time to hemostasis after partial hepatectomy, their long-term biocompatibility remains uncertain. We compared the 5-month histopathological footprint of a novel CA + PLA patch (Study group) with a licensed fibrinogen/thrombin matrix (TachoSil^® group) and electrocautery (Control group). Methods: Thirty-three male Wistar rats underwent a 3 × 1.5 cm hepatic segment resection and were randomized to the Control (n = 5), Study (n = 14), or TachoSil^® (n = 14) group. The animals were sacrificed on postoperative day (POD) 50, 100, or 150. Blinded semiquantitative scoring (0–3) was used to capture inflammation intensity, and the number of neutrophils (PMNs), lymphocytes (Ly’s), isolated histiocytes, and foreign-body giant cells (FBGCs). Results: The proportions of animals in each group across the different sacrifice time points were homogeneous (χ² = 4.34, p = 0.36). The median inflammation remained mild (2 [IQR 1–2]) in the Control and Study groups but lower in the TachoSil^® group (1 [1–2], p = 0.47). The FBGC scores differed markedly (score ≥ 2: 64% in Study, 0% in Control, 14% in TachoSil^®; p < 0.001). Fibrosis occurred almost exclusively in the Study group (79% vs. 0%; χ² = 22.4, p < 0.001). Mature vessels were most frequently observed in the TachoSil^® group (50%, aOR = 5.1 vs. Study, p = 0.04). Abscesses only developed in the Study group (29%, p = 0.046). Within the TachoSil^® group, inflammation (ρ = −0.62, p = 0.019) and Ly infiltration (ρ = −0.76, p = 0.002) declined with time; no significant temporal trends emerged in the Study group. Conclusions: At the five-month follow-up, there was an exuberant foreign-body reaction, dense collagen deposition, and a higher abscess rate around the CA + PLA patch compared with both TachoSil^® and cautery. Conversely, TachoSil^® evolved toward a mature, well-vascularized scar with waning inflammation. These findings underscore the importance of chronic-phase evaluation before clinical adoption of new hemostatic biomaterials. Full article

Background: Uvulopalatopharyngoplasty (UPPP) and expansion sphincter pharyngoplasty (ESP) are two standard surgical procedures for the treatment of snoring and obstructive sleep apnea. In a retrospective clinical trial, we compared the two surgical techniques regarding objective sleep parameters and patients’ reported outcomes. Materials and Methods: Patients treated with UPPP or ESP between January 2016 and February 2020 were included in this retrospective clinical trial. Pre- and postoperative AHI, BMI, and smoking habits were recorded. Subjective improvement was assessed by the ESS score and symptom relief reported by patients and their bed partners. Results: Between 2016 and 2020, 114 patients were included in the study, 74 patients suffered from OSA, and 30 patients had non-apnoeic snoring (AHI < 5/h). No preoperative sleeping studies were available in 10 patients (10/114; 9%). Based on the findings during drug-induced sedation endoscopy, most patients received an ESP (71/114, 62%), and 43 patients received a UPPP (43/114, 38%). Additionally, in 52/114 (46%), radio frequency ablation of the tongue base was performed if DISE revealed retrolingual collapse. ESP reduced AHI from 21.1 ± 10.8/h to 13.3 ± 12.1/h (p = 0.04), whereas UPPP caused a non-significant decrease in the AHI from 25.0 ± 13.8/h to 18.2 ± 14.6/h (p = 0.6). A minor secondary bleeding was observed in 32 patients, which was effectively treated with electrocautery or conservative therapy (32/114). This was more common in the ESP group (22/71; 31%) than in the UPPP group (10/43; 23%). Postoperative need for analgesics was higher in the ESP group than in the UPPP group. The ESS score showed no significant improvement after UPPP or ESP (p = 0.3), but subjective improvement in snoring was reported by 87/114 (76%) patients. Conclusion: AHI reduction was significantly higher in the ESP patient group than in the UPPP group. ESP patients had a slightly higher rate of minor secondary bleeding and postoperative need for analgesics than UPPP patients. Full article

The aim of the study was to compare tissue repair of incisions made using different microdissection electrocautery tips in an in vivo animal model. Skin incisions were made, including the subcutaneous tissue, in 30 adult Wistar rats using four types of instruments: a scalpel blade number 15, knife-type electrocautery, microdissection needle, and thin-cut electrode. The animals were divided into five groups based on the euthanasia time—24 h, 48 h, 72 h, 7 days, and 14 days. Each animal received four incisions, one with each type of instrument. Histological and histomorphometric analyses were performed using hematoxylin and eosin (HE) and Picrosirius red stains. Analysis of variance (ANOVA) showed that the type of dissector had no significant effect on type I collagen levels (p = 0.615), whereas the euthanasia time had a significant influence (p < 0.001). Estimated marginal means for type I collagen showed minimal variation among groups, ranging from 35.4% to 36.5%, suggesting limited clinical differences between instruments. These results indicate that while the choice of dissector has a limited impact on type I collagen deposition, time is a determining factor in the wound healing process. The thin-cut electrode enables incisions with tissue repair comparable to that of a number 15 scalpel, as it performs cutting, coagulation, and blending functions at lower temperatures. Full article

This study aimed to evaluate the effects of no tail docking on the performance, health, and behavior of piglets raised under commercial conditions in Brazil. The study included 768 weaned piglets from the Pietrain synthetic line, randomly divided into two groups: DT = the final third part of the tail-docked (n = 384) and NTD = non-tail-docked (n = 384). Tail docking was performed on day two using an electrocautery clipper for piglets from the DT group, and both groups were subjected to standard environmental enrichment with branched chains. In cases of tail biting, a contingency plan was adopted to mitigate this problem by enriching the pen with a sisal rope. Behavioral measurements were performed using scan sampling. Tail biting, reactivity to humans, and health were assessed using a methodology adapted from the Welfare Quality Protocol^®. The piglets were weighed at 140 days of age and inspected according to the parameters established by the Pig Genealogical Registration Service to be used as reproduction animals. The off-test rate was calculated based on the total number of piglets approved for animal use relative to the total number evaluated. During the nursery stage, the NDT piglets showed a trend toward significance (p = 0.07) toward a higher occurrence of tail biting than the DT piglets and exhibited a higher incidence of severe lesions. They also engaged more frequently (p < 0.05) in exploratory behavior, interacting with branched chains and sisal rope, than the DT piglets. During the finishing phase, tail biting was observed only in the NDT piglets (p = 0.001). The NDT piglets that did not require the contingency plan exhibited lower fear responses (p = 0.02) during human interactions in the nursery phase than the DT piglets. Conversely, the NDT piglets that required a contingency plan showed higher fear levels (p < 0.001). Productivity performance was not affected (p > 0.05), and new cases of tail biting ceased after the contingency plan was implemented. The number of animals that died or were removed did not differ between the treatments (p > 0.05). In conclusion, managing piglets with intact tails on commercial farms presents a significant welfare challenge. By contrast, docking the final third of the tail, in accordance with regulations, was associated with fewer negative welfare outcomes, even when best management practices were applied. Full article

Background: Traumatic injuries cause millions of deaths annually, with intra-abdominal hemorrhage as a leading cause. Achieving hemostasis remains challenging. This study evaluates the hemostatic properties of a novel biocompatible cyanoacrylate–polylactic acid patch. Methods: Thirty-six male Wistar rats were randomized into three groups (control, study, and TachoSil^®) and underwent a standardized liver resection. The hemostasis times were recorded, and blood samples were drawn to assess hemoglobin, hematocrit, and cytokine levels (IL-6 and TNF-α) using validated assays. Results: In the study group, a median time to hemostasis of 94 s was recorded, compared with 256 s for electrocautery (p < 0.001) and 120 s for TachoSil^® (p = 0.010). Hemoglobin levels significantly decreased postoperatively in all groups, with the TachoSil^® group showing the lowest median value (from 15.4 g/dL to 11.9 g/dL, p = 0.006). Furthermore, only the TachoSil^® group exhibited a marked inflammatory response with a significant rise in IL-6 (from 15.6 to 26.8 pg/mL, p = 0.04) and TNF-α (from 9.8 to 28.6 pg/mL, p = 0.01). Conclusions: The results demonstrated that the novel cyanoacrylate–polylactic acid patch achieved rapid hemostasis and was associated with reduced inflammatory responses compared with both electrocautery and TachoSil^®. These findings suggest that this hybrid material may offer a safer and more effective hemostatic alternative. Full article

Coronary heart disease, a leading global cause of mortality, has witnessed significant advancement through robotic coronary artery bypass grafting (CABG), with the internal mammary artery (IMA) emerging as the preferred “golden conduit” for its exceptional long-term patency. Despite these advances, robotic-assisted IMA harvesting remains challenging due to the absence of force feedback, complex surgical maneuvers, and proximity to the beating heart. This study introduces a novel virtual simulation platform for robotic IMA harvesting that integrates dynamic anatomical modeling and real-time haptic feedback. By incorporating a dynamic cardiac model into the surgical scene, our system precisely simulates the impact of cardiac pulsation on thoracic cavity operations. The platform features high-fidelity representations of thoracic anatomy and soft tissue deformation, underpinned by a comprehensive biomechanical framework encompassing fascia, adipose tissue, and vascular structures. Our key innovations include a topology-preserving cutting algorithm, a bidirectional tissue coupling mechanism, and dual-channel haptic feedback for electrocautery simulation. Quantitative assessment using our newly proposed Spatial Asymmetry Index (SAI) demonstrated significant behavioral adaptations to cardiac motion, with dynamic scenarios yielding superior SAI values compared to static conditions. These results validate the platform’s potential as an anatomically accurate, interactive, and computationally efficient solution for enhancing surgical skill acquisition in complex cardiac procedures. Full article

Background and Objectives: With the increasing life expectancy, the frequency of total thyroidectomies in elderly patients has risen, raising concerns regarding hemorrhage and recurrent laryngeal nerve palsy compared to the general population. Therefore, considering the frequent alteration of the coagulation status in such patients, innovative methods able to reach an accurate hemostasis appear highly desirable. This retrospective multicentric study aimed to compare the postoperative outcomes of patients treated with conventional hemostasis with patients treated with the Harmonic Scalpel (HS) and gelatin–thrombin matrix (Floseal). Materials and Methods: Patients undergoing total thyroidectomy were retrospectively enrolled and categorized into two groups: Group A patients underwent surgery with the Harmonic Scalpel and Floseal, while Group B underwent traditional hemostasis surgery with ligations and monopolar electrocautery. The primary endpoint was the drain output after 24 and 48 h and the presence of significant blood loss. Secondary endpoints included the presence of seroma, wound infection, hematoma, laryngeal nerve palsy, surgery duration, and onset of post-surgical hypocalcemia. Results: From January 2014 to January 2024, 870 individuals participated in the study. Group A (gelatin–thrombin and HS) comprised 502 patients, while Group B (Standard Hemostasis—control group) comprised 368 patients. The 24 h drain output was 52 ± 25 mL in Group A vs. 113 ± 27 mL in Group B, p = 0.003, while the 48 h drain output was 95 ± 29 mL in Group A and 113 ± 27 mL in Group B (p = 0.002). Significant blood loss occurred in eight patients (2.2%) of Group B vs. three cases (0.6%) in Group A (p = 0.039). Also, neck hematoma (p = 0.012), seroma (p = 0.005), and reoperation (p = 0.052) values were significantly lower in Group A. Conclusions: Surgery aided with HS, and gelatin–thrombin was associated with lower major and minor complications compared to the conventional approach, guarantying reduced operative time, ensuring hemostasis, and preserving parathyroid glands, even in elderly patients. Full article

Background and Objectives: This study aimed to assess the impact of monopolar electrocautery on the fetus during cesarean section. Materials and methods: A retrospective analysis was conducted with 552 patients delivered by cesarean section. Patients were grouped based on usage of monopolar electrocautery. In 272 patients, monopolar electrocautery was used to separate the tissues before the delivery. In 280 patients, no electrocautery was used. Newborn vital signs, Apgar scores, umbilical cord blood parameters, newborn serum parameters collected within 6th postpartum hour, and rate of newborn intensive care unit admission were compared. Results: The 1st and 5th minute Apgar scores were significantly higher in the electrocautery group; however, this difference lost its significance at the 10th minute. The median newborn pulse rate (148 (7) vs. 146 (6) beats per minute, p = 0.026), umbilical cord blood pH, and partial oxygen pressure were significantly higher in the electrocautery group compared to the no-electrocautery group (7.34 ± 0.06 vs. 7.31 ± 0.06, p < 0.001, and 25.5 (14.77) vs. 23 (16.08) mmHg, p = 0.025, respectively). The median umbilical cord blood serum calcium level was 1.51 (0.64) mmol/L in the electrocautery group, which was significantly lower than 1.9 (0.82) mmol/L in the no-electrocautery group (p = 0.002). The incidence of hypoglycemia was significantly lower in the electrocautery group than in the no-electrocautery group (2.2% vs. 5.7%, p = 0.035). Conclusions: Monopolar electrocautery during cesarean section affects the fetus, but it is safe to use it. Electrocautery is independently associated with umbilical cord blood pH and calcium level. Electrocautery may be associated with a lower incidence of hypoglycemia. Full article

This study explores the innovative use of CO2 laser technology in frenuloplasty, a significant shift from classic methods like scalpel surgery or electrocautery towards a minimally invasive approach. The research involved 15 patients aged 25 to 50, undergoing frenuloplasty with a CO2 laser system equipped with a 7-inch defocused handpiece, set at 20 Hz and 0.3 W. This method diverges from conventional laser techniques, focusing on controlled laser passes combined with manual traction to elongate the fibrous tissue of the frenulum. The results demonstrated that the CO2 laser technique allowed for a precise and progressive modification of the frenulum, significantly reducing the risks of hemorrhage and secondary intention fibrosis. The healing process was notably expedited, with patients reporting satisfactory outcomes within a two-week period. Statistically significant improvements were observed in patient-reported outcomes, as evidenced by the increases in the Short Form Health Survey (SF-12) scores, with the mean Physical Component Summary (PCS) score rising from 32.5 to 47.5 and the mean Mental Component Summary (MCS) score from 39.3 to 52.3 (p < 0.001 for both). The study concludes that CO2 laser frenuloplasty is an effective and safe technique, offering substantial benefits in terms of reduced healing time and enhanced patient satisfaction. The significant improvements in SF-12 scores underscore the positive impact on patient quality of life, advocating for the broader application of this technique in clinical practice. Further research is warranted to explore its potential in a wider clinical context. Full article

(1) Background: DIEP-based breast reconstruction necessitates wide undermining at the abdominal donor site, creating large wound areas. Flap harvesting is usually conducted using electrosurgical dissection devices. This study sought to compare the clinical outcomes in patients after using the PEAK PlasmaBlade (PPB) versus monopolar electrocautery (MPE). (2) Methods: This retrospective cohort study included 128 patients with DIEP-based breast reconstruction. Patient characteristics and information on the postoperative course were collected and a comparative evaluation was conducted. (3) Results: The MPE group exhibited significantly (p* = 0.0324) higher abdominal drainage volume (351.11 ± 185.96 mL) compared to the PPB group (279.38 ± 183.38 mL). A subgroup analysis demonstrated that PPB significantly reduced postoperative wound fluid in patients with BMI > 30 kg/m² (p* = 0.0284), without prior neoadjuvant chemotherapy (p** = 0.0041), and among non-smokers (p = 0.0046). Furthermore, postoperative pain was significantly (p**** < 0.0001) lower in the PPB cohort. (4) Conclusions: This study confirms the non-inferiority of the PEAK PlasmaBlade to conventional electrocautery for abdominal flap harvesting. The PPB demonstrated advantages, notably reduced drainage volume and lower postoperative pain levels. Recognizing patient subsets that benefit more from the PPB highlights the importance of personalized device selection based on patient characteristics. Full article

An arthroscopic capsular release (ACR) is used for persistent shoulder stiffness after an index surgery. No cases of post-ACR humeral head osteonecrosis have been reported to date. A 56-year-old male patient underwent open reduction and internal fixation using a hook plate for acromioclavicular joint dislocation. Despite hardware removal, the patient presented with unresolved shoulder pain and range-of-motion (ROM) limitations. He had a history of hypertension, chronic hepatitis B infection, and alcohol consumption. His preoperative ROM was 90° for active forward flexion, 90° for abduction, 40° for external rotation, and at a sacral level for internal rotation. His preoperative functional status was a visual analog scale (VAS) score of 4, an American Shoulder and Elbow Surgeons (ASES) score of 51, and a Constant–Murley (CMS) score of 48 through normal radiography and magnetic resonance imaging. A standard ACR was performed with a 360° release of the joint capsule via electrocautery ablation. Six months post-ACR, his ROM (forward flexion: 135°; abduction: 135°; external rotation: 70°; internal rotation: T10 vertebra) and functional outcomes (VAS 2; ASES 79; CMS 75) were significantly improved, without an interval change in radiographic assessment. However, 15 months post-operation, the patient experienced a recurrence of shoulder pain and subsequently underwent triamcinolone injections in both the 15th and 21st postoperative months. Radiography revealed humeral head osteonecrosis. Patients with intrinsic or extrinsic risk factors related to humeral head circulation disturbance should be monitored for humeral head osteonecrosis post-ACR. Full article

Thermal ablative techniques are part of the armamentarium of interventional pulmonologists for the treatment of a diverse range of pathologies, but most importantly used in airway obstruction and airway bleeding. These techniques can be categorized based on their onset of action into rapid and delayed ablative methods. Understanding the nuances of each technique is essential, as most clinical scenarios demand a combination of modalities, commonly referred to as a “multi-modality approach”. This comprehensive review aims to elucidate the fundamental principles of rapid ablative techniques, including laser therapy, argon plasma coagulation (APC), and electrocautery, along with the research that underpins their clinical application. Full article

Malignant distal biliary obstructions are becoming increasingly common, especially in patients with cancers of the pancreatic head, despite progress in medical oncology research. ERCP is the current gold standard for management of such strictures, but the emergence of EC-LAMS has rendered EUS-CDS both safe and efficient. It is a “game changer”; originally intended for ERCP failure, two randomised clinical trials recently proposed EUS-CDS as a first-intent procedure in palliative settings. For resectable diseases, the absence of iatrogenic pancreatitis associated with a lower rate of postsurgical adverse events (compared with ERCP) leads us to believe that EUS-CDS might be used in first-intent as a pre-operative endoscopic biliary drainage. Full article