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Objective: To clarify the incidence of excessive distension absorption in hysteroscopic surgery using 5% mannitol solution, evaluate the associated risks, and help to establish a safe fluid deficit threshold for such complication. Design: Retrospective descriptive study. Setting: Academic medical center. Patients: Ten thousand six hundred ninety-three patients underwent inpatient hysteroscopic surgery with 5% mannitol perfusion using a monopolar electrosurgical instrument from Jan. 2015 to Sep. 2020. Intervention(s): None. This study has been approved by the Ethics Committee of Sun Yat-sen Memorial Hospital. Measurements and main results: A fluid deficit of more than 1000 mL was defined as the diagnostic criteria for excessive distension absorption. The overall incidence of excessive distension absorption in this study was 0.46% (49/10693). The incidence was 2.57% (16/623) for transcervical resection of fibroid (TCRF), 2.36% (9/381) for retained products of conception (RPOC) removal, 1.20% (6/501) for hysteroscopic uterine septum resection (HSR), 0.48% (4/828) for transcervical resection of the endometrium (TCRE), and 0.53% (14/2621) for transcervical resections of adhesion (TCRA). Excessive distension absorption could occur within seven minutes in HSR. Among the patients diagnosed with excessive distension absorption, 30.77% (12/39) exhibited signs or symptoms related to circulation overload with a fluid deficit under 2500 mL, and 10.26% (4/39) developed pulmonary edema. Conclusion: Excessive distension absorption could happen in all kinds hysteroscopic surgical treatment including RPOC removal and TCRA which were rarely reported. The overall incidence of excessive distension absorption could be low. But it would be five times higher in certain procedures such as TCRF, RPOC removal and TCRA. Resection using a needle electrode in HSR and TCRA may contribute to the short time development of excessive distension absorption. 30.77% of the patients could not tolerate the fluid deficit of less than 2500 mL which was set as a threshold for isotonic distending media and presented with circulation overload related signs or symptoms. [ABSTRACT FROM AUTHOR]

The interface between dental restorations and the neighbouring soft tissue is of key significance for restorative success and longevity. Trauma-related enamel–dentine fractures are frequently present with the restorative challenge of subgingival margins and little remaining tooth structure. This report looks at two paediatric dental trauma patients with extensive crown fractures resulting in subgingival margins, which posed a poor long-term tooth survival. Electrosurgery was used before definitive composite restorations to allow for supragingival margins and access. Each patient attended the Child Dental Health Department at the University of Manchester Dental Hospital for assessment and treatment provision. CPD/Clinical Relevance: This article identifies electrosurgery as an increasingly useful adjunct to restorative management of traumatized permanent incisor teeth in paediatric patients. [ABSTRACT FROM AUTHOR]

Interventional pulmonology can be helpful in cases of malignant airway stenosis. We present a 73‐year‐old man diagnosed with lung cancer who presented with symptomatic airway stenosis caused by a large endobronchial tumor. Oncological treatment was started with chemotherapy, radiotherapy, and a multimodality bronchoscopic approach using balloon bronchoplasty, electrosurgery, and argon plasma coagulation. Response evaluation showed relief of symptoms, disappearance of the endobronchial tumor, and complete resolution of the airway stenosis. [ABSTRACT FROM AUTHOR]

Considering the increasing demand for personalized surgical care, as well as current healthcare resources limitations, the use of anatomical accurate 3D physical phantoms is becoming increasingly important for the training of surgeons and the test of surgical instruments. A lack of physical models is nowadays denoted regarding the training in electrosurgery, despite its wide diffusion in medical practice. This work reports an extensive characterization of electrosurgical physical phantoms fabricated with tissue‐mimicking ionogels and hydrogels. A careful design of the conductive gels allow the fine tuning of their mechanical and electrical properties, in order to match those of biological tissues. The manufacturing of a novel multi‐material skin stratification bench‐top pad is reported together with its use for training in both cold and electrical surgery. Furthermore, a feasibility study is reported, showing the use of conductive ionogels for simulating the coagulation of cortical vessels during brain surgery. [ABSTRACT FROM AUTHOR]

Introduction: Surgical procedures in contemporary practice frequently employ energy-based devices, yet comprehensive education surrounding their safety and effectiveness remains deficient. We propose an innovative course for residents that aims to provide basic electrosurgery knowledge and promote the safe use of these devices. Methods: We developed a simulated training course for first-year general surgery and orthopedic residents. First, a survey was conducted regarding their knowledge perception about energy devices. The course consisted of two online theoretical sessions, followed by three in-person practical sessions. First-year residents performed three video-recorded attempts using a cadaveric model and were assessed through a digital platform using the Objective Structured Assessment of Technical Skill (OSATS), a Specific Rating Scale (SRS), and a surgical energy-based devices scale (SEBS). Third-year residents were recruited as a control group. Results: The study included 20 first-year residents and 5 third-year residents. First-year residents perceived a knowledge gap regarding energy devices. Regarding practical performance, both OSATS and checklist scores were statistically different between novices at their first attempt and the control group. When we analyzed the novice's performance, we found a significant increase in OSATS (13 vs 21), SRS (13 vs 17.5), and SEBS (5 vs 7) pre- and post-training scores. The amount of feedback referred to skin burns with the electro-scalpel reduced from 18 feedbacks in the first attempt to 2 in the third attempt (p-value = 0.0002). When comparing the final session of novices with the control group, no differences were found in the SRS (p = 0.22) or SEBS (p = 0.97), but differences remained in OSATS (p = 0.017). Conclusion: This study supports the implementation of structured education in electrosurgery among surgical trainees. By teaching first-year residents about electrosurgery, they can acquire a skill set equivalent to that of third-year residents. The integration of such courses can mitigate complications associated with energy device misuse, ultimately enhancing patient safety. [ABSTRACT FROM AUTHOR]

Background: There is much heterogeneity in the instrumentation used for parenchymal transection in minimally invasive liver surgery. Instruments specifically designed for robotic parenchymal transection of the liver are lacking. We aim to gain insight into the safety and effectiveness of the SynchroSeal (Intuitive Surgical, Inc., Sunnyvale, CA), a novel bipolar electrosurgical device, in the context of liver surgery. Methods: The present study is a post-hoc analysis of prospectively collected data from patients undergoing robotic liver resection (RLR) using the SynchroSeal in two high-volume centres. The results of the SynchroSeal were compared with that of the previous generation bipolar-sealer; Vessel Sealer Extend (Intuitive Surgical, Inc., Sunnyvale, CA) using propensity score matching, after excluding the first 25 Vessel Sealer procedures per center. Results: During the study period (February 2020–March 2023), 155 RLRs meeting the eligibility criteria were performed with the SynchroSeal (after implementation in June 2021) and 145 RLRs with the Vessel Sealer. Excellent outcomes were achieved when performing parenchymal transection with the SynchroSeal; low conversion rate (n = 1, 0.6%), small amounts of intraoperative blood loss (median 40 mL [IQR 10–100]), short hospital stays (median 3 days [IQR 2–4]), and adequate overall morbidity (19.4%) as well as severe morbidity (11.0%). In a matched comparison (n = 94 vs n = 94), the SynchroSeal was associated with less intraoperative blood loss (48 mL [IQR 10–143] vs 95 mL [IQR 30–200], p = 0.032) compared to the Vessel Sealer. Other perioperative outcomes were similar between the devices. Conclusion: The SynchroSeal is a safe and effective device for robotic liver parenchymal transection. [ABSTRACT FROM AUTHOR]

Hysteroscopic surgery requires a balance of continuous controlled irrigation and aspiration to distend the endometrial cavity to a degree that provides the clear and stable visual environment necessary for diagnostic and therapeutic procedures. Whereas the preferred distending solution should be isotonic and isonatremic, radiofrequency (RF) electrosurgery with monopolar instrumentation can only be performed with non‐ionic (hyponatremic) solutions. Absorption of as little as 500 mL and certainly more than 1000 mL of non‐ionic solutions can result in fluid overload and/or dilutional hyponatremia with potentially serious adverse effects under certain conditions and patient characteristics. Both hysteroscopic RF electrosurgery with bipolar instrumentation and electro‐mechanical morcellation and aspiration systems use isotonic and isonatremic solutions. Depending on the clinical context, absorption of more than 1500 mL of isonatremic solutions can also result in serious adverse effects. Automated fluid management systems are preferred and recommended, and surgeons should aim to maintain the maximum allowable intravasation of distending media below 1000 and 1500 mL for non‐ionic and ionic fluids, respectively. [ABSTRACT FROM AUTHOR]

This article, titled "Electrosurgical Principles: Beyond Blue and Yellow Pedal," provides an overview of electrosurgical principles and their application in clinical practice. The use of electrosurgery has become widespread in endoscopic procedures, but education on these principles is limited. The article explains the fundamentals of electrosurgery, including the conversion of electrical energy into thermal energy and the effects of temperature on cell physiology. It also discusses different electrosurgical waveforms and their use in cutting and coagulating tissue. The article emphasizes the importance of understanding these principles to achieve the desired tissue effect and minimize risks. [Extracted from the article]

BACKGROUND Desmoplastic trichoepithelioma (DTE) is an uncommon benign adnexal tumor that histologically may mimic malignant tumors including basal cell carcinoma and microcystic adnexal carcinoma. OBJECTIVE To present a systematic review of the epidemiology, clinical characteristics, treatment, and outcome data on DTEs, with emphasis on comparing Mohs micrographic surgery (MMS) with other treatments. METHODS Using the OVID platform, MEDLINE and Embase were searched from inception for studies providing original data on DTEs. RESULTS A total of 338 cases of DTE from 61 articles were included. No recurrence/persistence (0%) was reported following MMS (n 5 24, mean follow-up of 41.9 months), 13.1% with standard excision (n 5 38, mean follow-up 16.9 months), and 2.1% for electrosurgery/cautery (n 5 49, follow-up 3-72 months). 100% recurrence/persistence for imiquimod (n 5 2) and liquid nitrogen (n 5 4) were identified. In patients who underwent biopsy only, there was a 12.5% recurrence/persistence (n 5 32, mean follow-up 16.5 months). Overall, duration of follow-up varied from 2 months to 6 years for the various management strategies. CONCLUSION Data are limited regarding DTE outcomes. In this review, surgical modalities, specifically MMS, had the lowest rates of recurrence/persistence compared with other options. Given that most lesions are found on cosmetically sensitive locations, MMS seems to be the optimal management strategy for actively managing DTEs. [ABSTRACT FROM AUTHOR]

Objectives: Loop electrosurgical excision procedure (LEEP), which is effectively used in the diagnosis and treatment of cervical intraepithelial neoplasia (CIN), can be performed under general and local anesthesia. The aim of this study is to retrospectively examine whether the chosen anesthesia method affects the surgical margin and the factors affecting the surgical margin. Materials and Methods: Data of 122 patients who met the inclusion criteria and underwent LEEP between 2016 and 2021 were retrospectively analyzed. Demographic data (age, body mass index, alcohol and smoking); gynecological anamnesis: Gravida, parity, number of living children, number of abortions, menopausal status, type of contraceptive method and presence of additional metabolic diseases (hypertension, diabetes, coronary artery disease) were recorded from the patients’ files and epicrisis. LEEP indications and pre-LEEP HPV information were recorded. LEEP procedure data: Anesthesia method used; general or local anesthesia, positive surgical margin rate (for example, the presence of CIN II/III at the ectocervical and/or endocervical resection margins was considered positive), size of the removed piece (anteroposterior length, transverse length and height, volume), pathology results were recorded and factors affecting margin positivity were examined. Results: It was determined that the type of anesthesia administered (general or local), patient age older than 40 years, patient being in menopause, and the size and volume of the sample taken during LEEP had no effect on margin positivity, whereas high-grade cervical cytology before LEEP, the presence of endocervical gland involvement, and the number of multiple passes in the excision were shown to increase the risk for margin positivity. Conclusion: We found that high-grade cervical cytology before LEEP, the presence of endocervical gland involvement, and multiple passes in excision were risk factors predicting a positive surgical margin; however, the type of anesthesia did not affect the surgical margin. [ABSTRACT FROM AUTHOR]

Purpose. To evaluate the effectiveness and safety of direct current cornea fulguration in the treatment of drug-resistant keratitis. Material and methods. 20 patients (20 eyes) diagnosed with drug-resistant infectious keratitis (bacterial, acanthamoeba, fungal), underwent fulguration of the infiltration zone with plasma electrocautery. In addition to a standard ophthalmological examination, all patients were tested for corneal thickness and lesion depth before surgery and 1 day, 1 month, and 3 months after surgery by anterior segment optical coherence tomography (OCT). After photofixation of the cornea, OCT data were used to dynamically assess the lesion area and deepithelialization. Results. In 95 % of cases (19 eyes), the infectious inflammatory process could be stopped in 3 to 7 weeks, with the opacification onset in the stromal layers of the cornea 2–3 weeks after the procedure. In these cases, after 2 weeks, the infiltrated or corneal ulcer area was completely epithelialized. Over a long postprocedural period (3 months), the corneal thickness in the inflammation area varied from 285 µm to 791 µm. During the entire observation period, the integrity of the cornea was maintained and transparency improved. 3 months after surgery, the average visual acuity corrected by spectacle lenses increased from 0.42 ± 0.35 to 0.54 ± 0.33. Conclusion. Direct current fulguration can be an effective and relatively safe urgent treatment for drug-resistant infectious keratitis.

Electrosurgical generator units (ESUs) are instrumental in modern therapeutic gastrointestinal (GI) endoscopy, converting household alternating current into high-frequency current to generate thermal energy within tissues. This review elucidates the essentials of electrosurgery, exploring the thermal effects on tissue, current resistance, voltage, current density, duty cycle, crest factor, and the distinctions between monopolar and bipolar circuitry. The concept of duty cycle, the proportion of time electrical current is delivered, and crest factor, the ratio of peak to root mean square voltage, are essential while comparing differently named modes across various commercially available ESUs. This article discusses the practical applications of electrosurgery in therapeutic GI endoscopy procedures, including endoscopic sphincterotomy, polypectomy, endoscopic mucosal resection, endoscopic submucosal dissection, and peroral endoscopic myotomy. It outlines recommended modes and settings for ESUs across various procedures, emphasizing the balance between cutting and coagulation to achieve optimal outcomes while minimizing adverse effects. The review further addresses special considerations for the use of grounding pads and the management of patients with implanted cardiac devices during electrosurgical procedures. This article concludes with a call for a deeper understanding of electrosurgical principles and their application in GI endoscopy to ensure patient safety and procedural success, backed by references to relevant literature and detailed tables summarizing electrosurgical modes and settings for various therapeutic interventions.

The main stages and principles of development of a high-frequency electrosurgical device are described, the mechanisms of action of high-frequency currents on biological tissues are considered, and the results of clinical testing of this medical device are presented. [ABSTRACT FROM AUTHOR]

Electrosurgical and ultrasonic devices are used in surgical procedures for hemostatic sealing and bisection of vascular tissues. Previous benchtop studies alternatively demonstrated successful infrared laser sealing and cutting of blood vessels, in a sequential, two-step approach. This study describes a smaller, laparoscopic device compatible design, and simultaneous approach to sealing and bisection of vessels, with potential optical feedback. A 1470-nm infrared diode laser sealed and bisected 40 porcine renal arteries, ex vivo. A reciprocating, side-firing, optical fiber, housed in a transparent square quartz optical chamber (2.7 × 2.7 × 25 mm outer dimensions), delivered laser energy over an 11 mm scan length, with a range of incident powers (41–59 W) and treatment times (5–21 s). Vessel diameters ranged from 2.5 to 4.8 mm. Vessel burst pressure measurements were performed on each cut end (n = 80) with success indicated by pressures exceeding 360 mmHg. All vessel ends were successfully sealed and bisected (80/80). The highest incident power, 59 W, yielded short treatment times of 5–6 s. Peak temperatures on the external chamber surface reached 103 oC. Time to cool down to body temperature measured 37 s. Infrared lasers simultaneously seal and bisect blood vessels, with treatment times comparable to, and temperatures and cooling times lower than reported for conventional devices. Future work will focus on integrating the fiber and chamber into a standard 5-mm-outer-diameter laparoscopic device. Customization of fiber scan length to match vessel size may also reduce laser energy deposition, enabling lower peak temperatures, treatment times, and cooling times. [ABSTRACT FROM AUTHOR]

Background: The use of high-frequency electric welding technology for intestinal end-to-end anastomosis holds significant promise. Past studies have focused on in vitro, and the safety and efficacy of this technology is uncertain, severely limiting the clinical application of this technology. This study investigates the impact of compression pressure, energy dosage, and duration on anastomotic quality using a homemade anastomosis device in both in vitro and in vivo settings. Methods: Two hundred eighty intestines and 5 experimental pigs were used for in vitro and in vivo experiments, respectively. The in vitro experiments were conducted to study the effects of initial pressure (50–400 kpa), voltage (40–60 V), and time (10–20 s) on burst pressure, breaking strength, thermal damage, and histopathological microstructure of the anastomosis. Optimal parameters were then inlaid into a homemade anastomosis and used for in vivo experiments to study the postoperative porcine survival rate and the pathological structure of the tissues at the anastomosis and the characteristics of the collagen fibers. Results: The anastomotic strength was highest when the compression pressure was 250 kPa, the voltage was 60 V, and the time was 15 s. The degree of thermal damage to the surrounding tissues was the lowest. The experimental pigs had no adverse reactions after the operation, and the survival rate was 100%. 30 days after the operation, the surgical site healed well, and the tissues at the anastomosis changed from immediate adhesions to permanent connections. Conclusion: High-frequency electric welding technology has a certain degree of safety and effectiveness. It has the potential to replace the stapler anastomosis in future and become the next generation of new anastomosis device. [ABSTRACT FROM AUTHOR]

Simple Summary: The present study aimed to evaluate the age-related distribution of HPV 16/18 genotypes and non-16/18 HPV genotypes in unvaccinated women. CIN3 in women younger than 30 years was significantly associated with HPV16/18 genotypes. The surprising fact of the present study is represented by the fact that in women under the age of 30, almost 90% of CIN3 cases were associated with HPV16/18, while CIN3 with non-16/18 HPV genotypes develops slowly and in older age. The data from the present study suggest that the risk of CIN3 is related to the woman's age and hr HPV genotype. These data are essential to optimize current and future screening programs. Background. The objective of the present study is to investigate the age-specific distribution of HPV genotypes in CIN3 lesions in screened unvaccinated women. These data are essential to optimize current and future screening programs. Methods. A multicenter retrospective study was conducted. A total of 408 unvaccinated women with positive histology and a high-risk HPV genotype were enrolled. Each woman at baseline had HPV DNA testing and HPV genotyping, and all women underwent targeted biopsy and/or treatment with a loop electrosurgical excision procedure (LEEP) before entering the study. We divided the genotypes into HPV16/18 and HPV non-16/18 (HPV31/33/45/35/39/51/52/58/59/66/68). Women were divided into increasing age categories: <30, 30–44, and ≥45. Results. The percentage of CIN3 associated with HPV16/18 is maximum in women under 30 years of age (85.1%), drops to 75.6% in women aged between 30 and 44 years, and up to 47.2% in women over 45 years. CIN3 in women younger than 30 years was significantly associated with HPV16/18 genotypes (p = 0). Discussion. The data from the present study suggest that the risk of CIN3 is related to the woman's age and hr HPV genotype. The data highlight two different types of CIN3: a more frequent type, related to HPV16/18, which develops rapidly and in young women, and another, relating to non-16/18 HPV, which develops later at an advanced age and slowly, through low-grade lesions. [ABSTRACT FROM AUTHOR]

Electrosurgical generator units (ESUs) are instrumental in modern therapeutic gastrointestinal (GI) endoscopy, converting household alternating current into high-frequency current to generate thermal energy within tissues. This review elucidates the essentials of electrosurgery, exploring the thermal effects on tissue, current resistance, voltage, current density, duty cycle, crest factor, and the distinctions between monopolar and bipolar circuitry. The concept of duty cycle, the proportion of time electrical current is delivered, and crest factor, the ratio of peak to root mean square voltage, are essential while comparing differently named modes across various commercially available ESUs. This article discusses the practical applications of electrosurgery in therapeutic GI endoscopy procedures, including endoscopic sphincterotomy, polypectomy, endoscopic mucosal resection, endoscopic submucosal dissection, and peroral endoscopic myotomy. It outlines recommended modes and settings for ESUs across various procedures, emphasizing the balance between cutting and coagulation to achieve optimal outcomes while minimizing adverse effects. The review further addresses special considerations for the use of grounding pads and the management of patients with implanted cardiac devices during electrosurgical procedures. This article concludes with a call for a deeper understanding of electrosurgical principles and their application in GI endoscopy to ensure patient safety and procedural success, backed by references to relevant literature and detailed tables summarizing electrosurgical modes and settings for various therapeutic interventions. [ABSTRACT FROM AUTHOR]

The article focuses on introducing a new transcatheter myotomy technique, SESAME, aimed at addressing left ventricular outflow tract obstruction in patients with hypertrophic cardiomyopathy (HCM) and facilitating transcatheter valve replacement (TVR). It is reported that this innovative approach utilizes intramyocardial guidewires and electrosurgery to widen the LVOT (Left Ventricular Outflow Tract), improving symptoms in HCM and TVR patients.

Background: The aim of this study is to determine the effectiveness of the LEEP (Loop Electrosurgical Excision Procedure) procedure in the preoperative evaluation of cervical involvement in endometrial cancer and to evaluate its contribution to the planning of the surgical procedure. Materials and Methods: 75 patients who were examined prospectively and whose histopathological results were compatible with endometrial cancer were divided into two groups to undergo endocervical curettage and LEEP. All patients underwent simple hysterectomy/radical hysterectomy and a surgical staging procedure including pelvic, para-aortic lymph node sampling, omentectomy, and cytology collection. Staging was done according to the FIGO 2009 surgical staging system. The aim was to determine the accuracy rates, sensitivity and specificity in determining cervical involvement by comparing the histopathological findings obtained from the preoperative ECC (Endecervical Curettage) and LEEP procedures of the patients with the operation pathologies. Results: When the pathology results of endocervical curettage samples were compared with the operation pathologies, it was determined that it was statistically significant, but the accuracy rate was 58.7%. When the samples taken from the patients who underwent the LoopElectrosurgicalExcision procedure were compared with the surgical pathologies, it was found to be statistically significant and the accuracy rate was found to be 93.5% (p = 0.037). Conclusions: Determining cervical involvement with the LEEP procedure is superior to the frequently applied endocervical curettage in terms of specificity, positive predictivity and accuracy. [ABSTRACT FROM AUTHOR]

The aim of the study was to assess sexual health in women who underwent Loop Electrosurgical Excisional Procedure (LEEP) for the treatment of cervical intraepithelial neoplasia 3 (CIN 3). One hundred thirty-one women were enrolled, and the Female Sexual Function Index (FSFI) questionnaire was administered before LEEP and 6 months after the procedure. In almost all of the participants, data revealed a statistically significant worsening in sexual quality of life after LEEP. Therefore, clinicians should be aware of these possible negative effects on sexual behavior, and provide women with appropriate, wide-ranging, and detailed counseling. The data obtained in the present study should help to plan appropriate counseling from communicating HPV diagnosis and medical treatment to CIN3 surgical procedure. [ABSTRACT FROM AUTHOR]

Abstract Considering the increasing demand for personalized surgical care, as well as current healthcare resources limitations, the use of anatomical accurate 3D physical phantoms is becoming increasingly important for the training of surgeons and the test of surgical instruments. A lack of physical models is nowadays denoted regarding the training in electrosurgery, despite its wide diffusion in medical practice. This work reports an extensive characterization of electrosurgical physical phantoms fabricated with tissue‐mimicking ionogels and hydrogels. A careful design of the conductive gels allow the fine tuning of their mechanical and electrical properties, in order to match those of biological tissues. The manufacturing of a novel multi‐material skin stratification bench‐top pad is reported together with its use for training in both cold and electrical surgery. Furthermore, a feasibility study is reported, showing the use of conductive ionogels for simulating the coagulation of cortical vessels during brain surgery.

Electrosurgical electrodes are the main dissecting devices widely used for surgeries throughout the world. The present study aimed to evaluate the thermal injury and safety within animals' organs following a minimally invasive electrosurgery technique with electrosurgical electrode AE40-300 (LIPO) and AE20-80 (LIFT). To ensure the effective application of electrosurgery in a clinical environment, it is crucial to minimize heat-induced injury to nearby tissues. In this study, the skin, liver, kidney, and femoral muscle dissected from 9 minipigs were used in tissue thermal spread experiments. Thermal imaging area analysis, maximum temperature, and time to reach basal temperature were evaluated. Thermography results revealed that the surgical temperature was significantly lower in the minimally invasive electrosurgery with AE40-300 (LIPO) and AE20-80 (LIFT) compared to the predicate device. In addition, AE40-300 (LIPO) and AE20-80 (LIFT) created a relatively small thermal injury area and thermal diffusion. Our results indicated that the tested devices named AE40-300 (LIPO) and AE20-80 (LIFT) reduced excessive thermal injury and could be applied to clinical use safely.

(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. [ABSTRACT FROM AUTHOR]

Objective The aim of the study is to evaluate the use of a bipolar electrocautery device for complete salpingectomy at cesarean to improve procedure completion rates, operative time, and surgeon reported satisfaction as compared with standard bilateral tubal ligation (BTL) and suture-cut-tie salpingectomy. Study Design This is a prospective cohort study of women undergoing planned, non-emergent cesarean with desired sterilization with complete salpingectomy utilizing a bipolar electrocautery device. Study patients were compared with historic controls from a randomized controlled trial (RCT) of complete salpingectomy via suture-cut-tie method versus BTL conducted at our institution (SCORE trial, NCT02374827). Outcomes were compared with groups from the original RCT. Results Thirty-nine women were consecutively enrolled (12/2018–11/2019) into the device arm of the study and compared with the original SCORE cohort (n = 40 BTL, n = 40 salpingectomy without a device). Salpingectomy performance with the bipolar electrocautery device was successfully completed in 100% (39/39) of enrolled women, with one device failure requiring the use of a second device, as compared with 95% (38/40) in the BTL (p = 0.49) and 67.5% (27/40) in salpingectomies without a device (p < 0.001). Mean operative time of sterilization procedure alone demonstrated device use as having the shortest operative time of all (device salpingectomy 5.0 ± 3.6 vs. no device 18.5 ± 8.3 minutes, p < 0.001; and vs. BTL 6.9 ± 5.0, p = 0.032). Mean sterilization procedure endoscopic band ligation (EBL) was demonstrated to be significantly different between each group, least amongst BTL followed by device (6.3 ± 4.8 vs. 8.4 ± 24.8, p < 0.001), and most by suture-cut-tie method (17.7 ± 14.3, p < 0.001 compared with device). Surgeon reported attitudes of complete salpingectomy performance in general practice outside an academic setting was greater with a device than without (79.5 vs. 35.3%; p < 0.001). Conclusion Use of a bipolar electrocautery device improved operative times and surgeon satisfaction for salpingectomy at cesarean over standard suture ligation. Device use improved surgeon reported outcomes and may improve incorporation of complete salpingectomy at cesarean. Key Points Electrocautery bipolar device use was safe at the time of salpingectomy during cesarean. Greater surgeon satisfaction occurs using a device than without. Decreased surgical time with device use is seen making the procedure equal to BTL. [ABSTRACT FROM AUTHOR]

Purpose: To compare conventional bipolar electrosurgery with advanced bipolar vessel sealing (ABVS) devices for total laparoscopic hysterectomy (TLH). Methods: A systematic review was conducted by searching Scopus, PubMed/MEDLINE, ScienceDirect, and Cochrane Library from January 1989 to November 2021. We identified all studies comparing ABVS devices with conventional bipolar electrosurgery in TLH and reporting at least one of the following outcomes: total blood loss, total operative time, hospital stay, perioperative complications, or costs. Meta-analysis was conducted with a random effect model reporting pooled mean differences and odds ratios (ORs) with related 95% confidence intervals (CIs). Results: Two randomized controlled trials and two retrospective studies encompassing 314 patients were included out of 615 manuscripts. The pooled estimated total blood loss in the ABVS devices group was lower than conventional bipolar electrosurgery of 39 mL (95% CI − 65.8 to − 12.6 mL; p =.004). The use of ABVS devices significantly reduced the total operative time by 8 min (95% CI − 16.7 to − 0.8 min; p =.033). Hospital stay length did not differ between the two groups, and a comparable overall surgical complication rate was observed [OR of 0.9 (95% CI 0.256 – 3.200; p =.878]. Conclusions: High-quality evidence comparing ABVS devices with conventional bipolar electrosurgery for TLH is lacking. ABVS devices were associated with reduced total blood loss and operative time; however, observed differences seem clinically irrelevant. Further research is required to clarify the advantages of ABVS devices over conventional bipolar electrosurgery and to identify cases that may benefit more from their use. [ABSTRACT FROM AUTHOR]

Aim: To seek the high‐risk factors of human papillomavirus (HPV) persistence and residual lesion or recurrence after loop electrosurgical excision procedure (LEEP) focus on the predictive value of intraoperative human papilloma virus (IOP‐HPV) testing. Methods: Intraoperative endocervical sample was obtained with a cytobrush from the remained cervix of 292 patients immediately after LEEP. HPV Genotyping was performed using a polymerase chain reaction technique. All patients followed by HPV genotyping and cytology every 3–6 months. The IOP‐HPV testing results and possible risk factors such as age, cytology grade, menopause status, margin involvement, preoperative HPV status, and cervical lesion grade were assessed in predicting persistence of HPV and residual lesion or recurrence after surgery. Results: There were 61 (20.9%) patients presented persistent HPV infection. Multivariate analyses showed that IOP‐HPV positive, post‐menopause and preoperative HPV multiplex infection was strongly associated with HPV persistence after LEEP, IOP‐HPV positive and post‐menopause was also associated with residua or recurrent disease after LEEP. Conclusions: IOP‐HPV positive, post‐menopause, and preoperative HPV multiplex infection are independent predictors of HPV persistence in patients with cervical squamous intraepithelial lesion treated by LEEP. IOP‐HPV test is a new approach that may potentially allow for early identification of patients at high risk of HPV persistence and residua or recurrent disease after LEEP, thereby possibly facilitate an attenuated follow‐up schedule for negative patients those at low risk of persistent HPV infection. [ABSTRACT FROM AUTHOR]

For decades, radiofrequency (RF)-induced tissue fusion has garnered great attention due to its potential to replace sutures and staples for anastomosis of tissue reconstruction. However, the complexities of achieving high bonding strength and reducing excessive thermal damage present substantial limitations of existing fusion devices. This study proposed a discrete linkage-type electrode to carry out ex vivo RF-induced intestinal anastomosis experiments. The anastomotic strength was examined by burst pressure and shear strength test. The degree of thermal damage was monitored through an infrared thermal imager. And the anastomotic stoma fused by the electrode was further investigated through histopathological and ultrastructural observation. The burst pressure and shear strength of anastomotic tissue can reach 62.2 ± 3.08 mmHg and 8.73 ± 1.11N, respectively, when the pressure, power and duration are 995 kPa, 160 W and 13 s, and the thermal damage can be controlled within limits. Histopathological and ultrastructural observation indicate that an intact and fully fused stomas with collagenic crosslink can be formed. The discrete linkage-type electrode presents favorable efficiency and security in RF-induced tissue fusion, and these results are informative to the design of electrosurgical medical devices with controllable pressure and energy delivery. [ABSTRACT FROM AUTHOR]

Objective: Electrothermal bipolar vessel sealing devices are electrosurgical devices that seal tissues and blood vessels up to 7 mm in diameter. This paper discusses our experience using electrothermal bipolar vessel sealing devices in transoral head and neck surgery. Methods: Electrothermal bipolar vessel sealing devices were used in five patients with lesions of varying size and type within the pharyngo-larynx. These were treated transorally by the otolaryngology department at the Royal Adelaide Hospital. Either the Medtronic LigaSure or BiZact devices were used for transoral resection, debulking or division of these lesions. Results: Electrothermal bipolar vessel sealing devices were considered helpful in four out of the five cases. Success was dependent on suitable transoral access. A single unsuccessful case reflected the LigaSure jaw's inability to engage a large tumour effectively. Conclusion: Electrothermal bipolar vessel sealing devices can be safely deployed transorally to treat lesions of the upper aero-digestive tract in selected patients. Further studies investigating additional indications would broaden applications of this approach. [ABSTRACT FROM AUTHOR]

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In electro-surgery, surgical smoke was hazard to surgeons and patient in theatre. In order to institute effective countermeasures, quantifying of the effect of tip temperature of electro-surgical unit to surgical smoke distribution in theatre was studied. The relation of tip temperature to power of electro-surgical unit through in vitro cutting experiment. Based on experiment data, the mathematical model was established to simulate the electro-surgery in laminar operation room. As the power of electro-surgical knife increased, the knife tip temperature increased. Total content of (CO, CO2, CH4, NH3) in waste gas and net flow rate of waste gas at outlet increased with the rising temperature of knife tip and formation rate of condensed tar droplets and non-viable particles also increased. Based on simulation, it was found that The maximum height of surgical smoke rising right above the incision of electro-surgical unit was increased with rising temperature of electro-surgical knife tip. There was a spread route of dispersed surgical smoke near the walls of theatre through natural convection. The polynomial fitting relationship was derived. As the tip temperature of knife increased from 200 to 500°C, maximum ascending height of surgical smoke right above the incision position of electro-surgical unit increased from 1.1 m to 1.45 m. When the tip temperature of electro-knife was more 400°C, the CO content in the surgeon's operating zone was more than 200 ppm, which would cause the surgeon's HbCO level increased. As the patient's tissue in the wound during operation was open, when the electro-knife of more than 400°C, the content of condensed tar droplets and in-viable particle was higher than 20 g/m3 and 12 g/m3 in the zone around patient's wound of open tissue, which should be hazard to health of patient. [ABSTRACT FROM AUTHOR]

Simple Summary: The aim of this study was to evaluate the incidence of high-grade glandular pathology in the histological cones of LEEP for CIN3 and to verify the different biological nature of the single CIN3 lesion from CIN3 coexisting with AIS. A sample of 414 women underwent LEEP for CIN3. From the histological examination of the cone, we selected 370 women with a single CIN3, 39 women with CIN3 coexisting with AIS, and 5 women with CIN3 coexisting with AC. Specific HR HPV genotypes and treatment outcome in the study groups were investigated. Women with CIN3 coexisting with AIS showed only four specific HR HPV genotypes (16, 18, 45, 33), the prevalence of genotype 18, the presence of skip lesions (9%), and occult adenocarcinoma (one case of 1A1 adenocarcinoma). Furthermore, CIN3 lesions coexisting with AIS have a higher rate of viral persistence and recurrence than single CIN3 lesions. These characteristics make CIN3 coexisting with AIS closer to the glandular pathology than to the squamous one, making hysterectomy necessary and cervical conization insufficient, which is instead considered the optimal treatment method for a single CIN3. The purpose of this study was to evaluate the incidence of AIS and AC in the histological cone of women treated for CIN3. Furthermore, through the study of the specific HR HPV genotypes, we obtained more information on the possible different nature between the single CIN3 lesion and the CIN3 coexisting with the glandular lesion. Methods. A sample of 414 women underwent LEEP for CIN3. The study sample consisted of 370 women with a CIN3 lesion alone and 44 women with a CIN3 lesion coexisting with AIS or adenocarcinoma. We studied the individual HR HPV genotypes and their frequency in the two groups under study. Furthermore, the therapeutic results and follow-ups for the population were studied on the entire study sample. Results. In patients with a single CIN3 lesion, 11 high-risk genotypes were detected; in patients with CIN3 associated with AIS or AC, only 4 different genotypes were detected (16, 18, 45, 33). Overall, the frequency of HPV 18 was significantly higher in CIN3 coexisting with AIS compared to solitary CIN3 lesions, χ2 = 27.73 (p < 0.001), while the frequency of other high-risk genotypes was significantly higher in patients with a single CIN3 than in patients with CIN3 coexisting with AIS. In our study population, mixed lesions (CIN3 coexisting with AIS), unlike their squamous counterparts (single CIN3 lesions), were characterized by skip lesions, which demonstrate more aggressive behavior and a higher rate of viral persistence and recurrence. Conclusion. A relatively high rate (10.7%) of AIS-AC was found in women treated for CIN3. Our study confirms the multifocal biological nature of the CIN3 lesion coexisting with AIS compared to the single CIN3 lesion. All this justifies the different treatments to which CIN3 lesions coexisting with AIS are addressed; in fact, the latter are treated with hysterectomy, while CIN3 is treated with conization alone. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the results of loop electrosurgical excisional procedures (LEEP) with colposcopic biopsy results of patients who presented to our hospital for vaginal smears. Material and Methods: The LEEP reports of patients who presented to our gynecology clinic between January 2015 and December 2020 were retrospectively evaluated. The data were obtained from electronic patient records and the department of medical pathology archives. Results: A total of 579 patients were evaluated with a mean age of 38.05±6.17 years. Colposcopy-guided biopsy was not taken from 102 patients. The results of the remaining 477 (82.4%) patients were: no dysplasia (n=12; 2.1%), Cervical intraepithelial neoplasia-I (CIN-I) (n=99; 17.1%), CINII (n=111; 19.2%), CIN-III (n=248; 42.8%), and cancer (n=7; 1.2%). Completed excision was performed in 87.0% of the patients using LEEP, the lesion was positive at the surgical margins in 10.9%, and the lesion could not be completely excised in 2.1%. The complication rate after LEEP was 3.1% including pelvic pain (n=5; 0.9%) and bleeding (n=13; 2%). The histopathologic results of LEEP were: benign (n=50; 8.6%), CIN-I (n=110; 19.0%), CIN-II (n=89; 15.4%), CIN-III (n=280; 48.4%), cancer (n=7; 1.2%), and metaplasia (n=37; 6.4%). The concordance between colposcopic biopsy and LEEP results was 85.9% for CIN-I, 71.2% for CIN-II, 98.4% for CIN-III, and 85.7% for cancer diagnoses. Conclusion: LEEP is a simple minimally invasive method used in the treatment of CIN, with low persistence, recurrence, and complication rates and increased human papillomavirus clearance in most patients. Our results support the consistency of cervical colposcopic biopsy and LEEP results. [ABSTRACT FROM AUTHOR]

Introduction: The routine use of heat-producing tools in the perioperative setting generates surgical smoke. Surgical smoke poses a known health hazard for perioperative staff working in the operating room. Objective: The objective of this best practice project was to promote evidence-based practices regarding surgical plume management in a pediatric operating room. Methods: This project was guided by the JBI Model of Evidence-Based Healthcare and used the JBI Practical Application of Clinical Evidence System and the Getting Research into Practice audit and feedback strategy to promote evidence-based practices regarding surgical smoke management in a pediatric operating room. Seven audit criteria representing best-practice recommendations were used. A baseline audit was conducted, followed by the implementation of multiple strategies developed by the key stakeholders. The project was finalized with a follow-up audit to determine any changes in compliance with best-practice recommendations. Results: Baseline audit data indicated an average of 41% compliance with best practices across all audit criteria, revealing the need for significant improvement in five of the seven criteria. Three barriers were identified and strategies were implemented, including the development and implementation of an educational module and a surgical smoke exposure risk assessment tool. Follow-up audits showed an overall improvement of 30% among five of the seven audit criteria. Conclusions: This project yielded improvements with best practices for surgical smoke management in the perioperative setting. However, additional work is required to ensure the sustainability of best practices in this setting. [ABSTRACT FROM AUTHOR]

Hemostasis is an important step in all surgical procedures. Mechanical methods of hemostasis have been gradually abandoned in favor of electrosurgery. The aim of this systematic review was to evaluate the effectiveness of electrosurgical instruments utilized in minimally invasive gynecological procedures. We performed a systematic review, including randomized controlled trials, prospective and retrospective studies, comparing the outcomes of different energy devices (EDs) used in laparoscopic gynecologic surgeries. We extracted data about blood loss (BL), mean operative time, post-operative pain, hospital stay and complications associated with each electrosurgical device. We included 30 studies reporting comparative outcomes concerning conventional (bipolar and monopolar) and innovative EDs (Harmonic scalpel, LigaSure, Plasma kinetic gyrus, Thunderbeat, EnSeal, Marseal, Caiman and ALAN). New EDs were found to be more efficient in complex surgeries due to less intraoperative BL and shorter operative time. No significant decrease in hospital stay, post-operative pain or complications was found with the use of new energy instruments. Although new electrosurgical devices seem an appealing and safer option, there is still insufficient evidence for one vessel-sealing technology to be considered superior to another. Therefore, monopolar and conventional bipolar (CB) are still widely used in laparoscopic gynecology. [ABSTRACT FROM AUTHOR]

Breast conserving resection with free margins is the gold standard treatment for early breast cancer recommended by guidelines worldwide. Therefore, reliable discrimination between normal and malignant tissue at the resection margins is essential. In this study, normal and abnormal tissue samples from breast cancer patients were characterized ex vivo by optical emission spectroscopy (OES) based on ionized atoms and molecules generated during electrosurgical treatment. The aim of the study was to determine spectroscopic features which are typical for healthy and neoplastic breast tissue allowing for future real-time tissue differentiation and margin assessment during breast cancer surgery. A total of 972 spectra generated by electrosurgical sparking on normal and abnormal tissue were used for support vector classifier (SVC) training. Specific spectroscopic features were selected for the classification of tissues in the included breast cancer patients. The average classification accuracy for all patients was 96.9%. Normal and abnormal breast tissue could be differentiated with a mean sensitivity of 94.8%, a specificity of 99.0%, a positive predictive value (PPV) of 99.1% and a negative predictive value (NPV) of 96.1%. For 66.6% patients all classifications reached 100%. Based on this convincing data, a future clinical application of OES-based tissue differentiation in breast cancer surgery seems to be feasible. [ABSTRACT FROM AUTHOR]

Transseptal puncture is necessary to access the left atrium and mitral valve from a transvenous approach but is poorly described in veterinary medicine. The procedure is generally regarded as difficult and dangerous, particularly given the size of most small animal patients. Precise imaging is paramount to the procedure to ensure that puncture occurs within the desired location and to monitor for potential complications. Transesophageal echocardiography, including biplanar two-dimensional and particularly three-dimensional modalities, has great potential to improve the success and safety of transseptal puncture due to superior visualization of the fossa ovalis and other intracardiac structures. Here, we describe the use of transesophageal echocardiography to guide transseptal puncture based on our experience in 159 dogs, with an emphasis on three-dimensional echocardiography. We also detail how to perform transseptal puncture from a jugular approach, which we consider preferable in most patients. Complications from transseptal puncture are discussed, along with ways to limit those complications. [ABSTRACT FROM AUTHOR]

Objective: Comprehensively assess the prevalence of monopolar electrosurgery‐related device complications among cochlear implant (CI) recipients. Study Design: Multifaceted retrospective review and survey. Setting: Tertiary medical center. Methods: Multifaceted approach including: (i) review of the current literature; (ii) historical review of institutional data from an academic, tertiary CI center; (iii) review of industry data provided by 3 Food and Drug Administration‐approved CI manufacturers; and (iv) survey of high‐volume CI centers. Results: Literature review identified 9 human studies, detailing 84 devices with 199 episodes of device‐cautery exposure. From studies reporting on patients records, no implant showed evidence of damage after exposure. One cadaveric study using dental cautery reported 1 episode of device damage. Review of institutional records did not identify any CI damage in 84 instances of exposure. Data from the 3 major implant manufacturers showed a single report of damage that could be reasonably linked to monopolar electrosurgery, out of a possible 689,426 CIs. Last, a survey of 8 high‐volume CI centers did not identify any adverse events associated with monopolar cautery. Conclusion: These data estimate the risk of adverse device‐related events or tissue injury to be extraordinarily low. Short of operating in immediate proximity to the CI (ie, the ipsilateral temporoparietal scalp), these data indicate that monopolar electrosurgery can be used in the body and the head‐and‐neck of CI recipients with nominal risk. These findings may guide decision‐making in cases that are optimally or preferably performed with monopolar electrocautery and can be used to counsel CI patients following inadvertent exposures. [ABSTRACT FROM AUTHOR]

Abstract Objective: To describe Top-hat results and their association with margin status and disease relapse in a referral facility in Brazil. Methods: A retrospective study of 440 women submitted to LEEP to treat HSIL, in which 80 cases were complemented immediately by the top hat procedure (Top-hat Group - TH). TH Group was compared to women not submitted to Top-hat (NTH). The sample by convenience included all women that underwent LEEP from January 2017 to July 2020. The main outcome was the histological result. Other variables were margins, age, transformation zone (TZ), depth, and relapse. The analysis used the Chi-square test and logistic regression. Results: The TH Group was predominantly 40 and older (NTH 23.1% vs. TH 65.0%, p

Novel dedicated devices allow transcatheter treatment of pure aortic regurgitation (AR). The JenaValve Trilogy Heart Valve System was introduced as the first dedicated and on-label AR transcatheter aortic valve replacement system, implementing a locator-based and calcium-independent anchoring mechanism. Here, we present the first-in-human transcatheter aortic valve replacement for pure AR via a transcaval access in a patient with prohibitive alternative arterial accesses.

The 20th century was a transformative era for neurosurgery, with significant advancements in neurotrauma treatment. Harvey Cushing, considered the father of modern neurosurgery, introduced innovative surgical techniques and monitoring methods that improved patient outcomes. The Glasgow Coma Scale, developed in 1974, revolutionized the evaluation of traumatic brain injury and became the international standard for assessing consciousness levels. The 20th century also saw progress in neurotrauma management due to political conflicts, such as the World Wars, leading to developments in surgical techniques, antibiotics, and intensive care units. The article concludes by highlighting the ongoing exploration of neurotrauma treatment, including spinal trauma, imaging techniques, robotics, and the impact of sports and societal progress. The history of neurotrauma demonstrates the resilience and creativity of humanity in overcoming challenges and advancing medical practices. [Extracted from the article]

Introduction: Mechanical force to achieve transseptal puncture (TSP) using a standard needle may lead to overshooting and injury, and can potentially be avoided using a radiofrequency (RF)‐powered needle or wire. Applying electrocautery to needles and guidewires as an alternative to purpose‐built RF systems has been associated with safety risks, such as tissue coring and thermal damage. The commercially available AcQCross needle‐dilator system (Medtronic) features a sharp open‐ended needle for mechanical puncture, as well as a built‐in connector to enable energy delivery for RF puncture. This investigation compares the safety and efficacy of the AcQCross needle to the dedicated VersaCross RF wire system and generator (Baylis Medical/Boston Scientific). Methods: In an ex vivo porcine model, VersaCross wire punctures were performed using 1 s, constant mode (approx. 10 W) with maximum two attempts. AcQCross punctures were performed by applying energy for 2 s using a standard electrosurgical generator at 10 W (max. five attempts), 20 W (max. two attempts), and 30 W (max. two attempts). Efficacy was assessed in terms of puncture success and a number of energy applications required for TSP. Safety was assessed quantitatively as force required for TSP, energy required to puncture, and incidence of tissue coring, as well as by qualitative assessment of puncture sites. Additional qualitative observation of tissue cores and debris were obtained from TSP performed in live swine. Results: RF TSP was 100% successful using the VersaCross wire with 1.0 ± 0.0 attempts. When power was used with the AcQCross needle, it failed to puncture at low (10 and 20 W) power settings; TSP was achieved with 30 W of energy with 91% success using 1.53 ± 0.51 attempts (p <.05 vs. VC) with greater variability (F1,33 = 9223.5, p <.0001). Compared to RF puncture using the VersaCross system, mechanical puncture, alone, using the AcQcross needle required six times more force (8 mm additional forward device displacement) to perforate the septum. Qualitative assessment of puncture sites revealed larger defects and more tissue charring with the AcQCross needle at 30 W compared to punctures with VersaCross wire. Tissue coring with the open‐ended AcQCross needle was observed in vivo and measured to occur in 57% of punctures using the ex vivo model; no coring was observed with the closed‐tip VersaCross wire. Conclusions: The AcQCross needle frequently required higher energy of 30 W to achieve RF TSP and was associated with tissue coring and charring, which have been, previously, reported when electrifying a standard open‐ended mechanical needle or guidewire. These findings may limit safety and effectiveness compared to the VersaCross system. [ABSTRACT FROM AUTHOR]

Objective • To analyze the association between persistent human papillomavirus (HPV) infection and vaginal microecological imbalance after surgical treatment of cervical high-grade squamous intraepithelial lesion (HSIL). Methods • This is a retrospective study, 180 cervical HSIL patients admitted to our hospital from May 2019 to May 2021 were selected, of these, 84 were treated with loop electrosurgical excision procedure (LEEP) and 96 with cold knife conization (CKC). Patients were followed up for HPV infection 1 year after surgery. There is a division into a persistent infection group (positive group) and a negative group based on the presence or absence of HPV, the detection technique was PCR amplification. The two groups were compared regarding preoperative HPV infection, vaginal micro-ecological indicators 1 year after surgery, and the correlation between persistent HPV infection and vaginal microecological imbalance. Results • At 1 year after surgery, among 180 cervical HSIL patients, 64 (35.56%) were persistently infected with HPV, with an age of (40.20 ± 4.85) years, including 36 (56.25%) with cervical intraepithelial neoplasia (CIN) grade II, 28 (43.75%) with cervical intraepithelial neoplasia (CIN) grade III, 116 (64.44%) with HPV negative, with an age of (40.22 ± 5.15) years, including 67 (57.76%) with CIN grade II and 49 (42.24%) with CIN grade III, the differences in age and CIN classification between the two groups were not statistically significant (P > .05). Preoperatively, 53 people (82.81%) with HPV viral load >100 RLU/CO in the HPV persistent infection group and 76 people (65.52%) with HPV viral load >100 RLU/CO in the HPV negative group, with statistically significant differences between the two groups (P < .05); The difference in HPV virus typing and HPV infection type between the two groups was not statistically significant (P > .05). At 1 year after surgery, the composition ratio of flora density class IV and flora diversity class IV were significantly higher in the HPV persistent infection group than in the HPV negative group, and the dominant bacteria were mainly gram-positive large bacillus, accounting for 83.33%, the difference between the two groups was statistically significant (P < .05); The differences in Nugent scores and pH values between the two groups were not statistically significant (P > .05). Logistic regression analysis showed that flora density, flora diversity, and dominant bacteria were all independent risk factors for persistent HPV infection after treatment in patients with HSIL (P < .05). Conclusion • After treatment of HSIL patients, clinical attention should be paid to monitoring of HPV infection but also to the changes in vaginal microecology, as timely correction of vaginal microecology can facilitate HPV regression and improve the patient’s prognosis. [ABSTRACT FROM AUTHOR]

Context: Melanin pigmentation of the gingiva exists in all ethnicities and genders. Demand for repigmentation is mainly for esthetic reasons. Gingival depigmentation is a mucogingival surgical procedure where depigmentation is done by various techniques. However, the selection of a method depends on the clinical experiences and individual preferences. Aim: The aim of the study is to compare the pain score using the Visual Analog Scale (VAS) and the recurrence rate of gingival pigmentation, using the three different techniques, i.e., scalpel, laser, and electrosurgery. Settings and Design: This randomized control trial was conducted on 30 systemically healthy patients divided into two groups. Materials and Methods: A split-mouth design was adopted and pigmentation was removed using scalpel and laser in Group I and scalpel and electrocautery in Group II. Dummett Oral Pigmentation Index scale and VAS were used to appraise the potency of hyperpigmentation and pain of the patient, respectively. Statistical Analysis Used: Independent t-test was used for the comparisons. P < 0.05 was considered statistically significant. Results: The pain intensity was up high in patients treated with scalpel compared to laser and electrocautery, which was statistically highly significant. Conclusion: The findings suggest that laser depigmentation still serves to be the best modality considering the bloodless field and reduced postoperative pain. [ABSTRACT FROM AUTHOR]

Congenital melanocytic nevi (CMN) carry an increased risk of melanoma and may be disfiguring, and consensus regarding treatment recommendations is lacking. While clinical monitoring is the standard of care, many caregivers are interested in its removal to prevent psychosocial burden or to decrease risk. Although melanoma can occur regardless of CMN removal, there are a variety of treatments that may offer improved cosmesis or local symptom control, including surgical excision, laser therapy, and other superficially destructive techniques. Regardless of the selected management, these patients are monitored for ongoing melanoma risk. An extensive discussion with families regarding the risks and benefits of observation versus active intervention is essential. To facilitate these discussions, we herein summarize current CMN management strategies and considerations. [ABSTRACT FROM AUTHOR]

Gingival retraction is commonly employed in dentistry. There are several methods that may be used, which fall into mechanical, chemo-mechanical and surgical techniques. The application of these methods depends on the clinical activity the clinician is performing, and there are advantages and disadvantages to each method. This review reflects on the current literature available on gingival retraction methods to provide clinicians with guidance on which methods to consider when undertaking the three most common clinical scenarios: master impression taking; cementation of indirect restorations whether tooth or implant retained; and for direct adhesive dentistry. CPD/Clinical Relevance: Selecting an appropriate gingival retraction method, for example for master impression taking, cementation of restorations and in adhesive dentistry is of value. [ABSTRACT FROM AUTHOR]