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Daniel G Deschler - One of the best experts on this subject based on the ideXlab platform.

  • A comparison of histopathologic margin assessment after steel scalpel, monopolar Electrosurgery, and ultrasonic scalpel glossectomy in a rat model.
    Laryngoscope, 2011
    Co-Authors: Kiran Kakarala, William C Faquin, Daniel G Deschler
    Abstract:

    EDUCATIONAL OBJECTIVE At the conclusion of this presentation, the participants should be able to describe the tissue effects of steel scalpel, monopolar Electrosurgery, and ultrasonic scalpel glossectomy with respect to histopathologic margin assessment in a rat model. OBJECTIVES Histopathologic margin assessment is important in guiding treatment and determining prognosis for squamous cell cancer of the oral tongue. Energy based devices for glossectomy produce varying degrees of tissue distortion and artifact that can influence margin assessment. The purpose of this study is to compare the tissue effects of three surgical methods of glossectomy with respect to margin assessment by a pathologist. STUDY DESIGN Blinded histopathologic study of three surgical techniques for glossectomy using a rat model. METHODS The anterior tongue of thirty Sprague-Dawley rats was excised using either steel scalpel, monopolar Electrosurgery, or ultrasonic scalpel (three groups of ten). Specimens were fixed in formalin and serially sectioned, and hematoxylin and eosin stains were examined by a pathologist blinded to the surgical procedure. Comparison between surgical techniques with respect to effect on the tissue margin was carried out using a previously described grading system for margin assessment. RESULTS Minimal tissue disruption at the surgical margin was produced by the steel scalpel, in contrast to monopolar Electrosurgery and harmonic scalpel, which both produced varying levels of tissue distortion. Margin fragmentation, cautery artifact, and artifact depth was greater with monopolar Electrosurgery when compared to harmonic scalpel. CONCLUSIONS Energy based devices cause tissue distortion which may in theory effect the ability to accurately assess surgical margins for tumor involvement on histopathology. In our rat model of glossectomy, the harmonic scalpel created less tissue distortion at the surgical margin than monopolar Electrosurgery. Further study is required to determine the clinical relevance of these findings.

  • A comparison of histopathologic margin assessment after steel scalpel, monopolar Electrosurgery, and ultrasonic scalpel glossectomy in a rat model.
    The Laryngoscope, 2010
    Co-Authors: Kiran Kakarala, William C Faquin, Daniel G Deschler
    Abstract:

    At the conclusion of this presentation, the participants should be able to describe the tissue effects of steel scalpel, monopolar Electrosurgery, and ultrasonic scalpel glossectomy with respect to histopathologic margin assessment in a rat model. Histopathologic margin assessment is important in guiding treatment and determining prognosis for squamous cell cancer of the oral tongue. Energy based devices for glossectomy produce varying degrees of tissue distortion and artifact that can influence margin assessment. The purpose of this study is to compare the tissue effects of three surgical methods of glossectomy with respect to margin assessment by a pathologist. Blinded histopathologic study of three surgical techniques for glossectomy using a rat model. The anterior tongue of thirty Sprague-Dawley rats was excised using either steel scalpel, monopolar Electrosurgery, or ultrasonic scalpel (three groups of ten). Specimens were fixed in formalin and serially sectioned, and hematoxylin and eosin stains were examined by a pathologist blinded to the surgical procedure. Comparison between surgical techniques with respect to effect on the tissue margin was carried out using a previously described grading system for margin assessment. Minimal tissue disruption at the surgical margin was produced by the steel scalpel, in contrast to monopolar Electrosurgery and harmonic scalpel, which both produced varying levels of tissue distortion. Margin fragmentation, cautery artifact, and artifact depth was greater with monopolar Electrosurgery when compared to harmonic scalpel. Energy based devices cause tissue distortion which may in theory effect the ability to accurately assess surgical margins for tumor involvement on histopathology. In our rat model of glossectomy, the harmonic scalpel created less tissue distortion at the surgical margin than monopolar Electrosurgery. Further study is required to determine the clinical relevance of these findings.

Kiran Kakarala - One of the best experts on this subject based on the ideXlab platform.

  • A comparison of histopathologic margin assessment after steel scalpel, monopolar Electrosurgery, and ultrasonic scalpel glossectomy in a rat model.
    Laryngoscope, 2011
    Co-Authors: Kiran Kakarala, William C Faquin, Daniel G Deschler
    Abstract:

    EDUCATIONAL OBJECTIVE At the conclusion of this presentation, the participants should be able to describe the tissue effects of steel scalpel, monopolar Electrosurgery, and ultrasonic scalpel glossectomy with respect to histopathologic margin assessment in a rat model. OBJECTIVES Histopathologic margin assessment is important in guiding treatment and determining prognosis for squamous cell cancer of the oral tongue. Energy based devices for glossectomy produce varying degrees of tissue distortion and artifact that can influence margin assessment. The purpose of this study is to compare the tissue effects of three surgical methods of glossectomy with respect to margin assessment by a pathologist. STUDY DESIGN Blinded histopathologic study of three surgical techniques for glossectomy using a rat model. METHODS The anterior tongue of thirty Sprague-Dawley rats was excised using either steel scalpel, monopolar Electrosurgery, or ultrasonic scalpel (three groups of ten). Specimens were fixed in formalin and serially sectioned, and hematoxylin and eosin stains were examined by a pathologist blinded to the surgical procedure. Comparison between surgical techniques with respect to effect on the tissue margin was carried out using a previously described grading system for margin assessment. RESULTS Minimal tissue disruption at the surgical margin was produced by the steel scalpel, in contrast to monopolar Electrosurgery and harmonic scalpel, which both produced varying levels of tissue distortion. Margin fragmentation, cautery artifact, and artifact depth was greater with monopolar Electrosurgery when compared to harmonic scalpel. CONCLUSIONS Energy based devices cause tissue distortion which may in theory effect the ability to accurately assess surgical margins for tumor involvement on histopathology. In our rat model of glossectomy, the harmonic scalpel created less tissue distortion at the surgical margin than monopolar Electrosurgery. Further study is required to determine the clinical relevance of these findings.

  • A comparison of histopathologic margin assessment after steel scalpel, monopolar Electrosurgery, and ultrasonic scalpel glossectomy in a rat model.
    The Laryngoscope, 2010
    Co-Authors: Kiran Kakarala, William C Faquin, Daniel G Deschler
    Abstract:

    At the conclusion of this presentation, the participants should be able to describe the tissue effects of steel scalpel, monopolar Electrosurgery, and ultrasonic scalpel glossectomy with respect to histopathologic margin assessment in a rat model. Histopathologic margin assessment is important in guiding treatment and determining prognosis for squamous cell cancer of the oral tongue. Energy based devices for glossectomy produce varying degrees of tissue distortion and artifact that can influence margin assessment. The purpose of this study is to compare the tissue effects of three surgical methods of glossectomy with respect to margin assessment by a pathologist. Blinded histopathologic study of three surgical techniques for glossectomy using a rat model. The anterior tongue of thirty Sprague-Dawley rats was excised using either steel scalpel, monopolar Electrosurgery, or ultrasonic scalpel (three groups of ten). Specimens were fixed in formalin and serially sectioned, and hematoxylin and eosin stains were examined by a pathologist blinded to the surgical procedure. Comparison between surgical techniques with respect to effect on the tissue margin was carried out using a previously described grading system for margin assessment. Minimal tissue disruption at the surgical margin was produced by the steel scalpel, in contrast to monopolar Electrosurgery and harmonic scalpel, which both produced varying levels of tissue distortion. Margin fragmentation, cautery artifact, and artifact depth was greater with monopolar Electrosurgery when compared to harmonic scalpel. Energy based devices cause tissue distortion which may in theory effect the ability to accurately assess surgical margins for tumor involvement on histopathology. In our rat model of glossectomy, the harmonic scalpel created less tissue distortion at the surgical margin than monopolar Electrosurgery. Further study is required to determine the clinical relevance of these findings.

William C Faquin - One of the best experts on this subject based on the ideXlab platform.

  • A comparison of histopathologic margin assessment after steel scalpel, monopolar Electrosurgery, and ultrasonic scalpel glossectomy in a rat model.
    Laryngoscope, 2011
    Co-Authors: Kiran Kakarala, William C Faquin, Daniel G Deschler
    Abstract:

    EDUCATIONAL OBJECTIVE At the conclusion of this presentation, the participants should be able to describe the tissue effects of steel scalpel, monopolar Electrosurgery, and ultrasonic scalpel glossectomy with respect to histopathologic margin assessment in a rat model. OBJECTIVES Histopathologic margin assessment is important in guiding treatment and determining prognosis for squamous cell cancer of the oral tongue. Energy based devices for glossectomy produce varying degrees of tissue distortion and artifact that can influence margin assessment. The purpose of this study is to compare the tissue effects of three surgical methods of glossectomy with respect to margin assessment by a pathologist. STUDY DESIGN Blinded histopathologic study of three surgical techniques for glossectomy using a rat model. METHODS The anterior tongue of thirty Sprague-Dawley rats was excised using either steel scalpel, monopolar Electrosurgery, or ultrasonic scalpel (three groups of ten). Specimens were fixed in formalin and serially sectioned, and hematoxylin and eosin stains were examined by a pathologist blinded to the surgical procedure. Comparison between surgical techniques with respect to effect on the tissue margin was carried out using a previously described grading system for margin assessment. RESULTS Minimal tissue disruption at the surgical margin was produced by the steel scalpel, in contrast to monopolar Electrosurgery and harmonic scalpel, which both produced varying levels of tissue distortion. Margin fragmentation, cautery artifact, and artifact depth was greater with monopolar Electrosurgery when compared to harmonic scalpel. CONCLUSIONS Energy based devices cause tissue distortion which may in theory effect the ability to accurately assess surgical margins for tumor involvement on histopathology. In our rat model of glossectomy, the harmonic scalpel created less tissue distortion at the surgical margin than monopolar Electrosurgery. Further study is required to determine the clinical relevance of these findings.

  • A comparison of histopathologic margin assessment after steel scalpel, monopolar Electrosurgery, and ultrasonic scalpel glossectomy in a rat model.
    The Laryngoscope, 2010
    Co-Authors: Kiran Kakarala, William C Faquin, Daniel G Deschler
    Abstract:

    At the conclusion of this presentation, the participants should be able to describe the tissue effects of steel scalpel, monopolar Electrosurgery, and ultrasonic scalpel glossectomy with respect to histopathologic margin assessment in a rat model. Histopathologic margin assessment is important in guiding treatment and determining prognosis for squamous cell cancer of the oral tongue. Energy based devices for glossectomy produce varying degrees of tissue distortion and artifact that can influence margin assessment. The purpose of this study is to compare the tissue effects of three surgical methods of glossectomy with respect to margin assessment by a pathologist. Blinded histopathologic study of three surgical techniques for glossectomy using a rat model. The anterior tongue of thirty Sprague-Dawley rats was excised using either steel scalpel, monopolar Electrosurgery, or ultrasonic scalpel (three groups of ten). Specimens were fixed in formalin and serially sectioned, and hematoxylin and eosin stains were examined by a pathologist blinded to the surgical procedure. Comparison between surgical techniques with respect to effect on the tissue margin was carried out using a previously described grading system for margin assessment. Minimal tissue disruption at the surgical margin was produced by the steel scalpel, in contrast to monopolar Electrosurgery and harmonic scalpel, which both produced varying levels of tissue distortion. Margin fragmentation, cautery artifact, and artifact depth was greater with monopolar Electrosurgery when compared to harmonic scalpel. Energy based devices cause tissue distortion which may in theory effect the ability to accurately assess surgical margins for tumor involvement on histopathology. In our rat model of glossectomy, the harmonic scalpel created less tissue distortion at the surgical margin than monopolar Electrosurgery. Further study is required to determine the clinical relevance of these findings.

Kittipat Charoenkwan - One of the best experts on this subject based on the ideXlab platform.

  • The Cochrane Library - Scalpel versus Electrosurgery for major abdominal incisions
    The Cochrane database of systematic reviews, 2017
    Co-Authors: Kittipat Charoenkwan, Kittipan Rerkasem, Zipporah Iheozor-ejiofor, Elizabeth Matovinovic
    Abstract:

    Background Scalpels or Electrosurgery can be used to make abdominal incisions. The potential benefits of Electrosurgery may include reduced blood loss, dry and rapid separation of tissue, and reduced risk of cutting injury to surgeons. Postsurgery risks possibly associated with Electrosurgery may include poor wound healing and complications such as surgical site infection. Objectives To assess the effects of Electrosurgery compared with scalpel for major abdominal incisions. Search methods The first version of this review included studies published up to February 2012. In October 2016, for this first update, we searched the Cochrane Wounds Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE (including In-Process & Other Non-Indexed Citations), Ovid Embase, EBSCO CINAHL Plus, and the registry for ongoing trials (www.clinicaltrials.gov). We did not apply date or language restrictions. Selection criteria Studies considered in this analysis were randomised controlled trials (RCTs) that compared Electrosurgery to scalpel for creating abdominal incisions during major open abdominal surgery. Incisions could be any orientation (vertical, oblique, or transverse) and surgical setting (elective or emergency). Electrosurgical incisions were made through major layers of the abdominal wall, including subcutaneous tissue and the musculoaponeurosis (a sheet of connective tissue that attaches muscles), regardless of the technique used to incise the skin and peritoneum. Scalpel incisions were made through major layers of abdominal wall including skin, subcutaneous tissue, and musculoaponeurosis, regardless of the technique used to incise the abdominal peritoneum. Primary outcomes analysed were wound infection, time to wound healing, and wound dehiscence. Secondary outcomes were postoperative pain, wound incision time, wound-related blood loss, and adhesion or scar formation. Data collection and analysis Two review authors independently carried out study selection, data extraction, and risk of bias assessment. When necessary, we contacted trial authors for missing data. We calculated risk ratios (RR) and 95% confidence intervals (CI) for dichotomous data, and mean differences (MD) and 95% CI for continuous data. Main results The updated search found seven additional RCTs making a total of 16 included studies (2769 participants). All studies compared Electrosurgery to scalpel and were considered in one comparison. Eleven studies, analysing 2178 participants, reported on wound infection. There was no clear difference in wound infections between Electrosurgery and scalpel (7.7% for Electrosurgery versus 7.4% for scalpel; RR 1.07, 95% CI 0.74 to 1.54; low-certainty evidence downgraded for risk of bias and serious imprecision). None of the included studies reported time to wound healing. It is uncertain whether Electrosurgery decreases wound dehiscence compared to scalpel (2.7% for Electrosurgery versus 2.4% for scalpel; RR 1.21, 95% CI 0.58 to 2.50; 1064 participants; 6 studies; very low-certainty evidence downgraded for risk of bias and very serious imprecision). There was no clinically important difference in incision time between Electrosurgery and scalpel (MD -45.74 seconds, 95% CI -88.41 to -3.07; 325 participants; 4 studies; moderate-certainty evidence downgraded for serious imprecision). There was no clear difference in incision time per wound area between Electrosurgery and scalpel (MD -0.58 seconds/cm2, 95% CI -1.26 to 0.09; 282 participants; 3 studies; low-certainty evidence downgraded for very serious imprecision). There was no clinically important difference in mean blood loss between Electrosurgery and scalpel (MD -20.10 mL, 95% CI -28.16 to -12.05; 241 participants; 3 studies; moderate-certainty evidence downgraded for serious imprecision). Two studies reported on mean wound-related blood loss per wound area; however, we were unable to pool the studies due to considerable heterogeneity. It was uncertain whether Electrosurgery decreased wound-related blood loss per wound area. We could not reach a conclusion on the effects of the two interventions on pain and appearance of scars for various reasons such as small number of studies, insufficient data, the presence of conflicting data, and different measurement methods. Authors' conclusions The certainty of evidence was moderate to very low due to risk of bias and imprecise results. Low-certainty evidence shows no clear difference in wound infection between the scalpel and Electrosurgery. There is a need for more research to determine the relative effectiveness of scalpel compared with Electrosurgery for major abdominal incisions.

  • scalpel versus Electrosurgery for major abdominal incisions
    Cochrane Database of Systematic Reviews, 2017
    Co-Authors: Kittipat Charoenkwan, Kittipan Rerkasem, Zipporah Iheozorejiofor, Elizabeth Matovinovic
    Abstract:

    Background Scalpels or Electrosurgery can be used to make abdominal incisions. The potential benefits of Electrosurgery may include reduced blood loss, dry and rapid separation of tissue, and reduced risk of cutting injury to surgeons. Postsurgery risks possibly associated with Electrosurgery may include poor wound healing and complications such as surgical site infection. Objectives To assess the effects of Electrosurgery compared with scalpel for major abdominal incisions. Search methods The first version of this review included studies published up to February 2012. In October 2016, for this first update, we searched the Cochrane Wounds Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE (including In-Process & Other Non-Indexed Citations), Ovid Embase, EBSCO CINAHL Plus, and the registry for ongoing trials (www.clinicaltrials.gov). We did not apply date or language restrictions. Selection criteria Studies considered in this analysis were randomised controlled trials (RCTs) that compared Electrosurgery to scalpel for creating abdominal incisions during major open abdominal surgery. Incisions could be any orientation (vertical, oblique, or transverse) and surgical setting (elective or emergency). Electrosurgical incisions were made through major layers of the abdominal wall, including subcutaneous tissue and the musculoaponeurosis (a sheet of connective tissue that attaches muscles), regardless of the technique used to incise the skin and peritoneum. Scalpel incisions were made through major layers of abdominal wall including skin, subcutaneous tissue, and musculoaponeurosis, regardless of the technique used to incise the abdominal peritoneum. Primary outcomes analysed were wound infection, time to wound healing, and wound dehiscence. Secondary outcomes were postoperative pain, wound incision time, wound-related blood loss, and adhesion or scar formation. Data collection and analysis Two review authors independently carried out study selection, data extraction, and risk of bias assessment. When necessary, we contacted trial authors for missing data. We calculated risk ratios (RR) and 95% confidence intervals (CI) for dichotomous data, and mean differences (MD) and 95% CI for continuous data. Main results The updated search found seven additional RCTs making a total of 16 included studies (2769 participants). All studies compared Electrosurgery to scalpel and were considered in one comparison. Eleven studies, analysing 2178 participants, reported on wound infection. There was no clear difference in wound infections between Electrosurgery and scalpel (7.7% for Electrosurgery versus 7.4% for scalpel; RR 1.07, 95% CI 0.74 to 1.54; low-certainty evidence downgraded for risk of bias and serious imprecision). None of the included studies reported time to wound healing. It is uncertain whether Electrosurgery decreases wound dehiscence compared to scalpel (2.7% for Electrosurgery versus 2.4% for scalpel; RR 1.21, 95% CI 0.58 to 2.50; 1064 participants; 6 studies; very low-certainty evidence downgraded for risk of bias and very serious imprecision). There was no clinically important difference in incision time between Electrosurgery and scalpel (MD -45.74 seconds, 95% CI -88.41 to -3.07; 325 participants; 4 studies; moderate-certainty evidence downgraded for serious imprecision). There was no clear difference in incision time per wound area between Electrosurgery and scalpel (MD -0.58 seconds/cm2, 95% CI -1.26 to 0.09; 282 participants; 3 studies; low-certainty evidence downgraded for very serious imprecision). There was no clinically important difference in mean blood loss between Electrosurgery and scalpel (MD -20.10 mL, 95% CI -28.16 to -12.05; 241 participants; 3 studies; moderate-certainty evidence downgraded for serious imprecision). Two studies reported on mean wound-related blood loss per wound area; however, we were unable to pool the studies due to considerable heterogeneity. It was uncertain whether Electrosurgery decreased wound-related blood loss per wound area. We could not reach a conclusion on the effects of the two interventions on pain and appearance of scars for various reasons such as small number of studies, insufficient data, the presence of conflicting data, and different measurement methods. Authors' conclusions The certainty of evidence was moderate to very low due to risk of bias and imprecise results. Low-certainty evidence shows no clear difference in wound infection between the scalpel and Electrosurgery. There is a need for more research to determine the relative effectiveness of scalpel compared with Electrosurgery for major abdominal incisions.

  • scalpel versus Electrosurgery for abdominal incisions
    Cochrane Database of Systematic Reviews, 2012
    Co-Authors: Kittipat Charoenkwan, Narain Chotirosniramit, Kittipan Rerkasem
    Abstract:

    Background Scalpels or Electrosurgery can be used to make abdominal incisions. The potential benefits of Electrosurgery include reduced blood loss, dry and rapid separation of tissue, and reduced risk of cutting injury to surgeons, though there are concerns about poor wound healing, excessive scarring, and adhesion formation. Objectives To compare the effects on wound complications of scalpel and Electrosurgery for making abdominal incisions. Search methods We searched the Cochrane Wounds Group Specialised Register (searched 24 February 2012); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 2); Ovid MEDLINE (1950 to February Week 3 2012); Ovid MEDLINE (In-Process & Other Non-Indexed Citations 23 February 2012); Ovid EMBASE (1980 to 2012 Week 07); and EBSCO CINAHL (1982 to 17 February 2012). We did not apply date or language restrictions. Selection criteria Randomised controlled trials (RCTs) comparing the effects on wound complications of Electrosurgery with scalpel use for the creation of abdominal incisions. The study participants were patients undergoing major open abdominal surgery, regardless of the orientation of the incision (vertical, oblique, or transverse) and surgical setting (elective or emergency). Electrosurgical incisions included those in which the major layers of abdominal wall, including subcutaneous tissue and musculoaponeurosis (a strong sheet of fibrous connective tissue that serves as a tendon to attach muscles), were made by Electrosurgery, regardless of the techniques used to incise the abdominal skin and peritoneum. Scalpel incisions included those in which all major layers of abdominal wall including skin, subcutaneous tissue, and musculoaponeurosis, were incised by a scalpel, regardless of the techniques used on the abdominal peritoneum. Data collection and analysis We independently assessed studies for inclusion and risk of bias. One review author extracted data which were checked by a second review author. We calculated risk ratio (RR) and 95% confidence intervals (CI) for dichotomous data, and difference in means (MD) and 95% CI for continuous data. We examined heterogeneity between studies. Main results We included nine RCTs (1901 participants) which were mainly at unclear risk of bias due to poor reporting. There was no statistically significant difference in overall wound complication rates (RR 0.90, 95% CI 0.68 to 1.18), nor in rates of wound dehiscence (RR 1.04, 95% CI 0.36 to 2.98), however both these comparisons are underpowered and a treatment effect cannot be excluded. There is insufficient reliable evidence regarding the effects of Electrosurgery compared with scalpel incisions on blood loss, pain, and incision time. Authors' conclusions Current evidence suggests that making an abdominal incision with Electrosurgery may be as safe as using a scalpel. However, these conclusions are based on relatively few events and more research is needed. The relative effects of scalpels and Electrosurgery are unclear for the outcomes of blood loss, pain, and incision time.

Kittipan Rerkasem - One of the best experts on this subject based on the ideXlab platform.

  • The Cochrane Library - Scalpel versus Electrosurgery for major abdominal incisions
    The Cochrane database of systematic reviews, 2017
    Co-Authors: Kittipat Charoenkwan, Kittipan Rerkasem, Zipporah Iheozor-ejiofor, Elizabeth Matovinovic
    Abstract:

    Background Scalpels or Electrosurgery can be used to make abdominal incisions. The potential benefits of Electrosurgery may include reduced blood loss, dry and rapid separation of tissue, and reduced risk of cutting injury to surgeons. Postsurgery risks possibly associated with Electrosurgery may include poor wound healing and complications such as surgical site infection. Objectives To assess the effects of Electrosurgery compared with scalpel for major abdominal incisions. Search methods The first version of this review included studies published up to February 2012. In October 2016, for this first update, we searched the Cochrane Wounds Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE (including In-Process & Other Non-Indexed Citations), Ovid Embase, EBSCO CINAHL Plus, and the registry for ongoing trials (www.clinicaltrials.gov). We did not apply date or language restrictions. Selection criteria Studies considered in this analysis were randomised controlled trials (RCTs) that compared Electrosurgery to scalpel for creating abdominal incisions during major open abdominal surgery. Incisions could be any orientation (vertical, oblique, or transverse) and surgical setting (elective or emergency). Electrosurgical incisions were made through major layers of the abdominal wall, including subcutaneous tissue and the musculoaponeurosis (a sheet of connective tissue that attaches muscles), regardless of the technique used to incise the skin and peritoneum. Scalpel incisions were made through major layers of abdominal wall including skin, subcutaneous tissue, and musculoaponeurosis, regardless of the technique used to incise the abdominal peritoneum. Primary outcomes analysed were wound infection, time to wound healing, and wound dehiscence. Secondary outcomes were postoperative pain, wound incision time, wound-related blood loss, and adhesion or scar formation. Data collection and analysis Two review authors independently carried out study selection, data extraction, and risk of bias assessment. When necessary, we contacted trial authors for missing data. We calculated risk ratios (RR) and 95% confidence intervals (CI) for dichotomous data, and mean differences (MD) and 95% CI for continuous data. Main results The updated search found seven additional RCTs making a total of 16 included studies (2769 participants). All studies compared Electrosurgery to scalpel and were considered in one comparison. Eleven studies, analysing 2178 participants, reported on wound infection. There was no clear difference in wound infections between Electrosurgery and scalpel (7.7% for Electrosurgery versus 7.4% for scalpel; RR 1.07, 95% CI 0.74 to 1.54; low-certainty evidence downgraded for risk of bias and serious imprecision). None of the included studies reported time to wound healing. It is uncertain whether Electrosurgery decreases wound dehiscence compared to scalpel (2.7% for Electrosurgery versus 2.4% for scalpel; RR 1.21, 95% CI 0.58 to 2.50; 1064 participants; 6 studies; very low-certainty evidence downgraded for risk of bias and very serious imprecision). There was no clinically important difference in incision time between Electrosurgery and scalpel (MD -45.74 seconds, 95% CI -88.41 to -3.07; 325 participants; 4 studies; moderate-certainty evidence downgraded for serious imprecision). There was no clear difference in incision time per wound area between Electrosurgery and scalpel (MD -0.58 seconds/cm2, 95% CI -1.26 to 0.09; 282 participants; 3 studies; low-certainty evidence downgraded for very serious imprecision). There was no clinically important difference in mean blood loss between Electrosurgery and scalpel (MD -20.10 mL, 95% CI -28.16 to -12.05; 241 participants; 3 studies; moderate-certainty evidence downgraded for serious imprecision). Two studies reported on mean wound-related blood loss per wound area; however, we were unable to pool the studies due to considerable heterogeneity. It was uncertain whether Electrosurgery decreased wound-related blood loss per wound area. We could not reach a conclusion on the effects of the two interventions on pain and appearance of scars for various reasons such as small number of studies, insufficient data, the presence of conflicting data, and different measurement methods. Authors' conclusions The certainty of evidence was moderate to very low due to risk of bias and imprecise results. Low-certainty evidence shows no clear difference in wound infection between the scalpel and Electrosurgery. There is a need for more research to determine the relative effectiveness of scalpel compared with Electrosurgery for major abdominal incisions.

  • scalpel versus Electrosurgery for major abdominal incisions
    Cochrane Database of Systematic Reviews, 2017
    Co-Authors: Kittipat Charoenkwan, Kittipan Rerkasem, Zipporah Iheozorejiofor, Elizabeth Matovinovic
    Abstract:

    Background Scalpels or Electrosurgery can be used to make abdominal incisions. The potential benefits of Electrosurgery may include reduced blood loss, dry and rapid separation of tissue, and reduced risk of cutting injury to surgeons. Postsurgery risks possibly associated with Electrosurgery may include poor wound healing and complications such as surgical site infection. Objectives To assess the effects of Electrosurgery compared with scalpel for major abdominal incisions. Search methods The first version of this review included studies published up to February 2012. In October 2016, for this first update, we searched the Cochrane Wounds Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE (including In-Process & Other Non-Indexed Citations), Ovid Embase, EBSCO CINAHL Plus, and the registry for ongoing trials (www.clinicaltrials.gov). We did not apply date or language restrictions. Selection criteria Studies considered in this analysis were randomised controlled trials (RCTs) that compared Electrosurgery to scalpel for creating abdominal incisions during major open abdominal surgery. Incisions could be any orientation (vertical, oblique, or transverse) and surgical setting (elective or emergency). Electrosurgical incisions were made through major layers of the abdominal wall, including subcutaneous tissue and the musculoaponeurosis (a sheet of connective tissue that attaches muscles), regardless of the technique used to incise the skin and peritoneum. Scalpel incisions were made through major layers of abdominal wall including skin, subcutaneous tissue, and musculoaponeurosis, regardless of the technique used to incise the abdominal peritoneum. Primary outcomes analysed were wound infection, time to wound healing, and wound dehiscence. Secondary outcomes were postoperative pain, wound incision time, wound-related blood loss, and adhesion or scar formation. Data collection and analysis Two review authors independently carried out study selection, data extraction, and risk of bias assessment. When necessary, we contacted trial authors for missing data. We calculated risk ratios (RR) and 95% confidence intervals (CI) for dichotomous data, and mean differences (MD) and 95% CI for continuous data. Main results The updated search found seven additional RCTs making a total of 16 included studies (2769 participants). All studies compared Electrosurgery to scalpel and were considered in one comparison. Eleven studies, analysing 2178 participants, reported on wound infection. There was no clear difference in wound infections between Electrosurgery and scalpel (7.7% for Electrosurgery versus 7.4% for scalpel; RR 1.07, 95% CI 0.74 to 1.54; low-certainty evidence downgraded for risk of bias and serious imprecision). None of the included studies reported time to wound healing. It is uncertain whether Electrosurgery decreases wound dehiscence compared to scalpel (2.7% for Electrosurgery versus 2.4% for scalpel; RR 1.21, 95% CI 0.58 to 2.50; 1064 participants; 6 studies; very low-certainty evidence downgraded for risk of bias and very serious imprecision). There was no clinically important difference in incision time between Electrosurgery and scalpel (MD -45.74 seconds, 95% CI -88.41 to -3.07; 325 participants; 4 studies; moderate-certainty evidence downgraded for serious imprecision). There was no clear difference in incision time per wound area between Electrosurgery and scalpel (MD -0.58 seconds/cm2, 95% CI -1.26 to 0.09; 282 participants; 3 studies; low-certainty evidence downgraded for very serious imprecision). There was no clinically important difference in mean blood loss between Electrosurgery and scalpel (MD -20.10 mL, 95% CI -28.16 to -12.05; 241 participants; 3 studies; moderate-certainty evidence downgraded for serious imprecision). Two studies reported on mean wound-related blood loss per wound area; however, we were unable to pool the studies due to considerable heterogeneity. It was uncertain whether Electrosurgery decreased wound-related blood loss per wound area. We could not reach a conclusion on the effects of the two interventions on pain and appearance of scars for various reasons such as small number of studies, insufficient data, the presence of conflicting data, and different measurement methods. Authors' conclusions The certainty of evidence was moderate to very low due to risk of bias and imprecise results. Low-certainty evidence shows no clear difference in wound infection between the scalpel and Electrosurgery. There is a need for more research to determine the relative effectiveness of scalpel compared with Electrosurgery for major abdominal incisions.

  • scalpel versus Electrosurgery for abdominal incisions
    Cochrane Database of Systematic Reviews, 2012
    Co-Authors: Kittipat Charoenkwan, Narain Chotirosniramit, Kittipan Rerkasem
    Abstract:

    Background Scalpels or Electrosurgery can be used to make abdominal incisions. The potential benefits of Electrosurgery include reduced blood loss, dry and rapid separation of tissue, and reduced risk of cutting injury to surgeons, though there are concerns about poor wound healing, excessive scarring, and adhesion formation. Objectives To compare the effects on wound complications of scalpel and Electrosurgery for making abdominal incisions. Search methods We searched the Cochrane Wounds Group Specialised Register (searched 24 February 2012); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 2); Ovid MEDLINE (1950 to February Week 3 2012); Ovid MEDLINE (In-Process & Other Non-Indexed Citations 23 February 2012); Ovid EMBASE (1980 to 2012 Week 07); and EBSCO CINAHL (1982 to 17 February 2012). We did not apply date or language restrictions. Selection criteria Randomised controlled trials (RCTs) comparing the effects on wound complications of Electrosurgery with scalpel use for the creation of abdominal incisions. The study participants were patients undergoing major open abdominal surgery, regardless of the orientation of the incision (vertical, oblique, or transverse) and surgical setting (elective or emergency). Electrosurgical incisions included those in which the major layers of abdominal wall, including subcutaneous tissue and musculoaponeurosis (a strong sheet of fibrous connective tissue that serves as a tendon to attach muscles), were made by Electrosurgery, regardless of the techniques used to incise the abdominal skin and peritoneum. Scalpel incisions included those in which all major layers of abdominal wall including skin, subcutaneous tissue, and musculoaponeurosis, were incised by a scalpel, regardless of the techniques used on the abdominal peritoneum. Data collection and analysis We independently assessed studies for inclusion and risk of bias. One review author extracted data which were checked by a second review author. We calculated risk ratio (RR) and 95% confidence intervals (CI) for dichotomous data, and difference in means (MD) and 95% CI for continuous data. We examined heterogeneity between studies. Main results We included nine RCTs (1901 participants) which were mainly at unclear risk of bias due to poor reporting. There was no statistically significant difference in overall wound complication rates (RR 0.90, 95% CI 0.68 to 1.18), nor in rates of wound dehiscence (RR 1.04, 95% CI 0.36 to 2.98), however both these comparisons are underpowered and a treatment effect cannot be excluded. There is insufficient reliable evidence regarding the effects of Electrosurgery compared with scalpel incisions on blood loss, pain, and incision time. Authors' conclusions Current evidence suggests that making an abdominal incision with Electrosurgery may be as safe as using a scalpel. However, these conclusions are based on relatively few events and more research is needed. The relative effects of scalpels and Electrosurgery are unclear for the outcomes of blood loss, pain, and incision time.