Comparative Analysis of the Effectiveness of Modern Endoscopic Methods of Treatment of BPH

Lower urinary tract symptoms caused by benign prostatic hyperplasia are the most common urological problem among men, affecting about a third of men over the age of 50 Of all surgical treatments, monopolar transurethral resection of the prostate (TURP), in which enlarged prostate tissue is resected piece by piece using a monopolar electrode, has been the standard method since the 1970s. It can significantly improve maximum flow rate (Qmax), urination-related symptoms (based on the International Prostate Symptom Assessment Scale (IPSS)), and health-related quality of life with long-term efficacy compared to medications or other minimally invasive treatments [4]. Since the 2000s, new energy systems for surgery for benign prostatic hyperplasia have rapidly become popular, including systems using bipolar energy and various laser systems such as holmium laser, potassium titanyl phosphate (KTP) laser, thulium laser and diode laser Over the past 10 years, the trend in the surgical treatment of benign prostatic hyperplasia has shifted from monopolar TURP to laser therapy and bipolar TURP. Based on the data on the effectiveness of the HoLEP technique, it becomes clear that HoLEP is ready to replace all these methods as a new standard, based on almost two decades of data that consistently demonstrate its better results and lower complication rate. This review summarizes the available literature by comparing HoLEP and traditional BPH treatments that are widely used and have long-term efficacy data. Despite the fact that there is such a wide arsenal of surgical treatment of BPH, each of these methods has its own advantages and disadvantages. This review article contains a significant portion of the best randomized data directly comparing HoLEP with alternative surgical treatments.

A pilot randomized controlled trial comparing THUNDERBEAT to the Maryland LigaSure energy device in laparoscopic left colon surgery

Background The THUNDERBEAT is a multi-functional energy device which delivers both ultrasonic and bipolar energy, but there are no randomized trials which can provide more rigorous evaluation of the clinical performance of THUNDERBEAT compared to other energy-based devices in colorectal surgery. The aim of this study was to compare the clinical performance of THUNDERBEAT energy device to Maryland LigaSure in patients undergoing left laparoscopic colectomy. Methods Prospective randomized trial with two groups: Group 1 THUNDERBEAT and Group 2 LigaSure in a single university hospital. 60 Subjects, male and female, of age 18 years and above undergoing left colectomy for cancer or diverticulitis were included. The primary outcome was dissection time to specimen removal (DTSR) measured in minutes from the start of colon mobilization to specimen removal from the abdominal cavity. Versatility (composite of five variables) was measured by a score system from 1 to 5 (1 being worst and 5 the best), and adjusted/weighted by coefficient of importance with distribution of the importance as follow: hemostasis 0.275, sealing 0.275, cutting 0.2, dissection 0.15, and tissue manipulation 0.1. Other variables were: dryness of surgical field, intraoperative and postoperative complications, and mortality. Follow-up time was 30 days. Results 60 Patients completed surgery, 31 in Group 1 and 29 in Group 2. There was no difference in the DTSR between the groups, 91 min vs. 77 min (p = 0.214). THUNDERBEAT showed significantly higher score in dissecting and tissue manipulation in segment 3 (omental dissection), and in overall versatility score (p = 0.007) as well as versatility score in Segment 2 (retroperitoneal dissection p = 0.040) and Segment 3 (p = 0.040). No other differences were noted between the groups. Conclusions Both energy devices can be employed effectively and safely in dividing soft tissue and sealing mesenteric blood vessels during laparoscopic left colon surgery, with THUNDERBEAT demonstrating some advantages over LigaSure during omental dissection and tissue manipulation. ClinicalTrial.gov # NCT02628093.

Bipolar TURP decreases post-operative morbidity – A prospective study in a tertiary care hospital from north India

Background: Transurethral resection of prostate is considered as gold standard surgical procedure for treatment of benign enlargement of prostate. It can be performed in two forms- monopolar transurethral resection and bipolar transurethral resection. Aims and Objective: This study was conducted to know which energy source among monopolar and bipolar energy leads to more post-operative morbidity after performing transurethral resection of prostate. Materials and Methods: In this study, total eighty (80) cases were included. They were suffering from lower urinary tract symptoms which were diagnosed to be due to benign enlargement of prostate after careful clinical and radiological examination. In forty cases, transurethral resection of prostate was performed by using monopolar energy source and in another forty cases, resection of prostate by transurethral route was done using bipolar energy source. Results: In our study, we found that development of TURP syndrome was more in monopolar TURP group in which pre-operative weight of prostate was more than 50 grams in comparison to bipolar TURP group in which there was no incidence of development of TURP syndrome in same class. Further, post-operative hospital stay and post-operative urethral catheter in situ was less in bipolar TURP group in terms of days as compared to monopolar TURP group. Conclusion: Our study concludes that Bipolar TURP is better in terms of development of less post-operative morbidity as compared to monopolar TURP. Bipolar TURP must be used extensively in teaching hospitals where students take more time than a seasoned surgeon to perform a surgical procedure and bipolar TURP will come handy in that situation.

Randomized comparative study of the effectiveness and safety of various bipolar devices during electrosurgical vaginal hysterectomy

AIM: The aim of this study was to investigate the morphometric features of tissues after exposure to bipolar energy of various electrosurgical generators and surgical hemostatic instruments used in vaginal hysterectomy. MATERIALS AND METHODS: The study included 48 individuals who underwent a vaginal hysterectomy. The patients were divided in three groups based on the instrument used for sealing blood vessels: a BiClamp was applied in Group 1 (n = 16), a TissueSeal PLUS COMFORT in Group 2 (n = 16), and a Thunderbeat in Group 3 (n = 16). The maximum temperature of tissue measured using a Fluke FLK TIS 40 9HZ thermal imaging infrared camera was compared within the groups. RESULTS: The maximum tissue temperature between the branches on electroligation, the minimum tissue temperature, and the tissue temperature at the coagulation boundary were significantly lower when using a TissueSeal PLUS COMFORT clamp than when using BiClamp and Thunderbeat clamps (H value = 41.8, p 0.01). Morphometric parameters (prevalence, coagulation depth and area) were the smallest with a TissueSeal PLUS COMFORT clamp compared to other clamps. CONCLUSIONS: Using a TissueSeal PLUS COMFORT clamp during vaginal hysterectomy is effective and safe and has the best thermometric and morphometric characteristics when applied to the tissue, thereby reducing the risk of lateral thermal damage. The possibility of perifocal heat transfer varies with the type of tool and with the temperature at the coagulation boundary.

Comparison of Two Different Bipolar Energy Resources in Transurethral Resection of Bladder Tumors

<b><i>Purpose:</i></b> To determine whether the use of different bipolar resources is associated with different results on tissue and perioperative parameters in patients undergoing bipolar transurethral bladder tumor resection (bTURBT). <b><i>Methods:</i></b> In this single-center prospective study, patients diagnosed with bladder tumor randomized to undergo TURBT either with a Gyrus PlasmaKinetic system (<i>n</i> = 62) or Olympus TUR in saline (TURis) system (<i>n</i> = 51). Primary endpoint was to evaluate the alteration of patients’ perioperative parameters, while secondary aim was to assess the thermal effect of these 2 different bipolar devices on the resected tissue samples by a grading system determined by tissue characteristics. <b><i>Results:</i></b> One hundred thirteen patients were randomized in the study, and 43 were excluded from the analysis due to the exclusion criteria. There were no significant differences between the groups in terms of mean age, tumor site, number of tumors, operative time, alteration in hemoglobin or hematocrit, blood transfusion rate, catheterization time, and postoperative stay. On the other hand, the ratio of obturator jerk was significantly higher in the Olympus TURis group (<i>p</i> = 0.028). The histopathological analyses of both groups determined muscularis propria and cautery artifact presence without a statistically significant difference (χ²: 0.476, <i>p</i> = 0.788). <b><i>Conclusion:</i></b> Although the perioperative complications of bTURBT are low in nature, bladder perforation resulted from obturator jerk still poses a risk for extravesical tumor implantation. Urologists should be aware of this risk especially when they are using a TURis system.

Efficacy of complex preventive approach to postoperative pelvic adhesions

Aim: to assess the efficacy of complex prevention of postoperative pelvic adhesions. Patients and Methods: this open-label comparative prospective study involved 222 women of reproductive age with gynecological diseases, tuboperitoneal infertility, and pelvic adhesions stage 1–2 diagnosed laparoscopically (according to the R-AFS classification). In the study group (n=112), the prevention of postoperative adhesions was performed using the authors’ algorithm that included separation of adhesions using HARMONIC ultrasonic energy, intra-abdominal injection of anti-adhesive agent based on a natural polymer of carboxymethyl cellulose, and IM sodium deoxyribonucleate from post-op day 1 with a 24-hour interval for 10 days. In the comparison group (n=110), separation of adhesions was performed using bipolar energy, and standard preventive measures were applied. The rate and severity of postoperative adhesions (via second-look laparoscopy), the recovery of reproductive function (by the fact of intrauterine pregnancy), and the quality of life (using MOS SF-36 and WHQ questionnaires) were evaluated. The levels of CD20+, CD4+, CD8+, and CD56+ lymphocytes cells were measured preoperatively and on postoperative days 3 and 14. Follow-up was 12 months. Results: authors’ preventive algorithm activates immunoregulatory mechanisms of cellular humoral immunity, reduces the rate (by 4.5 times, p<0.001) and severity of adhesions (p = 0.047), increases the rate of pregnancy by 1.6 times, and provides maximum physical and psychological quality of life. Conclusions: authors’ algorithm of the prevention of postoperative pelvic adhesions in women with gynecological diseases and tuboperitoneal infertility is characterized by reliable clinical efficacy as demonstrated by the improvement of both early and long-term surgical outcomes. KEYWORDS: postoperative pelvic adhesions, small pelvis, prevention, cellular humoral immunity, infertility, reproductive function, quality of life. FOR CITATION: Sulima A.N., Puchkina G.A. Efficacy of complex preventive approach to postoperative pelvic adhesions. Russian Journal of Woman and Child Health. 2021;4(2):130–136. DOI: 10.32364/2618-8430-2021-4-2-130-136.

Comparative study of histological changes (thermal artefacts) in resected specimens of monopolar and bipolar trans-urethral resection of bladder tumours

Objective The primary aim of the study was to study the histological changes (Thermal artefacts) noted in the resected specimens between the Monopolar and Bipolar Trans-Urethral Resection of Bladder Tumours (TURBT). Patients and Methods The study was done between March 2012 and Feb 2013. This was a comparative study between Monopolar and Bipolar resection specimens studied for histological changes (Thermal artefacts). Institutional Ethics Committee approval was obtained. Informed consent was taken from all patients. Patients were randomized into two groups, Monopolar Group or Bipolar Group of 50 each to undergo TURBT. Patients either underwent Monopolar or Bipolar TURBT in Glycine and Saline respectively. Results Thermal artefacts were graded according to WHO (World Health Organization) grading system. There was no difficulty noticed during histo-pathological examination of resected specimens. In Monopolar group, there were 27 (54%) grade 2 thermal damage, 17 (34%) grade 1 thermal damage and no grade-3 thermal damage in examined specimen. In Bipolar group, there were 07 (14%) grade 2 thermal damage, 12 (24%) grade 1 thermal damage and no grade 3 thermal damage in examined specimen. Conclusion The degree of thermal damage is much lesser in histological sections of specimen resected using Bipolar energy and interpretation of the grade is easier which is one of the most important prognosticators especially in bladder tumours since high grade lesions are proven beyond doubt to progress and recur.

Powering galactic superwinds with small-scale AGN winds

ABSTRACT We present a new implementation for active galactic nucleus (AGN) feedback through small-scale, ultrafast winds in the moving-mesh hydrodynamic code arepo. The wind is injected by prescribing mass, momentum, and energy fluxes across a spherical boundary centred on a supermassive black hole according to available constraints for accretion disc winds. After sweeping-up a mass equal to their own, small-scale winds thermalize, powering energy-driven outflows with dynamics, structure, and cooling properties in excellent agreement with those of analytic wind solutions. Momentum-driven solutions do not easily occur, because the Compton cooling radius is usually much smaller than the free-expansion radius of the small-scale winds. Through various convergence tests, we demonstrate that our implementation yields wind solutions, which are well converged down to the typical resolution achieved in cosmological simulations. We test our model in hydrodynamic simulations of isolated Milky Way – mass galaxies. Above a critical AGN luminosity, initially spherical, small-scale winds power bipolar, energy-driven superwinds that break out of the galactic nucleus, flowing at speeds $\gt 1000 \rm \, km \, s^{-1}$ out to $\sim 10 \, \rm kpc$. These energy-driven outflows result in moderate, but long-term, reduction in star formation, which becomes more pronounced for higher AGN luminosities and faster small-scale winds. Suppression of star formation proceeds through a rapid mode that involves the removal of the highest density, nuclear gas, and through a slower mode that effectively halts halo gas accretion. Our new implementation makes it possible to model AGN-driven winds in a physically meaningful and validated way in simulations of galaxy evolution, the interstellar medium and black hole accretion flows.

Prospective, Randomized, Comparative, Multicenter Study of the Hybrid Ultrasonic Advanced Bipolar Device and the Ultrasonic Coagulating Shears in Open Thyroidectomy

Background. The hybrid ultrasonic advanced bipolar device (HUB) that integrates ultrasonic energy and advanced bipolar energy was recently developed and applied to thyroid surgery. The purpose of this study was to compare the efficacy and safety of HUB and ultrasonic coagulating shears for open thyroidectomy. Methods. A total of 200 patients were enrolled from April to September 2017 in this prospective, randomized, multicenter study. Patients were randomly assigned to an ultrasonic group (n = 101) or a hybrid group (n = 99). Results. Operation times were similar in the 2 study groups, that is, 54.2 ± 25.2 minutes in the ultrasonic group and 50.2 ± 21.6 minutes in the hybrid group. Postoperative surgical results and morbidities were no different in the 2 groups. However, the total amount of bleeding was significantly less in the hybrid group (13.0 ± 17.7 mg vs 8.6 ± 11.5 mg; P = .042). Conclusions. Our study showed that there was no significant difference between the 2 groups in postoperative surgical results and morbidity. The total bleeding amount was significantly less in the hybrid group. The study shows that HUB is comparable to the ultrasonic coagulating shears in terms of efficacy and safety during thyroid surgery.