Safety and Efficacy of a Low-Level Radiofrequency Thermal Treatment in an Animal Model of Obstructive Meibomian Gland Dysfunction

Purpose: To evaluate the safety and efficacy of a low-level radiofrequency thermal treatment in obstructive MGD rabbit model.Materials and Methods: Meibomian gland orifices of central two-thirds of upper and lower eyelid margins were coagulated 2 times at 2-week intervals using a 5-MHz high-frequency electrosurgical unit. Sixteen eyes of 8 rabbits were treated with 1 session of radiofrequency thermal treatment (radiofrequency group) and 8 eyes of 4 rabbits were followed up without treatment (Control group). We evaluated lid margin abnormality and corneal staining scores, histologic examination of eyelids and meibomian gland, and meibography images before meibomian gland orifice closure, 4 weeks after meibomian gland orifice closure, and 4 weeks after radiofrequency thermal treatment.Results: There were significant improvements in lid margin abnormality score for upper and lower eyelids after radiofrequency thermal treatment (P<0.001 for upper and lower eyelids). Corneal staining score remained unchanged in radiofrequency group. However, it increased at the final follow-up in control group. Mean area of secretory acini showed a significant improvement, almost to the baseline levels, in radiofrequency group (P=0.004). On meibography, an improvement was seen in meibomian gland loss rate in radiofrequency group.Conclusions: Low-level of radiofrequency thermal treatment for heating the inner and outer eyelid surfaces is safe and effective for the treatment of obstructive MGD in a rabbit animal model of MGD.

The Effects of Educational Intervention on Operating Room Nurses' Application of Electrosurgical Units

Background: An electrosurgical unit is one of the most essential pieces of equipment in operating rooms. Over 80% of operations today make use of electrosurgical units. Training operating room nurses in correct application of electrosurgical units and evaluation of their application play a key role in making optimal use of the units and extending their lifetime, reducing occupational hazards for surgical teams, and enhancing the safety of patients. The present study aims to investigate the effects of an educational intervention on operating room nurses' application of electrosurgical units. Methods: The present study is a quasi-experimental work of research conducted in all the operating rooms of the hospitals located in Shiraz, Iran. Data were collected from 200 observations of 200 surgeries (100 before intervention and 100 after). The content of education was derived from a literature review and standard guidelines and was presented as a poster in the operating rooms. The data collection instruments consisted of a Demographic Information Questionnaire, a surgery checklist, and the checklist for operating room Nurses' application of electrosurgical units. Data were collected once before the intervention and then again one month after the intervention. The collected data were analyzed using the descriptive statistics of chi-square test and paired t-test at a significance level of 0.05 in SPSS v. 18.Results: The average age of the participating nurses was 31.540±6.772 years. The majority of the participants were female. The results showed a statistically significant difference between the means and standard deviations of the nurses' application of electrosurgical units scores before (18.330±2.666) and after (20.820±3.400) intervention. Conclusion: Introducing operating room nurses to the standard guidelines for application of electrosurgical units can improve the quality of services provided by the nurses, increase the safety of patients, and reduce occupational hazards. Thus, to improve operating room nurses' professional performance in application of electrosurgical units, medical managers and policy-makers should attach more importance to on-the-job training programs.

Autoplasma as a Hemostatic Agent for Endoscopic Surgery of Hollow Organs

Introduction. To maximize the effectiveness of hemostatic technologies, it is necessary to optimize local hemostasis through hybrid and controlled approaches, as well as to improve the conditions for tissue surgical dissection preventing perforation of hollow organs. This study is aimed at assessing the efficacy of stopping bleeding and the safety of resection of digestive hollow organs in experimental models of trauma to abdominal organs in laboratory animals.Materials and methods. Experiments were carried out in vivo on 20 rabbits. All animals were divided into 4 experimental groups (5 animals each): I — the control group, in which no methods for stopping bleeding were used; II — the group, in which infiltration of the wall of a hollow organ with saline solution was used; III — the group, in which physical hemostasis was applied using an electrosurgical unit and an argon plasma coagulation apparatus; IV — the group, animals in which underwent controlled local biological hemostasis using autoplasma. Prior to laparotomy, 2–3 ml of whole blood was taken from the rabbit’s ear for preliminary preparation of autoplasma. The prepared autoplasma was introduced into the area of resection or other operation of the mucous membrane of the rabbit’s digestive tract.Results and discussion. Although no statistical difference in the time of stopping bleeding was observed between the control (I) and saline (II) groups, one more episode of bleeding was noted in group II. Preventive local administration of autoplasma (group IV) was established to have a high hemostatic potential. As expected, electrocoagulation was more effective than saline; however, hemostasis achieved by means of argon plasma coagulation is characterized by rapid formation of a necrotic zone, which may lead to undesirable consequences in the long-term period.Conclusion. Preventive local administration of autoplasma and recombinant human protein has a high hemostatic potential in animals. In comparison, electrocoagulation is less effective due to the rapid filling of the pathological focus with blood.

PID fuzzy control applied to an electrosurgical unit for power regulation

The electrosurgical unit (ESU) is the most common device in modern surgery for cutting and coagulation of tissues. It produces high-frequency alternating current to prevent the stimulation of muscles and nerves. The commercial ESUs are generally expensive and their output power is uncontrolled. The main objective of the proposed study is to propose an economic ESU with an additional feature of output power regulation using a fuzzy logic controller (FLC) based proportional integral derivative (PID) tuned controller. Unlike the previous studies, the proposed controller is designed in a fully closed-loop control fashion to regulate the output power of the ESU to a fixed value under the consideration of highly dynamic tissue impedance. The performance of the proposed method is tested in the MATLAB/SIMULINK environment. In order to validate the superiority of the proposed method, a comparative analysis with a simple (PID) controller based ESU is presented.

Volatile Organic Compounds Exposure During Breast Surgery in Operating Rooms of A Hospital

Background: The composition and concentration distribution of volatile organic compounds (VOCs) in surgical smoke had seldom reported. This study aimed to investigate the profile of VOCs and their concentration in surgical smoke from breast surgery during electrocautery in different tissues, electrosurgical units, and electrocautery powers.Methods: Thirty-eight surgical smoke samples from 23 patients performed breast surgery were collected using evacuated stainless steel canisters. The concentrations of 87 VOCs in surgical smoke samples were analyzed by gas chromatography-mass spectrometry. The human tissues, electrosurgical units, and electrocautery power were recorded.Results: The median level of total VOCs concentrations in surgical smoke samples from mammary glands (total VOCs: 9,953.5 ppb; benzene: 222.7 ppb; 1,3-butadiene: 856.2 ppb; vinyl chloride: 3.1 ppb) using conventional electrosurgical knives were significantly higher than that from other tissues (total VOCs: 365.7–4,266.8 ppb, P < 0.05; benzene: 26.4–112 ppb, P < 0.05; 1,3-butadiene: 15.6–384 ppb, P < 0.05; vinyl chloride: 0.6–1.9 ppb, P < 0.05). A high methanol concentration was found in surgical smoke generated during breast surgery (736.7–4,304.6 ppb) using different electrosurgical units. An electrocautery power of ≥27.5 watts used for skin tissues produced a higher VOCs concentration (2,905.8 ppb).Conclusions: The surgical smoke samples collected from mammary glands using conventional electrosurgical knives had high VOCs concentrations. The carcinogens (including benzene, 1,3-butadiene, and vinyl chloride) and methanol were found in the surgical smoke samples from different electrosurgical units. The type of electrosurgical unit and electrocautery power used affected VOCs concentrations in surgical smoke.