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We investigate the influence of scleral cautery during cataract surgery on limbal vascular density and remodeling using anterior segment optical coherence tomography angiography (AS-OCTA). Twenty eyes of 20 patients who underwent cataract surgery with a sclerocorneal incision were included. Patients were divided into two groups: non-cautery ( n  = 10) and cautery ( n  = 10). The area around the incision site was scanned using AS-OCTA before surgery and at 1, 3, 5, 7, 14, 21, 28, and 90 days postoperatively. Images were analyzed to depict conjunctival vasculature (surface to a depth of 200 μm) and intrascleral vasculature (depth of 200 to 1000 μm). Vascular density was evaluated using ImageJ software. In the non-cautery group, intrascleral vascular density significantly increased during the wound-healing period up to 21 days postoperatively. Cautery application completely diminished this effect, resulting in significantly reduced intrascleral vascular density in the cautery group compared to the non-cautery group until 5 days after surgery. On the seventh day and later, intrascleral vascular density in the cautery group recovered, but the vascular pattern did not return to its preoperative state even at 90 days after surgery. Conjunctival flap vascular density was reduced for 28 days after surgery, with cautery application further decreasing conjunctival vascular density. AS-OCTA enabled separate observation of conjunctival and intrascleral vasculature. Intrascleral blood flow significantly increased after cataract surgery, but scleral cauterization markedly blocked this effect. The vascular reconstruction process following cataract surgery continued for almost a month, with cautery application leading to prolonged vascular disruption and altered vascular patterns.

Background To compare flange creation using high- vs. low-temperature cautery for three piece intraocular lenses (IOLs) with PMMA and PVDF haptics. Methods The ends of the haptics from ten three-piece IOLs with PMMA haptics (AR40, Johnson & Johnson, USA) and ten three-piece IOLs with PVDF haptics (PU6AS, KOWA, Japan) were each heated for 1 mm to form a flange—using low-temperature cautery (593 °C) on the ipsilateral haptic and high-temperature cautery (1205 °C) on the contralateral haptic. Flange size, shape, and formation time were analysed. Results There were no differences in flange shape and flange size between high- and low-temperature cautery for each haptic type ( p  > 0.05). Average flange size of the AR40 IOL and the PU6AS IOL were 422 ± 22 μm and 363 ± 14 μm, respectively. Haptic diameter were 172 ± 5 μm and 126 ± 3 μm, respectively. The shape of the AR40 IOL flange was conic and the shape of the PU6AS IOL flange was mushroom-like, independent of cautery temperature. Flange formation time was 1.7 ± 0.6 s with the high-temperature cautery and 3.7 ± 0.6 s with the low-temperature cautery, regardless of the haptic material. Conclusions Flange size and shape in PMMA and PVDF haptics are independent of low- and high-temperature cautery. However, the extended flange formation time associated with low-temperature cautery may allow for greater control during flange creation.

Objective Recurrent tracheoesophageal fistula (RTEF) is a serious complication after primary repair of esophageal atresia and tracheoesophageal fistula (EA/TEF). Treatment of RTEF involved an open surgery by thoracotomy. Technically it is a challenge with a high morbidity and mortality. Congenital tracheoesophageal fistula (CTEF) traditionally involved an open surgery by thoracotomy or cervicotomy. Many endoscopic techniques have been developed since the past decades: thoracoscopic or bronchoscopic approach for the treatment of RTEF and CTEF; nevertheless, optimal treatment is not still determined because of few numbers of patients, short-term follow-up, and different procedures. We report our experience and evaluated the efficacy in the chemocauterization of CTEF and RTEF, with the use of 50 % trichloroacetic acid (TCA) as a technique minimally invasive. Materials and methods From 2010 to 2014, fourteen patients with TEF (twelve RTEF and two CTEF) were selected for endoscopic management in two centers. Twelve patients had RTEF after primary repair of EA/TEF by thoracotomy approach, and two patients had CTEF in the upper pouch, diagnosed after EA/TEF (Type B) long gap, treated by thoracotomy and thoracoscopy, respectively. In all cases the diagnosis was confirmed by esophagram, bronchoscopy, and clinical evaluation. Under general anesthesia, a rigid pediatric bronchoscope with a 0° rod lens telescope and tele-monitoring was used to localize the TEF. Cotton soaked with 50 % TCA was applied on the TEF during 30 s, and the procedure was repeated 3 times. The endoscopic treatment was performed monthly until TEF closure was achieved. Results RTEF and CTEF were closed in all patients. The mean number of procedure in each patient was 1.8. Closure of TEF was confirmed by esophagram, bronchoscopy, and clinical evaluation. There were a bacterial pneumonia and bronchospasm as postoperative complications. Median follow-up was 41 months (8–72). All of these TEF remain completely obliterated, and all patients are asymptomatic. Conclusion Endoscopic management of congenital and recurrent TEF with the use of 50 % TCA is as a minimally invasive, effective, simple and safe technique in these patients and avoids the morbidity of open surgery.

A retrospective risk-adjusted analysis was completed using data from the National Surgical Quality Improvement Program (NSQIP) to (1) compare the risks of post-operative hematoma for thyroid surgery using conventional cautery compared alternative energy devices (defined as LigaSure and Harmonic Scalpel), and (2) compare operative times for the same. The primary outcome variable was post-operative hematoma occurrence. The secondary outcome variable was operative time. The exposure variable was use of conventional or alternative sources of cautery. All adult patients who underwent a total thyroidectomy, subtotal thyroidectomy or completion thyroidectomy between 2016 and 2018 were included. Multivariable linear and logistic regression analyses were performed to control for potentially confounding variables. A total of 13,330 cases were analyzed; 4342 used conventional cautery, and 8988 used alternative sources. There was a statistically significant decrease in post-operative hematoma risk using alternative sources of cautery compared to conventional cautery (OR 0.75; 95% CI 0.58–0.98) (p = 0.04). Use of alternative sources of cautery added 4.95 min onto operative time (95% CI 2.45–7.45) which was statistically significant (p < 0.0001). After controlling for confounding variables, there was a statistically significant lower rate of post-operative hematoma in thyroidectomies performed using alternative sources of cautery compared to those performed with traditional hemostatic methods. Alternative sources of cautery increased operative time by 4.95 min.

Purpose: To evaluate the effect of deep thermal punctal cautery in eyes with post-conjunctivitis cicatrization. Methods: This retrospective study consisted of patients who underwent deep thermal punctal cautery for post-conjunctivitis dry eye (PCDE). The diagnosis was based on a history suggestive of viral conjunctivitis in past followed by the onset of present clinical features of aqueous deficiency dry eye (ATD). All patients underwent a rheumatological evaluation to rule out underlying systemic collagen vascular disease as a cause for dry eye. The extent of cicatricial changes was noted. Best-corrected visual acuity (BCVA), Schirmer's test, and fluorescein staining score (FSS; total score of 9) were analyzed pre- and post-cautery. Results: Out of 65 patients (117 eyes), 42 were males. The mean age at presentation was 25.769 ± 12.03 years. Thirteen patients presented with unilateral dry eye. Pre-cautery BCVA (logarithm of the minimum angle of resolution [logMAR]) and Schirmer's test (mm) improved from 0.5251 ± 0.662 to 0.372 ± 0.595 (P value = 0.000, 95% confidence interval [CI]: 0.09-0.22), and 1.952 ± 2.763 to 4.929 ± 4.338 (P value = 0.000, 95% CI: -3.79--2.17); post-cautery, respectively. The pre-cautery FSS of 5.9 ± 2.82 reduced to 1.58 ± 2.38 (P value = 0.000, 95% CI: 3.46-5.17) post-cautery. The mean follow-up was 11.22 ± 13.32 months. No progression in cicatricial changes was noted in any eye during the follow-up. Re-canalization rate was 10.64%, and repeat cautery was performed with successful closure of puncta. Conclusion: Symptoms and clinical signs of ATD in PCDE patients improve with punctal cautery.

Anogenital warts (AGW) is one of the sexually transmitted infections (STIs) caused by human papillomavirus (HPV). Treatment modalities of AGW yield low clearance and recurrence rate, so that chemical cautery with trichloroacetic acid (TCA) and electrosurgery are widely used to remove the lesions without any severe side effects.IntroductionAnogenital warts (AGW) is one of the sexually transmitted infections (STIs) caused by human papillomavirus (HPV). Treatment modalities of AGW yield low clearance and recurrence rate, so that chemical cautery with trichloroacetic acid (TCA) and electrosurgery are widely used to remove the lesions without any severe side effects.To investigate the efficacy of chemical cautery with TCA and electrosurgery in AGW based on clinical trials or case series.ObjectiveTo investigate the efficacy of chemical cautery with TCA and electrosurgery in AGW based on clinical trials or case series.The systematic review was reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) but not registered to the International Prospective Register of Systematic Review (PROSPERO). To acquire proper and accurate information from relevant literature, two databases PubMed and the Cochrane Library were searched from January 2013 to March 2023.MethodsThe systematic review was reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) but not registered to the International Prospective Register of Systematic Review (PROSPERO). To acquire proper and accurate information from relevant literature, two databases PubMed and the Cochrane Library were searched from January 2013 to March 2023.Thirteen studies were included in this systematic review, comprising seven articles on chemical cautery and six electrosurgery articles. The highest cure rate of chemical cautery with TCA was 94.1% while electrosurgery was 100%. A relatively low recurrence rate during 1 year follow-up was observed in electrosurgery with 14.6%, whereas the chemical cautery was 27.6%.ResultsThirteen studies were included in this systematic review, comprising seven articles on chemical cautery and six electrosurgery articles. The highest cure rate of chemical cautery with TCA was 94.1% while electrosurgery was 100%. A relatively low recurrence rate during 1 year follow-up was observed in electrosurgery with 14.6%, whereas the chemical cautery was 27.6%.Electrosurgery for AGW treatment had higher cure rate with lower recurrence rate compared to chemical cautery with TCA. Numerous adverse effects of electrosurgery were reported include bleeding and scar formation as high risk of HPV infection.ConclusionElectrosurgery for AGW treatment had higher cure rate with lower recurrence rate compared to chemical cautery with TCA. Numerous adverse effects of electrosurgery were reported include bleeding and scar formation as high risk of HPV infection.

In computer-assisted surgery, it is typically required to detect when the tool comes into contact with the patient. In activated electrosurgery, this is known as the energy event. By continuously tracking the electrosurgical tools’ location using a navigation system, energy events can help determine locations of sensor-classified tissues. Our objective was to detect the energy event and determine the settings of electrosurgical cautery—robustly and automatically based on sensor data. This study aims to demonstrate the feasibility of using the cautery state to detect surgical incisions, without disrupting the surgical workflow. We detected current changes in the wires of the cautery device and grounding pad using non-invasive current sensors and an oscilloscope. An open-source software was implemented to apply machine learning on sensor data to detect energy events and cautery settings. Our methods classified each cautery state at an average accuracy of 95.56% across different tissue types and energy level parameters altered by surgeons during an operation. Our results demonstrate the feasibility of automatically identifying energy events during surgical incisions, which could be an important safety feature in robotic and computer-integrated surgery. This study provides a key step towards locating tissue classifications during breast cancer operations and reducing the rate of positive margins.

Cauterisation techniques are commonly used and widely accepted for the management of epistaxis. This review assesses which methods of intranasal cautery should be endorsed as optimum treatment on the basis of benefits, risks, patient tolerance and economic assessment. A systematic review of the literature was performed using a standardised methodology and search strategy. Eight studies were identified: seven prospective controlled trials and one randomised controlled trial. Pooling of data was possible from 3 studies, yielding a total of 830 patients. Significantly lower re-bleed rates were identified (p < 0.01) using electrocautery (14.5 per cent) when compared to chemical cautery (35.1 per cent). No evidence suggested that electrocautery was associated with more adverse events or discomfort. Limited evidence supported the use of a vasoconstrictor agent and operating microscope during the procedure. The included studies had considerable heterogeneity in terms of design and outcome measures. Consistent evidence suggests that electrocautery has higher success rates than chemical cautery, and is not associated with increased complications or patient discomfort. Lower quality evidence suggests that electrocautery reduces costs and duration of hospital stay.

A randomized trial involving 100 Ugandan infants with postinfectious hydrocephalus compared endoscopic third ventriculostomy plus choroid plexus cauterization with conventional ventricular shunting and found no difference in cognitive outcomes at 1 year.

The mechanical removal of bacteria is fundamental to the treatment of infected root canals, but complete sterilization of biofilms tends not to extend to uninstrumented areas. However, during electrical conduction to a root canal filled with a conductor, the higher impedance where the root canal is narrower generates Joule heat that may result in a large temperature increase and sterilization. The effect of a high-frequency electric current on the wall of a simulated narrow root canal was investigated by scanning electron microscopy (SEM) and energy dispersive X-ray spectrometry (EDS). Simulated root canals, 0.1 mm in diameter, were prepared in dentine blocks. The root canal wall was treated with Plank-Rychlo solution for 5 min to create a decalcified layer. The simulated root canal was filled with either saline or NaClO, and 150 or 225 V at 520 kHz was applied for 0 s, 1 s, or 5 s. As the conduction time increased, and when the saline was replaced with NaClO, the proportion with a flat decalcified surface decreased, dentinal tubules and a lava-like morphology were significantly more evident on SEM (p < 0.01), and EDS showed significant decreases in carbon and oxygen and increases in calcium (p < 0.01). It was concluded that filling uninstrumented root canals with NaClO and using electrical conduction for 5 s could incinerate and eliminate the organic material of the root canal wall. The application of high-frequency electric current may lead to the cure of many cases of persistent apical periodontitis.