An electrical plasma dissection tool for surgical treatment of chronic ulcers: Results of a prospective randomised trial

Which Kind of Prognosis is Better in the Treatment of Cervical and Lumbar Disc Herniation with Coblation Nucleoplasty?

Introduction

Coblation nucleoplasty is a minimally invasive procedure developed for the treatment of symptomatic disc herniation.

Methods

We evaluated 118 cases of cervical and lumbar intervertebral discs treated with coblation nucleoplasty. The clinical results were assessed using the visual analogue scale (VAS), modified MacNab criteria, and efficacy. Complications and the re-surgery rate were also evaluated. The procedure was carried out under CT guidance, and the patients were followed up for 1 day, 1 month, 6 months, and 5 years postoperative.

Results

At the 5-year follow-up, the VAS score in the cervical and lumbar groups significantly decreased from 6.20 to 2.43 and 6.11 to 3.29, respectively. While MacNab scores were indistinguishable at the 6-month follow-up, they differed significantly between the cervical (58.2%) and lumbar (34.9%) groups at the 5-year follow-up. At the 5-year follow-up, 6 patients in the cervical group and 11 in the lumbar group underwent conventional operation. The efficacy of coblation nucleoplasty at the 5-year follow-up was higher in cervical group (81.82%) compared with lumbar group (61.90%).

Conclusion

The results of this study suggest that coblation nucleoplasty is a safe and effective treatment option for patients with cervical and lumbar disc herniation. The long-term benefits of this procedure were more pronounced in patients with cervical disc herniation.

Clinical Trial Registration

The trial was registered on ClinicalTrials.gov (ChiCTR2400089145).

Photobiomodulation and photodynamic therapy applied after electrocauterization for skin healing optimization in rats

Photobiomodulation-PBM and Photodynamic Therapy-PDT have been used to induce healing. However, the effects of these therapies on skin-lesions induced by electrocautery are unknown, aiming at more favorable clinical and esthetic results. Electrocauterization was done in 78-female Wistar-rats using a system that includes an electrocautery and red-LED. The groups were: No injury, Injury, Injury + ALA (topical 5-aminolevulinic acid application), Injury + LED and Injury + ALA + LED (topical ALA application followed by photoactivation with LED). After 2nd, 7th and 14th days post-injury, immuno-histomorphometric analyses (inflammatory infiltrate, blood vessels, fibroblasts, eschar/epidermal thickness, IL-10 and VEGF) and biochemical assays of MPO (neutrophil), NAG (macrophage), nitrite, DCF (H₂ O₂ ), carbonyl (membrane's damage), sulfhydryl (membrane's integrity), SOD, GSH, hydroxyproline and re-epithelialization area were performed. The Injury + LED and Injury + ALA + LED groups controlled inflammation and oxidative stress, favoring angiogenesis, fibroblasts proliferation and collagen formation. Therefore, the PBM or PDT was effective in tissue formation with thinner eschar and epidermis, resulting in less scarring after electrocauterization.

Comparative healing of swine skin following incisions with different surgical devices

Background

Electrosurgical technology is widely used in surgical dissection and hemostasis, but the generated heat creates thermal injury to adjacent tissues and delays wound healing. The plasma blade (PB) applies pulsed radiofrequency (RF) to generate electrical plasma along the edge of a thin, flat, insulated electrode, minimizing collateral tissue damage. This study aimed to evaluate wound healing in swine skin following incision with a new surgical system that applies low-temperature plasma (NTS-100), a foreign PB, conventional electrosurgery (ES), and a scalpel blade.

Methods

In vitro porcine skin and an in vivo porcine skin model were used in this study. Full-thickness skin incisions 3 cm in length were made on the dorsum of each animal for each of the 5 surgical procedures at 0, 21, 28, 35, and 42 days. The timing of the surgical procedures allowed for wound-healing data points at 1, 2, 3, and 6 weeks accordingly. Local operating temperature and blood loss were quantified. Wounds were harvested at designated time points, tested for wound tensile strength, and examined histologically for scar formation and tissue damage.

Results

Local operating temperature was reduced significantly with NTS-100 (cut mode 83.12±23.55 °C; coagulation mode 90.07±10.6 °C) compared with PB (cut mode 94.46±11.48 °C; coagulation mode 100.23±6.58 °C, P<0.05) and ES (cut mode 208.99±34.33 °C, P<0.01; coagulation mode 233.37±28.69 °C, P<0.01) in vitro. Acute thermal damage from NTS-100 was significantly less than ES incisions (cut mode: 247.345±42.274 versus 495.295±103.525 µm, P<0.01; coagulation mode: 351.419±127.948 versus 584.516±31.708 µm, P<0.05). Bleeding, histological scoring of injury, and wound strength were equivalent for the NTS-100 and PB incisions.

Conclusions

The local operating temperature of NTS-100 was lower than PB, and NTS-100 had similarly reliable safety and efficacy.

Comparison of PEAK PlasmaBlade™ to conventional diathermy in abdominal-based free-flap breast reconstruction surgery-A single-centre double-blinded randomised controlled trial

BACKGROUND

Electrosurgery makes dissection with simultaneous haemostasis possible. The produced heat can cause injury to the surrounding tissue. The PEAK PlasmaBlade™(PPB) is a new electrosurgery device which may overcome this by having the ability to operate on a lower temperature, therefore reducing collateral thermal damage.

METHOD

A single-centre, double-blinded, randomised controlled trial (RCT) was conducted which included 108 abdominal-based free-flap breast reconstruction patients who had their flap raise performed using either the PPB (n = 56) or the conventional diathermy (n = 52). Data were collected during their in-patient stay and out-patient appointments. The primary outcome value was the number of days the abdominal drains were required.

RESULTS

Baseline characteristics were similar between the groups, except a significantly lower flap weight in the PPB group. The median number of days the drains were required did not differ significantly (p = 0.48; 6.0 days for the diathermy and 5.0 days for the PPB). The total drain output (p = 0.68), the inflammatory cytokine in the drain fluid (p>0.054) and complications (p>0.24) did not differ significantly between the two groups. At the 2-week follow-up appointment, there was a trend towards less abdominal seromas on abdominal ultrasound (p = 0.09) in the PPB group which were significantly smaller (p = 0.04).

CONCLUSION

The use of the PPB did not result in a significant reduction of drain requirement, total drain output or inflammatory cytokines but did reduce the size of seroma collections at the 2-week follow-up appointment. Therefore, the use of the PPB device could reduce early seroma formation after drain removal.

Comparative Morphological Effects of Cold-Blade, Electrosurgical, and Plasma Scalpels on Dog Skin

The aim of the present study was to evaluate the histological results of the Onemytis^® plasma surgery device with Airplasma^® technology. We compared the efficacy and the effect on tissues of the new plasma electrocoagulation system with electrosurgery and a scalpel blade. Samples of healthy skin tissue from four dogs that underwent mastectomy were evaluated. Three different incision modes were used, i.e., a cold blade, electrosurgery, and the Onemytis^® plasma scalpel were evaluated histologically to assess invasiveness and tissue injuries at different distances from the cutting surface. The histological examinations showed moderate necrosis caused by Onemytis^®, compared to the use of the more invasive electrosurgery, which induces thermal damage that extends beyond 1000 µm. Our study shows that the use of the plasma scalpel reduces the extension of the thermal lesion on the skin compared to an electrosurgical scalpel.

Robotic waterjet wound debridement - Workflow adaption for clinical application and systematic evaluation of a novel technology

Objective

We evaluated the clinical potential of a novel robotic system for autonomous performance of waterjet wound debridement.

Summary background data

Within the last decade, waterjet wound debridement has proven to be a valid alternative to the conventional approach using sharp spoons and scalpel.

Methods

The DLR MIRO robot using the DLR MICA instrument for robotic surgery was adapted for actuation of an ERBEJET 2 flexible endoscopic waterjet probe. Waterjet debridement of various wound shapes and sizes using a porcine skin model was compared between this novel robotic system and a control group of human medical professionals with regard to wound area cleaned by the waterjet, off-target area, and procedural time.

Results

After the wound area was registered in the robotic system, it automatically generated a cleaning path and performed debridement based on generated surface model. While the robotic system demonstrated a significant advantage for the covered wound area (p = 0.031), the average off-target area was not significantly different from human controls. Human participants had high variability in cleaning quality across users and trials, while the robotic system provided stable results. Overall procedural time was significantly lower in trials performed by humans.

Conclusions

Robotic waterjet wound debridement is a promising new technological approach compared to the current clinical standard of interventional wound therapy, providing higher efficiency and quality of wound cleaning compared to human performance. Additional trials on more complicated wound shapes and in vivo tissue are necessary to more thoroughly evaluate the clinical potential of this technology.

An electrical plasma dissection tool for surgical treatment of chronic ulcers: Results of a prospective randomised trial

Cutaneous ulceration is a difficult medical problem and a major source of morbidity for patients. In the surgical treatment of ulcers, debridement is the first step, and it can be carried out using several surgical tools. Recently, new surgical devices have emerged using plasma-mediated electrical discharges with a lower peak temperature. A prospective single-blind trial was conducted on chronic ulcers not responsive to common non-surgical management. Patients were randomly separated into 2 groups: Group A received surgical debridement with conventional electrocautery, and Group B received surgical debridement using the plasma-mediated device. Histological samples were collected intraoperatively to evaluate the thermal damage during the surgical procedure and 2 weeks after surgery to evaluate the inflammatory response and collagen deposition. The width of coagulation necrosis at the incision margins in Group B was significantly shorter compared with Group A (P = .001). The inflammatory cell infiltration showed a cellular distribution percentage that was quite equal between the 2 groups. The granulation tissue showed an abundant deposition of dense and mature collagen in Group B, compared with Group A, where the mature collagen appeared in small quantities (P < .001). Microbial culture showed a lower incidence of postoperative infections in Group B compared with the control group (P < .05). The study demonstrated, based on the results, that the new technology with the use of a lower temperature electrosurgical device represents an effective therapeutic weapon for the surgical treatment of skin ulcers, both vascular and extravascular types.