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Injury and adhesion formation following ovarian wedge resection with different thermal surgical modalities
Author(s) -
Bhatta N.,
Isaacson Keith,
Flotte Thomas,
Schiff Isaac,
Anderson R. Rox
Publication year - 1993
Publication title -
lasers in surgery and medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.888
H-Index - 112
eISSN - 1096-9101
pISSN - 0196-8092
DOI - 10.1002/lsm.1900130311
Subject(s) - electrosurgery , medicine , charring , laser , surgery , nd:yag laser , electrocoagulation , adhesion , diathermy , hemostasis , materials science , optics , composite material , physics
The purpose of this study is to determine the role of bleeding, acute thermal damage, and charring in adhesion formation. Postoperative adhesions were compared following ovarian wedge resection in 48 rabbits using different lasers, electrosurgery, and scalpel. Twelve ovaries were sectioned per modality, in randomized pairs. Acute thermal injury as assessed by histology, bleeding, and charring differed amonge the modalities used. Adhesions were assessed 4 weeks later, by an investigator completely blinded of the treatment protocol. The adhesion scores were 11.6 ± 8.0 with pulsed Er:YAG laser; 11.9 ± 7.5 with scalpel; 8.3 ± 9.3 with electrocautery; 6.7 ± 8.8 with a continuous (c.w.) Nd:YAG laser; 5.3 ± 4.8 with c.w. CO 2 laser; 3.1 ± 2.7 with pulsed CO 2 laser; 1.7 ± 1.8 with pulsed Ho:YAG laser; and 0.8 ± 1.5 in the control (no resection) group. Ho:YAG, Nd:YAG, and electrocautery were completely hemostatic. Bleeding was minimal with the CO 2 lasers. Er:YAG and scalpel caused maximum bleeding, requiring hemostatic measures to prevent exanguination. Charring occurred with electrocautery, CO 2 laser, and Nd:YAG laser. Bleeding and charring correlated with adhesion formation, but the histological depth of thermal damage did not. The Ho:YAG laser is a hemostatic, fiber‐optic compatible laser causing significantly fewer adhesions (P<0.04) than scalpel, electrocautery, Nd:YAG, Er:YAG, and c.w. CO 2 lasers. Clinical use of the Ho:YAG laser, and the role of carbonization in promoting adhesions, deserve further study. © 1993 Wiley‐Liss, Inc.