Browsing by Subject "Electrocautery"

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    Endoscopic Unroofing of a Choledochocele
    (American College of Gastroenterology, 2017-12-20) El Hajj, Ihab I.; Lehman, Glen A.; Tirkes, Temel; Sherman, Stuart; Medicine, School of Medicine
    A 42-year-old man with previous laparoscopic cholecystectomy was referred for further evaluation of recurrent acute pancreatitis. Secretin-enhanced magnetic resonance cholangiopancreatography showed a 16 mm × 11 mm T2 hyperintense cystic lesion at the major papilla (Figure 1). Upper endoscopic ultrasound (EUS) showed a 15 mm × 10 mm oval, intramural, subepithelial lesion at the major papilla (Figure 2). Endoscopic retrograde cholangiopancreatography (ERCP) showed an 18-mm bulging lesion at the major papilla with normal overlying mucosa (Figure 3); injected contrast collected into a 16-mm cystic cavity (Figure 4). Findings were suggestive of type A choledochocele. A 10–12-mm freehand precut papillotomy was made with a monofilament needle-knife (Huibregtse Single-Lumen Needle Knife, Cook Medical, Bloomington, IN) using an ERBE VIO electrocautery system (ERBE USA; Marietta, GA). The incision was made as long as safely possible in an attempt to open the choledochocele completely and thus expose its walls and contents. We used a standard pull sphincterotome and ERBE electrocautery to perform the pancreatic sphincterotomy, followed by placement of a pancreatic stent. Biliary sphincterotomy was performed using the same technique (settings for needle-knife and pull sphincterotomies: Endocut I, blend current, effect 2/duration 2/interval 3). Biopsies of the inverted choledochocele showed biliary mucosa and duodenal columnar epithelium with inflammation and fibrosis, and no dysplasia. Follow-up ERCP at 4 weeks showed adequate unroofing of the choledochocele (Figure 5); the pancreatic stent was subsequently removed. The patient reported no recurrence of acute pancreatitis at 6-, 12-, and 18-month follow-up intervals.
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    Smoke Evacuation in Dermatology: A National Cross-Sectional Analysis Examining the Behaviors and Perceptions of Dermatologists and Dermatologic Surgeons
    (National Society for Cutaneous Medicine, 2021) Hooper, Perry; Holmes, Samantha; Que, Syril Keena T.; Dermatology, School of Medicine
    Background: Despite associated hazards of surgical smoke, there is limited data regarding smoke evacuation practices among dermatologists. Such information is especially relevant at this time as dermatologic procedures often involve exposure to aerosolized particles and known carcinogens. Objective: To examine the barriers underlying historically low utilization of smoke protection among dermatologists Methods: A survey was sent to dermatologists through the Association of Professors of Dermatology (APD) list-serv and a cross-sectional analysis of responses was performed. Results: A total of 85 dermatologists responded. Twenty-four (28.2%) reported use of smoke evacuators during > 50% of dermatologic procedures. The odds of using smoke evacuation was 2.8 times higher in dermatologists with 10 or more years of experience (95% CI, 1.1-7.5; p=0.0358). The most commonly reported barriers to smoke evacuation were limited staffing (63.5%) and set-up time (61.2%). Sixty-seven (78.8%) respondents reported that a hands-free evacuator could potentially increase the use of smoke evacuation in their practices. Limitations: Survey sent on academic listserv with relatively small sample size and limited generalizability. Conclusions: Smoke evacuation remains low among dermatologists despite the risks. Identifying reasons for low utilization and receptiveness to potential solutions is necessary to improve safety practices relating to smoke evacuation.