Radio Surgical Treatments with the radioSURG® 2200
Removal of a Gynecomastia ambilateral
Case Report
The 19 year old patient was suffering from Gynecomastia ambilateral, which he wanted to be
removed before he was going to serve the military.
Fig.1: Preoperative, left hand side
The surgical team
The Surgical Procedure
The intended incision is marked at the mammary areola (Fig. 2). The inner line is for the real
incision and the outer line for the perimammary arc resection after removal of the fatty
tissue.
The initial cut is performed with the fine needle electrode No. 41 (Fig. 3) which allows
adjusting the length of the wire according to the situation. The unmodulate wave was
chosen because it causes the lowest lateral heat. The setting was CUT 27 watt. To increase
the conductivity when working on the skin surface it is important to moisten the skin in
advance with a wet swab. In deeper layers this is not necessary any longer. It is clearly
visible that the surgical margins are not discoloured or necrotic.
Fig.2: The designated cutting lines are
already marked out.
Fig.3: The initial cut is performed with the
fine needle electrode No. 41
Smaller bleedings are stopped immediately via bipolar forceps, setting bipolar coagulation 22
watt, coagulation degree c5 (Fig.4).
Fig.4: The bipolar hemostasis is
especially gentle.
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Fig.5: The preparation of the fatty tissue is
performed via the long slender blade electrode
The preparation of the fatty tissue is performed via the long slender blade electrode (Fig.5). As
the conductivity of fatty tissue is rather poor the unit must be set higher. In this case, the fatty
tissue was prepared and removed with the pure cutting current at 47 watt. (Fig.6 and Fig.11).
The red muscle pectoralis major, which was not hurt, is clearly visible (Fig.7).
Fig.6: The fatty tissue is removed.
Fig.7: The intact muscle pectoralis major
Following the perimammary arc resection is performed along the marked outer line (Fig.8).
Due to this a new mastopathy is avoided by lifting the tissue. The breast is now flat. Also
here it can bee seen clearly, that in spite of using radio frequency surgery the tissue showed
no discoloration and, therefore, no necroses (Fig.9). The wound was closed with resorbable
thread, in this case Vicryl (Fig.10).
Fig.8: Perimammary arc resection
Fig.9: In spite of using radio frequency surgery
the tissue shows no discoloration.
Fig.10: Wound closure with Vicryl-thread
Fig.11: The weight of the removed fatty tissue was on the left hand side
10 gram, on the right hand side 12 gram
The surgeon
The difference between pre- and postoperative status can definitely be seen.
The patient was able to leave the hospital after some hours.
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Conization at the Portio Uteri
Case Report
The 27 year old patient suffered an abort 7 days ago. Within the abort curettage a
conspicuous Portio result was diagnosed, a histological cervical dysplasia grade 3, also
referred to as CIN III. Therefore, the conization became necessary.
Special Electrodes for the Conization
For this application the special electrode BIO-CONE is available (Fig.1 and Fig.2). This
electrode offers additional to the diagonal mounted cutting wire a rotary disk with 3 thorns.
The wire rotates around the little fixation disk, so the conus can be extracted accurately.
Fig.1: The fixation thorns are clearly visible.
Fig.2: With the corrugated shaft end the activated electrode
is quickly turned 360 degrees.
The Graphics Clarify the Mode of Operation:
The BIO-CONE electrode is inserted into the endocervicale canal and the cervix is fixated via the
stabilization thorns. Following, the shaft of the activated electrode is quickly turned around 360
degrees. The radio surgical unit will be deactivated and the BIO-CONE electrode will be removed
together with the tissue sample.
Nine sizes of the BIO-CONE electrodes are available – from narrow deep to short flat.
The Surgical Procedure
The use of the BIO-CONE electrode is unproblematic. The conus can be extracted without
difficulties. As the excision had to be examined histo-pathologically the extraction was
performed with the cutting and coagulation wave CUT/COAG, 65 watt, coagulation degree
c3. At this, the lowest heat is generated and the excision can be examined up to the incision
edges.
Fig.3: Status preoperative
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Figures 4-6: The BIO-CONE electrode which has been inserted into the endocervicale canal is activated and turned around 360
degrees quickly with the corrugated end of the shaft. The cutting wire gently separates the tissue.
Histo-pathological Examination of the Excisions up to
the Incision Edges possible
As the histological examination of the excision has to be performed up to the incision edges,
it is of great advantage, that the margins of the extracted conus are not discolored or
necrotic due to the generated low heat.
Fig.7: The excision can be examined up to the incision edges, as it is not discolored
or necrotic.
Hemostasis and Postoperative Treatment
Due to the fact that the patient was pregnant one week ago, the vessels are still well
supplied with blood. Therefore, the bleeding is stronger as under normal conditions.
The hemostasis (Fig.8) is performed via ball electrode, setting the radio surgical unit
radioSURG® 2200 at MONO COAG 60 watt (Fig.9), coagulation degree c3.
Fig.8: hemostasis via ball electrode
Fig.9: Settings at the radioSURG® 2200 unit
Fig.10: Operating staff
After the bleeding has been stopped the patient is supplied with a vaginal tamponade.
Recommendations for the Patients
It is basically recommended, that the patients should rest a lot for the next 2 weeks and
strictly refrain from full baths, public spas, saunas and sexual intercourse for 4 – 6 weeks.
Normally the patients can leave the hospital the same day.
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Gynecological Sample Excisions
Case Report
During a gynecological routine checkup of a 68 year old patient, the smear showed a
conspicuity making sample excisions necessary.
Due to the age of the patient the vulva is atrophied and already removed on the right hand
side. (Fig.1 and Fig.2).
Fig.1: The already anesthetized patient
Fig.2: Status preoperative
The Surgical Procedure
The excisions were performed via a diamond electrode, setting filtered cutting current CUT,
22 watt (Fig.3). Without pressure and tension the tissue samples can be taken. Almost no
bleeding occurred.
Fig.3: The sample excisions were taken via a diamond
electrode.
Fig.4: It is clearly visible that the incision edges of the
sampling areas are not discolored or necrotic.
Three sample excisions are taken in the positions 12, 9 and 6 o'clock (Fig.4). Again it is of
great importance that prior to the excision the skin surface is lightly moistened with saline
solution to raise the conductivity of the radio waves.
The Sample Excisions can be Histo-Pathologically
examined up to the Incision Edges.
Due to the gentle surgery method with radio wave surgery the excisions can be histopathologically examined up to the incision edges, as they are neither discoloured nor
necrotic. This is an immense advantage of radio surgery. The healing process of the excision
areas occurs usually without problems as normally after radio surgery. The patient can leave
the hospital after some hours.
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The Surgeon
Advantages of Radio Surgery
The application of radio surgery is a great advantage in all surgical areas. With the thin
needle electrodes all surgical and anatomical lines can be followed. The cutting can be
carried out without tension or pressure. The subcutaneous fatty tissue does not shift or slide.
The operation area is to the largest extend free of bleeding as it is possible to set a fitting
coagulation degree. This gives a clear overview over the operation area. The development of
heat is much lower with radio surgery as in conventional HF-surgery, a cosmetically flawless
and appealing result is always generated. Healing process takes place without bothering scar
tissue.
When using radio surgery and the BIO-CONE electrode for conization, almost no bleeding
occurs after the surgery and the patients have less post-operative pain. The operation can
be performed ambulant. Applying radio surgery in the megahertz range has the advantage,
that the excision can be extracted with much less heat development. In radio surgery this is
called "cold cutting", not to be confused with the conventional HF-surgery working in the
kilohertz range. As the excisions can be histo–pathologically examined up to the incision
edges and bleeding is minimal, the radio surgery method is superior to the use of the scalpel
or laser surgery.
The radio surgery unit radioSURG® 2200 can be used for all kinds of surgery and not only
for the above mentioned cases. Because of the broad range of application the costs for
purchasing this devise are fast amortized, and are only a small amount compared to the
purchase of a high cost laser. radioSURG® 2200 is an universal unit for all medical fields.
For all radio surgical treatments the use of a smoke evacuation system is
recommended.
RadioSURG® 2200 – one unit for all
surgical procedures.
The surgeries were performed in the gynecological Hospital St. Vincenz - a
DKG-DGS* certified Breastcenter - Limburg/Lahn – by Chief Physician –
Dr. Peter Scheler, MD.
Thank you for the support.
* DKG = Deutsche Krebs Gesellschaft / DGS = Deutsche Gesellschaft für Senologie
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