RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA
BANGALORE
ANNEXURE – II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. /Name of the candidate &
Address (In block letters) / Dr. SANGAMESHWAR .A.PATILDEPT. OF SURGERY,
M.R.MEDICAL COLLEGE,
GULBARGA-585105
Permanent address / S/o ANNARAO PATIL,
POST INGALGI (VIA WADI) TALUK CHITTAPUR
DISTRICT GULBARGA
2. /
Name of the Institution
/ H.K.E.SOCIETY’SMAHADEVAPPA RAMPURE
MEDICAL COLLEGE,
GULBARGA – 585105
3. /
Course of study and subject
/ M.S. (GENERAL SURGERY)4. /
Date of admission to course
/ May 20095. /
Title of the topic
/ COMPARATIVE STUDY OF ABDOMNAL INCISION MADE BY ELECTROCAUTREY AND STEEL SCALPEL6. / Brief resume of the intended work
6.1 / Need for the study:
Before the introduction of non explosive anaesthetic agents,electro surgery instruments had only limited usage.Originally advised for use underwater in transurethral work,this equipment later gained acceptance in areas such as pelvic surgery,minor skin procedures,and neurosurgery.Today it is widely used in many tissues, but few surgeons employ it to open skin. This reluctance to start abdominal operation with this device is attribute to the belief that an increase in devitalised tissue due to burning might lead to an increase in infection rate and that there is an increased likelihood of keloid formation in a scar produced by thermal cut.
In our setup there have been no studies comparing the study of abdominal incision made by elecrocautery and steel scalpel. Hence this study has been taken up.
6.2 /
Review of literature
THOSE DISEASES WHICH MEDICINE DOES NOT CURE,IRON CURES;THOSE WHICH IRON CANNOT CURE FIRE CURES;THOSE WHICH FIRE CANNOT CURE ARE TO BE RECKONED INCURABLE.The use of electricity in medicine dates back atleast to the late 16th century when William Gilbert,physician to Queen Elizabeth performed experiments with magnetism and electricity that led to his title of ‘Father of Electrotherapy’.
Literature:
In 1891 D’Arsonial led the actual groundwork for electrosurgery with his work on high frequency currents which established the limit of approximately 10000 hertz above which there was no neuromuscular stimulation,and documented the the associated temperature in body temperature and respiration.The biterminal D’aarsonial apparatus was capable of delivering a high current with a spark from 5-15 mm long in air,which produced an analgeic effect without pain.1
In America William Clark,working without knowledge of European studies altered available machines to produce more amperage for greater destruction of tissues. He coined the term ‘dessication’ and used his apparatus to remove any sort of surface growth,including intraoral malignancy,breast cancer and cancer of cervix.2
A study conducted by Ellis ,was one of the earliest reports on the breaking strength as a parameter of wound healing.He found that only 60 % of wounds in skin of dogs healed per primum as compared to 97.5% of those made with a steel scalpel and that the breaking strength of those that healed did not equal that of the scalpel wounds for 21 days.3
A study conducted by Rappaport et al have described an increased incidence of tissue damge and significant reduction in tensile strength of healing wounds .The continuous current used for cutting produces intense heat so rapidly that the tissues explode into steam leaving a cavity in the cell matrix.4
A study conducted by Allan et al noted that statistically significant differences occuring in the 1st and 35 th postoperative day, was probably a consequence of the scalpel wound being held together by fibrin whilst the diathermy wounds were held together by the necrotic tissus produced by the passage of electric current.However between the 7th and 10 th postoperative days when wound dehiscence is more likely to occur,no difference in the rupture strength could be detected.5
A study conducted by Arnaud et al in 1980 published his own work,in which he concluded that no difference was apparent in bursting strength between scalpel and diathermy incision in rats.Complete repair had occurred across the abdominal wound at the 15th day and no histological delay in the process of healing was noted.6
A study conducted by Pearlman et al has shown scalpel incisions are associated with greater blood loss than electrocautery incisions.Cautery incisons were less painful and no differences in the number of wound seromas/ infections were noted between the treatment groups.7
A study conducted by Lawrenson et al revealed no apparent difference in tensile strength between scalpel incisions and electrocautery incisions at 1 week ,although there was a histological difference however at 1 month, no microscopic or histological difference could be observerd between the 2 groups.8
7 / 6.3 /
Objectives of the study
1. to compare the use of electrosurgery and steel scalpel in making adominal incisions with regards to2. Wound blood loss
3. Operating time
4. Wound infection rates
5. Postoperative pain
7. / Material and Methods
7.1 / Source of Data:
Patients admitted in all surgical units of Basaveshwar Teaching and General Hospital
7.2 /
Methods of collection of data (including sampling procedure, if any)
Methodical entry of records of patients admitted and treated at Basaveshwar Teaching and General Hospital Gulbarga .Data is entered in the Proforma made for the study is collected for the study.Inclusion criteria:
Any patient requiring Kidney incsions,Midline laporotomy incisions,Kochers incision for surgical treatment
Exclusion criteria:
1. Patients requiring incisions to be made over previous surgical scars
2. Patients on anti coagulant therapy
3. pregnancy
4. emergency surgeries
Age group:15-70 years old
Study duration: 18 months from DECEMBER 2009 to MAY 2011
No of cases: 60
Mode of study: control group study
7.3 /
Does the study require any investigation or intervention to be conducted on patients or other humans or animals? If so please describe briefly.
Yes, the study requires investigations like –· Complete Haemogram (Haemoglobin, Total leucocyte count, Differential leucocyte count, Erythrocyte sedimentation rate)
· Urine routine, microscopy,
· Blood urea and serum creatinine
· HbSAg and HIV
· Plain X ray abdomen - erect posture/supine
· Serum electrolytes
· Blood sugar
· Chest x ray
7.4 / Has ethical clearance been obtained from your institution in case of 7.3?
YES. Ethical clearance has been obtained from “Ethical Clearance Committee” of the institution for the study. It is in the form of signature from Head of Dept. Surgery and Dean of M R Medical college Gulbarga.
8. / List of References
1. Glover JL,Bendick PJ,Link WJ.The use of thermal knive sin surgery:electrosurgery,lasers,plasmascalpel.Current problems in surgery 1978;15:1-78
2. Kearns Sr,Conolly EM, MC Nally S,MC Namara DA,Deasy J.Randomised clinical trial of diathermy versus scalpel incisions in elective midline laparotomy.Br J Surg 2001 ;88:41-44
3. Lawrenson KE,Stephens FO.The use of electrocutting and electrocoagulation in surgery Aust NZ J of Surg 1970;39(4):417-421.
4. Rappaport WD,Hynter GC,Allen R et al.Effect of electrocautery on the healing of midline laparotomy incisions.Am J surg 1990;160:618-620.
5. Allan NS,Spitz S,Black MM et al.comparitive study of scalpel and electrosurgical incisions on subsequent wound healing.J Pediatrr Surg 1982;17(1) :52-54.
6. Arnaud Jp,Adloff M,.electrosurgery and wound healing;An expeimental study in rats.Eur J Surg 1980;12(6):439-443.
7. Pearlman NW ,Steigmann GV, Vance V et al.Arch Surg 1991;126:1018-1020
8. Lawrenson KE,Stephens FO.The use of electrocutting and electrocoagulation in surgery Aust NZ J of Surg 1970;39(4):417-421.
9. /
Signature of Candidate
10. /Remarks of Guide
/ Eletrosurgery has now become an indispensable tool in every operating room and is now being used as choice of abdominal incision over the routinely used scalpel incision.Hence this gives good scope for comparative study .11. / Name & Designation of (in block letters)
11.1 Guide
/ Dr. R.G.DEVANI M.S {GE.NERAL SURGERY}PROFESSOR
DEPT. OF SURGERY
M.R.MEDICAL COLLEGE, GULBARGA.
11.2 Signature
11.3 Co-guide (If any)
/ Nil11.4 Signature
/ nil11.5 Head of the Department
/ Dr. S.A.HALKAI M.S {GENERAL SURGERY}PROFESSOR & HEAD
DEPT. OF. SURGERY
M.R.MEDICAL COLLEGE, GULBARGA.
11.6 Signature
12. /12.1 Remarks of the Chairman and Principal
12.2 Signature