Bipolar Cautery in Aneurysms: Effective but Underutilised Technique
Vikas Janu, Raghavendra Kumar Sharma, Mohit Agrawal, Ashutosh Jha, Jigish Ruparelia, Suryanarayanan Bhaskar, Deepak Kumar JhaABSTRACT
Background:
Bipolar cautery for aneurysms is an effective technique, described in the literature about 50 years back by Yasargil, however, there is an inadequacy of articles highlighting the technique.
Materials and Methods:
Operative videos of aneurysm surgeries were analysed to select the videos/photographs which can help readers to understand the technical nuances of using bipolar cautery during aneurysm surgeries. Cautery was used after the completion of sharp dissection around the neck and demarcation of proximal and distal vessels in non-giant aneurysms. Cautery setting was kept around 10%–20% of the maximum. Blunt tip forceps were used with continuous irrigation. A shaft instead of the tip of the cautery was used.
Results:
Bipolar cautery resulted in the shrinkage of the wall of the aneurysm. It had a similar effect on the neck, fundus or transition zone between the neck and fundus. It helped in controlling the bleeding from the fundus even during intraoperative rupture of the aneurysms. Even the flimsy wall of the fundus shrunk, which prevented their rupture during dissection. It was very useful to make giant aneurysm fundus shrink to a smaller size providing space for dissection. The wide neck could be modified to a desirable shape for easier clip applications.
Conclusion:
Fear of intraoperative rupture by cautery appears misconceived. It causes shrinkage of the wall of the aneurysm, can stop bleeding from the fundus and can change the shape of the neck fundus, which helps clipping the aneurysms easily.