title: Strategies to minimize adhesion formation after surgery.
abstract: OBJECTIVE
  To compare the potential for postoperative laparoscopic adhesion formation utilizing either monopolar cautery or ultrasonic energy and to determine whether there is added benefit with the addition of a suspension of hyaluronate/carboxymethylcellulose in saline versus  saline alone.
  
  
  METHODS
  Injuries were induced in rabbits by using monopolar cautery on 1 uterine horn and adjacent sidewall and ultrasonic energy on the opposite. Hyaluronate/carboxymethylcellulose or saline was added to every other animal. Autopsies were performed after 3 weeks.  Clinical and pathologic scoring of adhesions was performed by blinded investigators.
  
  
  RESULTS
  A very significant difference occurred in pathologic adhesion scores favoring the ultrasonic scalpel when the animals were treated with saline. However, a borderline significant difference  was found in pathologic scores favoring the ultrasonic scalpel compared to the monopolar cautery. There was no significant difference in clinical adhesion scores between the 2 modalities. No significant difference in either score was found with the addition of hyaluronate/carboxymethylcellulose  or saline with either instrument.
  
  
  CONCLUSIONS
  No benefit was found for adhesion prevention with hyaluronate/carboxymethylcellulose. Although no reduction was achieved in clinical adhesions, the ultrasonic scalpel resulted in fewer histologic signs of tissue inflammation in the early  postoperative period, suggesting that further clinical adhesions might develop over time with cautery.
authors: Department of Obstetrics & Gynecology, Divisions of Minimally Invasive Surgery, Winthrop University Hospital, Mineola, New York 11501, USA. pfvgyn@aol.com
authors: Patrick F
authors: PF
authors: Vetere
authors: George
authors: G
authors: Lazarou
authors: Carlene
authors: C
authors: Mondesir
authors: Kai
authors: K
authors: Wei
authors: Poonan
authors: P
authors: Khullar
authors: Lorna
authors: L
authors: Ogden
mesh_terms: D000818:Animals; D002266:Carboxymethylcellulose Sodium / Q000627:therapeutic use; D004564:Electrocoagulation; D006820:Hyaluronic Acid / Q000008:administration & dosage / Q000627:therapeutic use*; D008567:Membranes, Artificial; D011817:Rabbits; D012965:Sodium Chloride / Q000627:therapeutic use; D000267:Tissue Adhesions / Q000517:prevention & control*; D014464:Ultrasonic Therapy
chemical_list: D008567:Membranes, Artificial; C118198:Seprafilm; D012965:Sodium Chloride; D006820:Hyaluronic Acid; D002266:Carboxymethylcellulose Sodium