Background: Electrocautery during fetoscopic surgery is impossible in the electrolyte-containing amniotic
fluid. Intrauterine insufflation of carbon dioxide may cause lethal hypercapnia and acidosis
in the fetus. Therefore, other media must be considered.
Objective: To evaluate the efficacy of electrocautery in different media that have been described
for fetoscopic surgery.
Materials and Methods: Using bipolar electrocautery, lesions were made in 16 skin/cartilage specimens
from the ears of New Zealand White rabbits in 5 different media: air, 85% glycerine, 1.5%
glycine, electrolyte solution, and perfluorodecalin. The efficacy of electrocautery in the different media
was compared by calculating mean necrosis indices—the quotient of native to necrosed tissue
thickness—and assessing the qualitative histologic changes.
Results: In all media except the electrolyte solution, the cauterized areas showed clear sequellae
of electrocautery such as thinning, loss of tissue architecture, increased stromal staining, and nuclear
disintegration. Mean necrosis indices were 1.38 ± 0.24 for air, 1.37 ± 0.28 for glycerine, 1.32 ±
0.23 for perfluorodecalin, 1.31 ± 0.14 for glycine, and 1.05 ± 0.10 for electrolyte solution (P < 0.01
for electrolyte solution compared to all other media). No significant differences were detected between
the nonconductive substances.
Conclusion: In our tests, air, glycine, glycerine, and perfluorodecalin allowed similarly effective
electrocauterization. As expected, bipolar electrocautery in electrolyte solution is ineffective. The
perfluorocarbon perfluorodecalin may have other potential advantages as a medium in endosurgery,
such as low surface tension, biologic inertia, optical clarity, and insolubility of blood.
