الفهرس 
Chapter (1): Cesarean sectionOnly 14 pages are availabe for public view
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Abstract
Cesarean section is one of the most frequent major surgical procedures performed worldwide (Bamigboye and Hofmeyr, 2003), and it has various operative techniques (Mathai and Hofmeyr, 2007).
The surgical techniques for performing cesarean delivery had changed from time to time, from surgeon to surgeon and these changes were involved both of the uterine and skin incisions(Dahlke et al., 2013).
Traditionally scalpels are used for making skin incisions that produce little damage to surrounding tissues. However, there has been a continuous surge in identifying other methods of skin incision and in the past years electrosurgical instruments had achieved great attention in this regard (Kumar et al., 2015).
There has been a widespread use of diathermy for haemeostasis, but fear of production of large scars and improper tissue healing has restricted their usage in making skin incisions (Ly et al., 2012). Electrodes used in making diathermy incision generate a pure sinusoidal current which produces cleavage in tissue planes without creating damage to the surrounding areas. This is one of the reasons of less damage inflicted to the tissues leading to minimal scar formation (Kearns et al., 2001).
Skin bleeding is the problem after starting surgery. A continuous skin bleeding may obscure the operating field, and the surgeon feels discomfort, number of gauze pieces, suture material, and precious operating time is also wasted. The usage of diathermy cautery decreases skin bleeding and total operative time also shortens (Valluru et al., 2015).
Diathermy incision is a safe and expedient technique. It takes less time than scalpel incision and loss of blood also lower during incision.
Diathermy is associated with lesser post operative pain and complications than the scalpel incisions (Talpur et al., 2015).
E.S.U is an essential instrument in operation theatres. E.S.U is the most common electrical equipment in operation theatres. Diathermy incision is quick and has reduced blood loss (Ahmad and Ahmed, 2011).
Cutting mode diathermy skin incisions are more comfortable to the patients and the surgeons also. There is so much of the literature that suggests the usage of high-frequency cautery for making surgical incision (Valluru et al., 2015).
Electrosurgical technology offers essentially two types of devices for energy delivery: monopolar and bipolar. The monopolar instrument, the Bovie being the most common example, delivers current through an active electrode, which then travels through the patient and back to the generator through a conductive adhesive grounding pad applied to the patient before beginning the procedure. Bipolar instruments resemble surgical forceps, with both the active electrode and the return electrode functions being performed at the surgical site. The electrosurgical energy does not travel through the patient but is confined to the tissue between the forceps (Massarweh et al., 2006).
The aim of this study was to compare the use of diathermy versus scalpel in making skin incision during cesarean section regarding post operative pain, incision time, incisional blood loss, operative time,wound healing and wound complications.
This was a randomized, comparative study conducted in obstetrics and gynecology department of Menoufia University Hospital and obstetrics and gynecology department of Shobra General Hospital from March 2016 till February 2017.
Patients included were 200 pregnant women who underwent elective cesarean section.
Excluding criteria included patients with incomplete data or whom were lost during follow up, emergency cesarean section, anemia (HB<10gm %), diabetes mellitus, cardiac disease (anticoagulant therapy), liver impairment, renal impairment and immunocompromised (steroid therapy).
All the operations were performed under general anesthesia. Antibiotic prophylaxis was given (a single dose of first generation cephalosporins) at the time of induction of anesthesia.
The participants were divided into 2 groups, 100 women had skin incised with scalpel and 100 women had skin incised with diathermy (cutting mode).
In this study the skin and subcutaneous tissue were incised with scalpel or a diathermy pen electrode set on cutting mode delivering pure sinusoidal current of 360 KHz by a low transverse incision according to each group till parietal peritoneum which was opened bluntly. Hemostasis was performed with coagulation diathermy, and large subcutaneous veins were suture ligated in patients of both groups. Closure was in layers (uterus, peritoneum, muscles and sheath). Subcutaneous tissue was sutured with vicryl 2-0 and skin was sutured subcuticularly with proline 2-0 with no drain.
Results of this study demonstrated that diathermy incision was associated with significantly less incision time and operative time than scalpel incision.
Results of this study also demonstrated that diathermy incision was associated with significantly less blood loss than scalpel incision.
As regard postoperative pain, results demonstrated that pain scores were more in scalpel than diathermy incision at 1, 4, 8, 16 & 24 hrs postoperatively.
As regards wound healing and wound complications rate, results demonstrated that there was no significant difference between diathermy and scalpel incision.
In conclusion, the use of diathermy for skin incision in cesarean section in this study was associated with reduced incisional blood loss, incisional time, operative time and postoperative pain. It has no effect on wound closure (epithelialization) and was not associated with any delay in wound healing. It has been adjudged safely in this study if conducted in the proper way and manner with little or no side effect.