Dear Sir, I read with great interest the cold coagulation of pulmonary bleb / bullae. It should help to minimize the collateral damage of hot coagulation. However, this damage can be effectively minimized by setting the coagulataion setting to about 10-12 (on a Valleylab cautery machine). This setting is frequently used by me while doing LVRS when tiny emphysematous blebs are noted along the margins of lung. Also, this setting is used for endobronchial ablation of tumours without any visible collateral damage on subsequent bronchoscopy. I have seen even cardiac surgeons using this setting over epicardium for tiny bleeding points. Hope this helps the surgeons who don't have access to cold coagulation RF system. With kind regards. Dr. Satinder Kumar Jain Senior Consultant Cardiothoracic & Vascular Surgeon C-20/A, New Krishna Park Vikaspuri, New Delhi - 110018 India
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