A range of energy sources are used in gynecologic laparoscopy. These energy sources include monopolar electrosurgery, bipolar electrosurgery (including “advanced bipolar” devices that incorporate tissue feedback monitoring), and various types of laser and ultrasonic technologies
3. HISTORY
• 3000 B.C- Egyptians used heat to
treat tumour (Firedrill)
• 1881: Morton- 100,000 Hz does
not produce shock
• Origin of Electrosurgery :Dr P
Bozzini - Electrocauterization
(1887)
• First high frequency current
used - 1893
• Dr William Bovie and Dr Cushing
-Pioneer of Modern
Electrosurgery(1926)
Dr Bovie
Dr Cushing
4. ENERGY SOURCES & ITS DEVICES
Electrosurgery- 1)Monopolar
2)Bipolar
i. Ligasure
ii. Gyrus PK
iii. Enseal
iv. Caiman
Ultrasonic - Harmonic ACE
Integrated - Thunderbeat
6. PROPERTIES OF ELECTRICITY
• Ohms Law V=I x R
Where V=Voltage
I=Current
R=Resistance
• The passage of high frequency
electric current through tissue
creates the desired clinical
effect.
•Current flows through Path of
Least resistance
7. ELECTROCAUTERY ≠ ELECTROSURGERY
• Electrosurgery is not synonymous with electrocautery, despite their mutual
use of electrical current to deliver their respective treatment goals.
• Electrocautery uses electrical current to heat a metal wire that is then applied
to the target tissue in order to burn or coagulate the specific area of tissue. It
is not used to pass the current through tissue, but rather is applied directly
onto the targeted area of treatment.
• Electrosurgery - Electrical current passes through tissue to accomplish a
desired result. The electricity used is a form of alternating current similar to
the that used to generate radio waves.
13. BIPOLAR ELECTROSURGERY
• The two tine (prongs) forceps
functions as active and return
electrodes
• Grasped tissue completes the
circuit
• Coagulation
• Less thermal injury
14.
15.
16. FACTORS MODIFYING THE TISSUE EFFECTS
CURRENT DENSITY VS TISSUE IMPEDANCE
• Size of active electrode
• Cut or Coagulation mode
• Power setting
• Duration of exposure
• Tissue Impedance
21. • Seal time: 2-4 seconds
• Seals vessel upto 7 mm
• Tolerates 3 times SBP
• Max. Temperature 60-90⁰C
• Thermal Spread 4.5 mm
22. ENSEAL
• Only System Control energy deposition
• Nonpolar thermostat in jaws
• Adjusts energy according to tissue
impedance
• Less heat required: Tissue
• Volume reduced by compression
23. • Seals vessel 1 to 7 mm
• Tolerates 7 times SBP
• Seal Temperature 100⁰C
• Thermal Spread 1 mm
24. PLASMA KINETIC GYRUS
• Plasmacision
• Bipolar PK Technology
• Serrated Jaw
• No Feedback Controlled System but an audio
alarm
25.
26. CAIMAN
• Tip first closure: Retains tissues within
the jaws for improved compression
• Advanced Bipolar Seal & Cut technology
• 80⁰Articulating Jaw
• Seals vessels 7 mm
• Thermal spread <1mm
33. • Cut and coagulate simultaneously
• Uses ultrasonic vibrations instead
of electric current
• Cut through thicker tissues
• Takes longer time
• Hemostasis only along with cutting
• Mist production affects visibility
• Minimal energy transfer (1mm) to
surrounding tissue so it cannot
cause bowel injury!!
34.
35. THUNDERBEAT
• World’s 1st and only integrated energy
system
• Hybrid device
• Combines ultrasonic and bipolar energies
• Precise dissection
• Best visibility
• Fastest cutting speed
• Minimal thermal spread (<1mm)
• Only Cut
• Only hemostasis without cutting also
possible
36.
37. ADVANCES IN ELECTRO SURGERY
• Tissue Response Generator
• Split return electrode pad
• Active Electrode Monitoring
• Voice Command System
• Argon Plasma Coagulation
43. • Active Electrode Monitoring (AEM) Technology-
System in which shielded and monitored instruments
continuously direct stray energy, the cause of stray
electrosurgical burns, away from the patient via a
protective shield.
46. TAKE HOME MESSAGE
• Making the correct choice of energy sources makes a lot of
differences.
• Not only the correct choice but understanding the limitations
of these technologies is also essential.
• Cost factor.
• Thermal spread.