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Safe use of electrosurgery in gynaecology
1. Safe use of electrosurgery in
gynaecology
Dr Muhamed Al Bellehy MD
Consultant Obstetrics and gynecology
Dr Muhamed Al Bellehy MD
2. the two types of electric current:
o direct current (DC), which moves in one direction
(unidirectional),
o AC, which periodically reverses direction
(bidirectional).
Electrosurgery electrocautery
the application of high‐frequency
alternating current (AC) in surgery to
achieve various thermal tissue effects
including cutting, desiccation and
coagulation.
the passive transfer of
heat to the tissue with no
current passing through
it.
uses AC with high frequency
o AC to avoid electrolysis
o high frequency to avoid the
Faradic effect of nerve and
muscle stimulation.
uses DC
Faradic effect ceases at frequencies >
100 kHz.
Because frequencies commonly used in
are >500 kHz, which are similar to
radiofrequency (RF), the term RF
electrosurgery is used.
Dr Muhamed Al Bellehy MD 2
21. Current flows 100% of
time + > 200 V
Tissue Vaporization Cutting
Current flows 6% of
time
Tissue Cools in between
form a coagulum
Coagulation +
Some Cutting when > 200 V
Dr Muhamed Al Bellehy MD 21
23. Coagulation +
Some Cutting when > 200 V
BLEND mode
Activate Current and higher Voltage in a certain way to obtain effect mixed
of cutting and coagulation
Dr Muhamed Al Bellehy MD 23
33. Contact area at
Dispersive blade 10000
times > active electrode
Current density at
Dispersive blade 10000
times < active electrode
Temp at Active
electrode 10000 times >
Dispersive blade
Dr Muhamed Al Bellehy MD 33
37. Increasing the Contact
area of the active
electrode decreases
current density more
coagulation
decreasing the Contact
area of the active
electrode increases
current density more
cutting
Dr Muhamed Al Bellehy MD 37
39. AKA electrosection
• Active electrode is held just
lightly against the tissue
• Using the cutting or blend
modes
• When using the blend mode
cutting + hemostasis of small
BVs
Excessive power sparking and tissue drag
Dr Muhamed Al Bellehy MD 39
40. AKA Spray
AKA non contact coagulation
• Use spark or fulguration mode
• Active electrode is held a small
distance from the tissue
• Spark of, electricity will pass to
the tissues minimal tissue
heating + large superficial
coagulum
Dr Muhamed Al Bellehy MD 40
41. • Use spark or fulguration mode
• Active electrode is held a small
distance from the tissue
• Spark of, electricity will pass to
the tissues minimal tissue
heating + large superficial
coagulum
Dr Muhamed Al Bellehy MD 41
44. • Coagulation mode *bi – mono
polar*
• Active electrode is held in
direct contact with the tissue
• This result in less heat gradualy
delivered and Spark of,
electricity will pass to the
tissues deep coagulum
Dr Muhamed Al Bellehy MD 44
45. • Use spark or fulguration mode
• Active electrode is held a small
distance from the tissue
• Spark of, electricity will pass to
the tissues minimal tissue
heating + large superficial
coagulum
Dr Muhamed Al Bellehy MD 45
46. • Best with bi polar*
Dr Muhamed Al Bellehy MD 46
57. Bowel perforation and injury
to perianal region will result in
leakage of methane and
hydrogen ?? fire
Alcohol disinfectants
not allowed to dry
?? fire
Dr Muhamed Al Bellehy MD 57
58. Hand held electrodes should
be kept in non conductive
place to avoid danger of
accidental activation
Dr Muhamed Al Bellehy MD 58
59. Activating the active electrode
when the not in contact with
patient’s body electrical
glove burns
Dr Muhamed Al Bellehy MD 59
60. Activating the active electrode when the
surgeon is in contact with active electrode and
the patient electrical pathway through the
surgeon’s hand electrical glove burns
Dr Muhamed Al Bellehy MD 60
61. Prolonged Activation of the active electrode
increased residual heat tissue injury
Short Activation of the active electrode should
be practiced
Dr Muhamed Al Bellehy MD 61
62. Prolonged Activation
of the active
electrode
increased heat
carbonization + tissue
sticks to the electrode
As the active
electrode keeps
contact with the
tissue
carbonization of
the sticking tissue
continue further
increase resistance
decrease
clinical effect
staff
wrongly
increase the
power
settings
the tip of the electrode should be kept clean !
Dr Muhamed Al Bellehy MD 62
65. Grounded Generators
1. The ground is part of the circuit
between the dispersive blade and
the generator
2. Current pass through the
dispersive blade to the ground
Dr Muhamed Al Bellehy MD 65
69. When the contact area
with the grounded object
is small and the
resistance is less than
that at the dispersive
blade
high current density at
the contact area
alternate site burn
Dr Muhamed Al Bellehy MD 69
70. Isolated
generators
The ground is not part of the circuit
between the dispersive blade and
the generator
The Current pass through the body and the
current returning through the dispersive
blade can be measured – and must be
almost equal
Dr Muhamed Al Bellehy MD 70
71. Isolated
generators
When the difference between Current the
passes through the body and the current
returning through the dispersive blade– is
too large system is deactivated
Dr Muhamed Al Bellehy MD 71
72. Isolated
generators
When the difference between Current the
passes through the body and the current
returning through the dispersive blade– is
too small system is not deactivated
When the difference– is too small not
necessarily indicates a leak
Thus there is a
small possibility
of alternate site
burn
Dr Muhamed Al Bellehy MD 72
73. Allow for a small leak Thus there is a small possibility
of alternate site burn
Dr Muhamed Al Bellehy MD 73
74. A visual check before the procedure, to
confirm that the patient is not contact with
a conducting object
Dr Muhamed Al Bellehy MD 74
75. Electricity may pass through a conducting
implantable burns
Dr Muhamed Al Bellehy MD 75
76. The dispersive blade should not be placed
near or over a conducting implantable
Piercings and jewelry near the surgical site
should be removed
Dr Muhamed Al Bellehy MD 76
77. Short bursts for 6 seconds
Use bipolar
Avoid monopolar over
surrounding tissues
Dr Muhamed Al Bellehy MD 77
80. Contact area at
Dispersive blade 10000
times > active electrode
Current density at
Dispersive blade 10000
times < active electrode
Temp at Active
electrode 10000 times >
Dispersive blade
Dr Muhamed Al Bellehy MD 80
81. When Contact area at
Dispersive blade is
reduced
Current density at
Dispersive blade is
increased
When Contact area at
Dispersive blade is
severely reduced
circuit blade burn
Dr Muhamed Al Bellehy MD 81
82. When choosing the site of dispersive blade consider
• Surgical site
• Contact with the table
• Accessories
• implants
Close to surgical site
Dr Muhamed Al Bellehy MD 82
83. When choosing the
site of dispersive blade
consider
• Choose a well
vascularized
muscular area
Dr Muhamed Al Bellehy MD 83
85. Poor placement of the
Dispersive blade
contact area is reduced
Decrease tissue effect
Staff increase power
output
Increase chance of
burns
Dr Muhamed Al Bellehy MD 85
88. Return electrode
monitoring (REM)
Uses a small amount of
current to measure the
conduction between the
two blades of the split
blade
If high resistance small
contract area or poor
tissue conduction
Dr Muhamed Al Bellehy MD 88
89. Return electrode
monitoring (REM)
Uses a small amount of
current to measure the
conduction between the
two blades of the split
blade
If high resistance small
contract area or poor
tissue conduction
THEN DEACTIVE THE
SYSTEM
Dr Muhamed Al Bellehy MD 89
97. When the cords are wrapped around an instrument
electromagnetic field will charge it with electric current
patient injury if in contact
Dr Muhamed Al Bellehy MD 97
98. Do not use near any electronic devices or connections
Dr Muhamed Al Bellehy MD 98
106. View during laparoscopy is limited to a conical area in
front of the endoscope
Dr Muhamed Al Bellehy MD 106
107. Contact of the instruments with tissues outside filed of
vision injury
• Bleeding
• Perforation
• Leakage of body fluids
• Ignition of bowel gases
X
• Do not activate the current when instrument is not
visualized or near any organ or other instruments
• Avoid contact of the tip shortly after activation
• Avoid prolonged activation of current to reduce
residual instrument heat
Dr Muhamed Al Bellehy MD 107
112. high voltage causes spark Direct coupling with out contact
Dr Muhamed Al Bellehy MD 112
113. To avoid this
• As low voltage as possible
• Cutting > coagulation
• Activate the current only when in direct conatct with the
tissues
Dr Muhamed Al Bellehy MD 113
120. When monopolar current is
used at high voltage
creates high
electromagnetic field
charge nearby instruments
with current
Dr Muhamed Al Bellehy MD 120
121. This does not occur with
bipolar instruments, as the
electromagnetic field has
opposing directions
Dr Muhamed Al Bellehy MD 121