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Energy Sources in SurgeryDr. M. RameshDirector,B.E.S.T. Institute & Research Centre.A V Hospital,Bangalore, India.
Dr.M.RameshELECTROSURGERYDEFINITION• Electrosurgery is the use of radiofrequencyalternating current to raise cellulartempe...
Dr.M.RameshHistorical Background16th Century Application of electricalcurrent in living tissues1890s d’Arsonal High freque...
Dr.M.RameshCurrent (I) is a measure of the electron momentpast a given point in the circuit in a fixed period oftimes ~amp...
Dr.M.RameshOdell water tower analogyB.E.S.T.Institute
Dr.M.RameshOhm’s Law: I = V/RW = V x I= V x (V/R) = V2/ RI = CurrentV = VoltageR = ResistanceP = PowerB.E.S.T.Institute
Dr.M.RameshElectrosurgical Unit• Converts a 60 cycles / sec (60 Hz), lowvoltage alternating current into highervoltage rad...
Dr.M.RameshElectrosurgical CircuitsB.E.S.T.Institute
Dr.M.RameshBiological effects of ElectricCurrents• Electrolytic effect - Low frequency AC &DC.• Faradic effect - High freq...
Dr.M.RameshTissue effects of R.F.ElectricalCurrent• Vaporization or cutting• Desiccation or coagulationboth continuous or ...
Dr.M.RameshTissue Effects of ElectrosurgeryB.E.S.T.Institute
Dr.M.RameshMonopolar ElectrocauteryADVANTAGE• Easy to use• Cutting and Coagulation currents• Dissecting capabilitiesDISADV...
Dr.M.RameshMonopolar CuttingA higher voltage leads to a higher sparkintensity and a higher spark intensity resultsin a dee...
Dr.M.RameshBipolar ElectrocauteryADVANTAGE• Small volume of tissue injured• Less risk of burn injury• Safe with pacemakers...
Dr.M.RameshElectrodes & Tissue ContactB.E.S.T.Institute
Dr.M.RameshVariables affecting the tissueeffects of radio frequency current.• Generator output• Power density(size & shape...
Dr.M.RameshAdvantages of Electrocutting• Reduced bleeding• Preclution of germ implantation• Avoidance of mechanical damage...
Dr.M.RameshTissue effects of heatingB.E.S.T.InstituteTemperature (Centigrade)---------------------------------------------...
Dr.M.RameshTissue effects of heatingB.E.S.T.InstituteTemperature (Centigrade)---------------------------------------------...
Dr.M.RameshComplications• Endogenous burns• Exogenous burns• Pseudo burnsB.E.S.T.Institute
Dr.M.RameshComplications• Active Electrode Trauma• Current diversion– Alternate ground site burns– Direct coupling– Indire...
Dr.M.RameshDirect & Indirect CouplingB.E.S.T.Institute
Dr.M.RameshCapacitive CouplingB.E.S.T.Institute
Dr.M.RameshDispersive Electrode burnsB.E.S.T.Institute
Dr.M.RameshArgon Beam Coagulator• Uses a spray of ionized argon gas as theactive electrode rather than a metallic blade• A...
Dr.M.RameshCryotherapy• A technique of in situ tissue ablation thatuses freezing temperatures to cause celldeath• Used for...
Dr.M.RameshCryotherapyMechanism of action:Cold shock injuryReduction in cell volume by osmotic dehydrationDenaturation of ...
Dr.M.RameshInfrared Coagulator• Generates coagulation heat energy byinfrared irradiation• Hand held wand is a round metall...
Dr.M.RameshUltrasound Dissector• Uses high-frequency mechanical vibrationsto fragment tissue• Used in ophthalmic, neuro, h...
Dr.M.RameshUltrasonic knife• Produces vibrations at 55.5KHz at the tip ofthe blade via a hand piece transducer• The moving...
Dr.M.RameshLASER• Light Amplification by the SimulatedEmission of Radiation• Differs from regular light in the followingpr...
Dr.M.RameshLASERLasers primarily being used for surgery• Carbon Dioxide• Nd:YAG• Argon• Ho:YAG• KTP• Diode
Dr.M.RameshTHANKYOUB.E.S.T.InstituteVisit www.lapsurgery.net
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Electrosurgery.ppt

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Electrosurgery.ppt

  1. 1. Energy Sources in SurgeryDr. M. RameshDirector,B.E.S.T. Institute & Research Centre.A V Hospital,Bangalore, India.
  2. 2. Dr.M.RameshELECTROSURGERYDEFINITION• Electrosurgery is the use of radiofrequencyalternating current to raise cellulartemperature as a way to vaporize orcoagulate tissue.• Cautery (Kauterion = hot iron)destruction or denaturation of tissue is by apassive transfer of heat or application of acaustic substance.B.E.S.T.InstituteB.E.S.T.Institute
  3. 3. Dr.M.RameshHistorical Background16th Century Application of electricalcurrent in living tissues1890s d’Arsonal High frequency A.C.1908 Lee de Forest H.F generator usingvacuum tubes1926 W.T. Bovie Low-cost spark-gapgenerator1950s Nonflamable inhalationanastheticsB.E.S.T.Institute
  4. 4. Dr.M.RameshCurrent (I) is a measure of the electron momentpast a given point in the circuit in a fixed period oftimes ~amperes.Voltage (V) is the pressure with which theelectrons are pushed through the tissue ~volts.Resistance (R) is the measure of the difficulty thata given tissue presents to the passage of electrons~ohms.Power (W) is the capacity to do work / unit time~watts. B.E.S.T.Institute
  5. 5. Dr.M.RameshOdell water tower analogyB.E.S.T.Institute
  6. 6. Dr.M.RameshOhm’s Law: I = V/RW = V x I= V x (V/R) = V2/ RI = CurrentV = VoltageR = ResistanceP = PowerB.E.S.T.Institute
  7. 7. Dr.M.RameshElectrosurgical Unit• Converts a 60 cycles / sec (60 Hz), lowvoltage alternating current into highervoltage radio frequency (500 KHz - 3.0MHz) current.• Produces current with a variety of waveforms.B.E.S.T.Institute
  8. 8. Dr.M.RameshElectrosurgical CircuitsB.E.S.T.Institute
  9. 9. Dr.M.RameshBiological effects of ElectricCurrents• Electrolytic effect - Low frequency AC &DC.• Faradic effect - High frequency AC upto 20Khz.• Thermal effect - High frequency AC morethan 300 KHz.B.E.S.T.InstituteB.E.S.T.Institute
  10. 10. Dr.M.RameshTissue effects of R.F.ElectricalCurrent• Vaporization or cutting• Desiccation or coagulationboth continuous or blended currents.• Fulguration - High voltage modulatedcurrent with a short duty cycle.Vaporization and fulguration - non contactprocedures. B.E.S.T.Institute
  11. 11. Dr.M.RameshTissue Effects of ElectrosurgeryB.E.S.T.Institute
  12. 12. Dr.M.RameshMonopolar ElectrocauteryADVANTAGE• Easy to use• Cutting and Coagulation currents• Dissecting capabilitiesDISADVANTAGE• Larger volume of tissue injured• Can interfere with pacemakers• Requires distant return electrodeB.E.S.TInstitute
  13. 13. Dr.M.RameshMonopolar CuttingA higher voltage leads to a higher sparkintensity and a higher spark intensity resultsin a deeper zone of coagulation during thecutting process.B.E.S.T.Institute
  14. 14. Dr.M.RameshBipolar ElectrocauteryADVANTAGE• Small volume of tissue injured• Less risk of burn injury• Safe with pacemakers• Effective in wet fieldsDISADVANTAGE• More skill required• Coagulation current only• No dissecting capabilities B.E.S.TInstitute
  15. 15. Dr.M.RameshElectrodes & Tissue ContactB.E.S.T.Institute
  16. 16. Dr.M.RameshVariables affecting the tissueeffects of radio frequency current.• Generator output• Power density(size & shape of electrodes)• Electrode tissue proximity.• Tissue impedance• Electrode speed/time on tissue• Distension mediaB.E.S.T.Institute
  17. 17. Dr.M.RameshAdvantages of Electrocutting• Reduced bleeding• Preclution of germ implantation• Avoidance of mechanical damage to thetissue• Endoscopic applicabilityB.E.S.T.Institute
  18. 18. Dr.M.RameshTissue effects of heatingB.E.S.T.InstituteTemperature (Centigrade)---------------------------------------------------------------------------34 - 44 44 - 50 50 - 80---------------------------------------------------------------------------Effect :Visible None None BlanchingDelayed Edema Necrosis Sloughing---------------------------------------------------------------------------Mechanism Vasodilatation, Disruption CollagenInflammation of cell denaturationmetabolism---------------------------------------------------------------------------
  19. 19. Dr.M.RameshTissue effects of heatingB.E.S.T.InstituteTemperature (Centigrade)---------------------------------------------------------------------------80 - 100 100 - 200 > 200---------------------------------------------------------------------------Effect :Visible Shrinkage Steam Carbonization“popcorn” crateringDelayed Sloughing Ulceration Larger crater---------------------------------------------------------------------------Mechanism Dessication Vaporization Combustionof tissuehydrocarbons---------------------------------------------------------------------------
  20. 20. Dr.M.RameshComplications• Endogenous burns• Exogenous burns• Pseudo burnsB.E.S.T.Institute
  21. 21. Dr.M.RameshComplications• Active Electrode Trauma• Current diversion– Alternate ground site burns– Direct coupling– Indirect coupling– Capacitive coupling• Dispersive electrode burns• Smoke inhalation B.E.S.T.Institute
  22. 22. Dr.M.RameshDirect & Indirect CouplingB.E.S.T.Institute
  23. 23. Dr.M.RameshCapacitive CouplingB.E.S.T.Institute
  24. 24. Dr.M.RameshDispersive Electrode burnsB.E.S.T.Institute
  25. 25. Dr.M.RameshArgon Beam Coagulator• Uses a spray of ionized argon gas as theactive electrode rather than a metallic blade• Allows even, efficient and broad applicationof the coagulating current to the tissues.• Ideal for obtaining haemostasis along thecut surface of the liver following hepaticresection
  26. 26. Dr.M.RameshCryotherapy• A technique of in situ tissue ablation thatuses freezing temperatures to cause celldeath• Used for cutaneous lesions, tumours of thehead and neck, cervix, rectum, prostate,breast and liver.• Used in uresectable or multiple livermetastases from colorectal cancer.
  27. 27. Dr.M.RameshCryotherapyMechanism of action:Cold shock injuryReduction in cell volume by osmotic dehydrationDenaturation of vital cellular enzymesPerforation of cell membranes by intracellular icecrystalsDestruction of tumour microvasculature
  28. 28. Dr.M.RameshInfrared Coagulator• Generates coagulation heat energy byinfrared irradiation• Hand held wand is a round metallic cylinderthat generates the infrared light thatemanates through the crystal lens at the endof the wand.
  29. 29. Dr.M.RameshUltrasound Dissector• Uses high-frequency mechanical vibrationsto fragment tissue• Used in ophthalmic, neuro, hepato-biliaryand oncologic cytoreductive surgery• Fragments tissue by contact with high watercontent cells – Vibration generate vaporpockets within the cells that lead todisruption and fragmentation
  30. 30. Dr.M.RameshUltrasonic knife• Produces vibrations at 55.5KHz at the tip ofthe blade via a hand piece transducer• The moving blade couples with the tissue,resulting in breakage of protein hydrogenbonds and thus protein coagulum forms• Can perform cutting and heamostasis withminimal damage• Limited lateral spread and thermal injury• No electrical energy transferred to patients
  31. 31. Dr.M.RameshLASER• Light Amplification by the SimulatedEmission of Radiation• Differs from regular light in the followingproperties:– Coherence– Monochromaticity– Collimation
  32. 32. Dr.M.RameshLASERLasers primarily being used for surgery• Carbon Dioxide• Nd:YAG• Argon• Ho:YAG• KTP• Diode
  33. 33. Dr.M.RameshTHANKYOUB.E.S.T.InstituteVisit www.lapsurgery.net

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