This document provides an overview of surgical diathermy, including: - Types of diathermy like monopolar and bipolar systems - Operative principles involving generating radiofrequency energy to cut and coagulate tissue - Effects on tissue depending on current intensity including coagulation, fulguration, and cutting - Preoperative patient preparation to reduce risks like ensuring no flammable materials are used - Indications for diathermy including controlling bleeding and removing unwanted cells - Potential risks like fires or explosions if not used properly and ways to reduce complications like ensuring good contact of diathermy pads

1. SURGICAL DIATHERMY
CLINICAL PRESENTATION
DEPARTMENT OF SURGERY
BMSH
DR BATUBO

2. OUTLINE
INTRODUCTION
TYPES OF SURGICAL DIATHERMY
OPERATIVE PRINCIPLE
PREOPERATIVE PREPARATION
INDICATIONS AND USES
RISKS, DANGERS AND COMPLICATIONS

3. INTRODUCTION

4. Diathermy is one of the most commonly used tool
in the operating theatre.
It is the generation of heat in body tissues by means
of radiofrequency energy, within the range of 300-
3000kHz.
used for
 surgical cutting,
controlling bleeding by causing coagulation “hemostasis”
at the surgical site and
destruction of unwanted cells.

5. TYPES OF SURGICAL DIATHERMY
• monopolar – generator, active electrode
(diathermy pen), patient, return electrode
(diathermy pad)
• Bipolar – active and return electrode between
two tines of forceps

6. One advantage with this type is that production of
the cutting current is virtually impossible.
The field of coagulation is limited to the contact
area;
the surrounding tissues are not damaged.
There is no patient plate attached.

7. Operative Principles
 Surgical diathermy produces radio frequency( 300kHz-
3MHz), alternating current, and patient’s body forms part of
an electric circuit
 The passage of current through the tissue produces a heating
effect beneath each electrodes
 A high frequency current flows through active electrode
 Cell ruptured-fumes or evaporates.
 Return path through dispersive electrode
 RF generation can be activated by a foot switch or finger
switch on the surgical handle.

8. Effect of RF on cell includes:
1. Thermal effect.
2. Electrolytic effect.
3. Faradic effect.
Operating frequency and typical value
 Operating frequency 300 KHz –to-3MHz
 Monopolar : CUT “ 0-to-350”watts
COAG” 0-to-100” watts
 Bipolar : CUT “ 0-to-50” watts
COAG “ 0-to-10” watts

9. EFFECTS OF SURGICAL DIATHERMY
• The effects of diathermy depend largely on
the intensity of the current passing through
the tissues
• Can be divided into 3 categories
1.Coagulation
2.Fulguration
3.Dissection or cutting

10. Degree of Tissue Destruction
• Superficial: Dissection and fulguration
• Deeper Tissue: Coagulation
• Tissue Cutting: section

11. COAGULATION
One applies and slowly moves the electrode across
the lesion until slightly pink to pale coagulation
occurs.
uses low-voltage and high-amperage current in a
biterminal fashion to cause deeper tissue
destruction and hemostasis with minimal
carbonization
High amperage causes deep tissue destruction and
hemostasis.

12.  A curette may then be used to remove the
coagulum.
 Haemostasis: by touching the electrode directly to
the bleeding vessel, or by using biterminal forceps.
The heat generated seals the vessel by fusion of its
collagen and elastic fibers.
It is useful for vascular lesions

13. Fulguration and Dissection
use high-voltage and low-amperage current in a
monoterminal fashion to produce superficial tissue
destruction
DISSECTION:
the electrode contacts the skin and superficial skin
dehydration occurs as a result of Ohmic heating.
they are best suited for superficial and relatively
avascular lesions, such as verrucae and seborrheic
keratosis.
Are not suitable for very vascular lesions

14. FULGURATION
electrode is held 1-2 mm from the skin surface
 causes tissue dehydration by sparks
cause superficial epidermal carbonization.
This carbon layer has an insulating effect and
minimizes further damage to the underlying dermis.
lesions treated by fulguration usually heal rapidly
with minimal scarring

15. SECTION OR CUTTING
uses undamped or slightly damped, low voltage,
high-amperage current in a biterminal fashion to
vaporize tissue with minimal peripheral heat
damage.
Undamped current yields cutting without
coagulation
 slightly damped current provides some
coagulation.

16. Advantages of electrosection are
1.its speed
2.its ability to simultaneously cut and
3.seal bleeding vessels
 in the excision of large, relatively vascular lesions,
such as acne keloidalis nuchae and rhinophyma,
Malignant growth

17. PREOPERATIVE PREPARATION
History and ph.exam
Notice risk factors of the procedure:
1.bleeding diathesis,
2.poor healing, such as vasculopathy,
3. poor general medical condition.
Identify : cardiac pacemakers or implantable
cardiodefibrillators

18. All Jewelry should be removed  Risk of burning
For Prep use: nonalcohol prep solution
(risk of ignite)
Use chlorhexidine or povidone-Iodine
 work in the perianal Region:
Use moist packing over anus to prevent ignition of
methane

19. POINTS TO REMEMBER IN PROPER
PATIENT PLATE USE
Avoid placement near scars, implant sites or ECG
electrodes
A muscular well vascularised area is most suitable
Site must be clean, dry & shaved
Protect skin integrity by ensuring pt is not resting
on dispersive plate clamp

20. Do not allow fluid to pool at dispersive site
Check pt contact & connection before commencing
Only aqueous fluids should be used for irrigation
On completion of procedure, remove the plate
carefully & inspect the skin
Document use of diathermy in pt’s record

21. SUGGESTED SITES FOR PLATE
PLACEMENT
• CALF
• UPPER ARM
• ABDOMEN
• MID BACK
• BUTTOCKS
• ANTERIOR & POSTERIOR THIGH

22. INDICATIONS AND USES

25. RISKS, DANGERS AND COMPLICATIONS
Explosion if flammable, volatile anaesthetic agents
are used, e.g ether or cyclopropane
Gas explosion in obstructed hollow viscera
Electrocution of the patient or surgeon because of
faulty cables
Superficial burns
Diathermy burns

26. CONCLUSION
Advances in medical technology have produced
better and safer diathermy equipment
We may see in the future microchip functioning
diathermy units
Knowledge and adequate patient preparation will
prevent the risks, danger and complications

27. THANKS