The document discusses diathermy, which uses high frequency electrical current to cut and coagulate tissue during surgery. It has three main uses - coagulation, fulguration, and cutting. Coagulation involves sealing blood vessels using temperatures of 60-70°C. Fulguration destructively coagulates tissue with charring at over 100°C. Cutting divides tissues during bloodless surgery. Complications can include burns, channeling of current, and interference with pacemakers. Laparoscopic surgeries are more prone to issues due to lack of direct vision and retained heat in tips.

1. {
PRINCIPLES, EFFECTS AND
COMPLICATIONS OF
DIATHERMY IN SURGERY
Sindhujha Balasankar

2. INTRODUCTION
The first use of an
electrosurgical generator in
an operating room
occurred on October 1,
1926. The surgery was
performed by Dr. Harvey
Williams Cushing

3.  ESU are used for surgical cutting and for controlling
bleeding by causing coagulation “hemostasis” at the
surgical site.
 The “high frequency diathermy” involves the
transference of electrical energy into heat which
,when impact to the bodily tissues, will heat the
normal cell fluid, eventually through it is boiling
point.

4. TYPES
3 forms of diathermy :
 Shortwave
 Ultrasound
 Microwave

5.  The electrosurgical generator is the module in which
electrical energy drawn from the mains supply is converted
to a high frequency current
 At the point of application, this electrode builds up a highly
concentrated field in the tissue surrounding the contact
point.
 The concentration of energy within a small area produces the
desired electrosurgical effect in the region around the active
electrode
PRINCIPLES OF
ELECTROSURGERY

6.  Temperatures above 45°C cause a breakdown in the structure
of living tissue and disruption of the function of protein
molecules.
 The process is referred to as denaturisation.
 The origin is a thermal effect.

7. SURGICAL USES
Diathermy can be used for 3 purposes :
 Coagulation – Sealing of blood vessels.
 Fulguration – the destructive coagulation of tissues
with charring.
 Cutting – used to divide tissues during bloodless
surgery.

8.  Temperatures of 60 – 70°C in the area around the active
electrode lead to a slow boiling of the intra-cellular fluid
through the cell membrane.
 As a result of this effect, the cell shrinks several cells link up
to form chains.
 A "welding effect" is initiated which stops the bleeding.
COAGULATION

9.  Temperatures of above 100°C in the region around the active
electrode lead to the rapid evaporation of the fluid within the
cell membrane.
 As a result, the cell membrane ruptures forming vapour around
the electrode which in turn involves other cells lying in the path
of the electrode as it moves.
ELECTROTOMY

11. Monopolar
Bipolar
DIATHERMY TYPES

12. *Patient forms a part of the electrical circuit
MONOPOLAR CAUTERY

13.  Where electrical current passes from one electrode near
the tissue to be treated to other fixed electrode (indifferent
electrode) elsewhere in the body.
 Usually this type of electrode is placed in contact with
buttocks or around the leg.
MONOPOLAR

14. BIPOLAR
 Bipolar, where both electrodes are mounted on same pen-like
device and electrical current passes only through the tissue
being treated.
 Advantage of bipolar electrosurgery is that it prevents the flow
of current through other tissues of the body and focuses only on
the tissue in contact.
 This is useful in microsurgery and in patients with cardiac
pacemaker.

16. COMPLICATIONS
 Explosion
 Burns
 Channeling
 Short circuit instances
 Interference with pace maker functions
Complications are more laparoscopic surgeries

17. EXPLOSION
 Sparks from diathermy can ignite any volatile
or gases or fluid within the theatre.
 Alcohol based skin preparation can catch fire if
they are allowed to pool or around the patient.

18. BURNS
 Faulty application of the indifferent electrode with
inadequate contact area.
 Patient being earthed by touching any metal object.
 Faulty insulation of diathermy leads.
 Inadvertent activity such as accidental activation of foot
pedal.

19.  Occurs if current passes through a narrow channel or a
pedicle to the active electrode, enough heat may be
generated within this channel to coagulate tissues
 Coagulation of penis in a child undergoing circumcision
 Coagulation of spermatic cord when the electrode is
applied to the testis
CHANNELLING

20.  Diathermy of wrong structure because of lack of clarity of vision.
 Faulty insulation of any lap instrument.
 Intraperitoneal contact of diathermy with another metal
instrument.
 Inadvertent activity while tip is out of vision of the camera.
 Retained heat in the tip – touching the bowel.
WHY LAP SURGERIES HAVE MORE
COMPLICATIONS IN DIATHERMY?

21.  Bailey and Love’s short practice of surgery 26th edition
REFERENCES