In operating room the most hazardous devise used in a daily basis is diathermy. A basic understanding of electricity is needed to safely apply electrosurgical technology for patient care.

1. Diat her my
Jamilah saad Alqahtani
CNS,MSN,NS,RGN,BSN,
OR Specialist

2. OUTLINES
Introduction
History
Types
Definition & uses
Electrosurgery modalities
Principles of Electrosurgery
Live demo

3. Introduction
• In operating room the most hazardous devise used in a daily basis is
diathermy.
• A basic understanding of electricity is needed to safely apply
electrosurgical technology for patient care.
• Electrosurgery is one of the most commonly used energy systems in
laparoscopic surgery.
• The surgical team should have a good understanding of the
principles of electrosurgery and tissue effects to avoid
complications.
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4. Introduction
• The risk of complications is linked to the surgeon's fundamental
knowledge of instruments, surgical technique, biophysics,
relevant anatomy, and safe technical equipment.
• Electrosurgery should only be performed by a physician who has
received specific training in this field and who is familiar with the
techniques used to prevent burns.
• Concerns have also been raised regarding the toxicity of surgical
smoke produced by electrosurgery. This has been shown to
contain chemicals which may cause harm by inhalation by the
patients, surgeon or operating theatre staff.
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5. History
• The conception of electrosurgery
began in the early 19th century when
the French physicist Becquerel first
used electrocautery. Rather than using
boiled oil to achieve hemostasis, he
passed direct current through a wire
thereby heating it and effectively
cauterizing tissue upon contact.
• In 1881, D. Arsonoval pioneered the
use of alternating current.

6. History
• It was not until the late 1920s that
collaboration between the physicist,
William T. Bovie and the neurosurgeon
Harvey Cushing resulted in the
predecessor of today's electrosurgical
unit.
• This model was used until 1968 when a
smaller model was developed by
Valleylab, which has since produced
today's platform of electrosurgical units

7. T y p e s o f
D i a t h e r m y
 Radiosurgery
 Electrosurgery:
• Monopolar
• Bipolar

8. Electrosurgery
Definition
Electrosurgery is the application of a high-frequency
electric current to human (or other animal) tissue
as a means to remove lesions, staunch bleeding, or
cut tissue.
Uses
Electrosurgery can be used to cut, coagulate,
desiccate, or fulgurate tissue
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9. Electrosurgery modalities
• electrosurgical modalities
1. monopolar and
2. bipolar .
3. or circuit topologies.
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10. monopolar
• In the monopolar modality the patient lies on top of the return
electrode ,a relatively large metal plate or a relatively large
flexible metalized plastic pad which is connected to the other
electrode of the A.C. current source.
• The surgeon uses a single, pointed ,probe to make contact with
the tissue.
• The electrical current flows from the probe tip, through the body
and then to the return electrode, from which it flows back to the
electrosurgical generator.
• It might seem that the monopolar modality would cause heating
of the entire body cavity
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12. Monopolar
Monopolar can be used for several modalities including cut, blend,
desiccation, and fulguration.
Using a pencil instrument, the active electrode is placed in the entry
site and can be used to cut tissue and coagulate bleeding.
The return electrode pad is attached to the patient, so the electrical
current flows from the generator to the electrode through the target
tissue, to the patient return pad and back to the generator.
Monopolar is the most commonly used because of its versatility and
effectiveness.
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13. BIPOLAR
The bipolar modality is used less often, but is easier to
explain.
Bipolar electrosurgery uses lower voltages so less energy
is required. But, because it has limited ability to cut and
coagulate large bleeding areas, it is more ideally used for
those procedures where tissues can be easily grabbed on
both sides by the forceps electrode.

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15. Bipolar
Electrosurgical current in the patient is restricted to just the tissue between the arms of the forceps
electrode. This gives better control over the area being targeted, and helps prevent damage to other
sensitive tissues.
With bipolar electrosurgery, the risk of patient burns is reduced significantly.
In the most common techniques, the surgeon uses forceps that are connected to the electrosurgical
generator.
The current moves through the tissue that is held between the forceps. Because the path of the electrical
current is confined to the tissue between the two electrodes, it can be used in patients with implanted
devices to prevent electrical current passing through the device causing a short-circuit or misfire.
It is always recommended to review the implanted device user manual prior to preforming any
electrosurgical application, to avoid complications

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18. Principles of Electrosurgery
Often “electrocautery” is used
to describe electrosurgery.
Is it correct ?

19. Principles of Electrosurgery
• Often “electrocautery” is used to describe
electrosurgery. This is incorrect.
Electrocautery refers to direct current
(electrons flowing in one direction), whereas
electrosurgery uses alternating current
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20. Principles of Electrosurgery
Modern day
electrosurgery is the
utilization of
alternating current at
radiofrequency levels.
During electrocautery,
current does not enter
the patient's body.
Only the heated wire
comes in contact with
tissue.
In electrosurgery, the
patient is included in
the circuit and current
enters the patient's
body.

21. Principles of Electrosurgery Cont’
Electrical energy is
converted to heat in
tissue as the tissue resists
the flow of current from
the electrode.
Three tissue effects are
possible with today's
electrosurgical units—cutting,
desiccation, and fulguration.
Achieving these
effects depends
on the following
factors:
current density,
time,
electrode size,
tissue conductivity, and
current waveform

22. Prevention of unintended harm
• For the high power surgical uses during
anesthesia the monopolar modality relies on a
good electrical contact between a large area
of the body and the return electrode or pad .
• Severe burns (3rd degree) can occur if the
contact with the return electrode is
insufficient, or when a patient comes into
contact with metal objects serving as an
unintended leakage path to Earth/Ground.
• Common return electrode locations include
lateral portions of the outer thighs, abdomen,
back, or shoulder blades.
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23. Prevention
of
unintended
harm
The use of the bipolar option does not
require the placement of a return
electrode because the current only passes
between tines of the forceps or other
bipolar output device.
Electrosurgery should only be performed
by a physician who has received specific
training in this field and who is familiar
with the techniques used to prevent
burns.
Concerns have also been raised regarding
the toxicity of surgical smoke produced by
electrosurgery. This has been shown to
contain chemicals which may cause harm
by inhalation by the patients, surgeon or
operating theatre staff.

24. Safety Alert:
DO NOT use or prescribe shortwave diathermy,
microwave diathermy or therapeutic ultrasound
diathermy (all now referred to as diathermy) for
patients implanted with any type of Medtronic
neurostimulation system
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25. Reference
• Fairchild SS. Perioperative nursing: Principles and
practice: Little, Brown; 1996.
• Berry K, Kohn M. Operating room technique. New
York: Mosby. 2004:345-62.
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC
3407433/
• http://www.boviemedical.com/2016/10/03/bipol
ar-electrosurgery-vs-monopolar-electrosurgery/
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC
3407433/
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27. Now time
for
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