Electrosurgery And Energised Dissection

1. ELECTROSURGERY AND ENERGISED
DISSECTION
Presenter:- Dr Jibreel Yousuf
Post Graduate Department of General and
Minimal Invasive Surgery,SKIMS
Moderator:- Dr Natasha Thakur

2. CONTENTS
I. Introduction
II. Definition
III. Principle
IV. Basic Types
V. Advanced Energy Devices
VI. Complications
VII. Summary

3. INTRODUCTION
The development of electrosurgery in the 1920s
revolutionized the surgeon’s ability to achieve
haemostasis. The physicist William Bovie, in
collaboration with the surgeon Harvey Cushing,
was the first to pioneer the routine use of
electrosurgery in clinical practice.

4. DEFINITION
Electrosurgery is the use of radiofrequency (RF)
alternating current (frequency range of 200 kHz-3.3 MHz)
to raise intracellular temperature in order to achieve
vaporization or the combination of desiccation and
protein coagulation.

5. PRINCIPLE
When an electrical current passes through a conductor, some of its energy appears
as heat. The heat produced depends on:
the intensity of the current
the wave form of the current
the electrical property of the tissues through which the current passes
the relative sizes of the two electrodes.

6. BASIC TYPES
Monopolar diathermy
Bipolar diathermy

7. MONOPOLAR DIATHERMY

11. DISPERSIVE ELECTRODE OR
CAUTERY PAD PROPERTIES
It should have a wide area of contact
Put over well-vascularized muscle mass to maximize the conduction of current
Avoid areas of vascular insufficiency and other areas of high resistance, such as scar
tissue, oedematous tissues or bony prominences
Ensure that metal prostheses and electrocardiogram (ECG) electrodes (potentially an
alternative pathway for current to discharge), are out of the direct path of the circuit. For
the same reason, all metal piercings should be removed
Ideally, choose a position in the same quadrant as the operative site to ensure that the
current travels the shortest distance through the patient’s tissues
The appropriate size of return electrode should be used; paediatric plates are available
for patients under 22 kg
Good adhesive contact(hairless)

12. ENERGY SOURCES:-
CUTTING VS
COAGULATION

13. • Cutting:-
• USED TO DIVIDE TISSUES
DURING BLOODLESS SURGERY
• AT THE CELLULAR LEVEL
sufficient heat is applied to the
tissue to cause cell water to
explode into steam.

15. • Coagulation:–
• In coagulation, a heating effect
leads to cell death by
dehydration and protein
denaturation.

17. BIPOLAR DIATHERMY

20. ADVANTAGES OF
BIPOLAR OVER
MONOPOLAR
QUATERY

21. • In bipolar cautery circuit is getting
completed locally only and in Monopolar
cautery circuit involves the whole body
• Bipolar cautery can be used in patients
with cardiac pace makers
• Lateral spread of current that can cause
injury to nearby nerves is more in
monopolar cautery
• So Monopolar cautery is avoided in
thyroid,parotid,penile surgery and
avoided wherever there is end arteries

22. ADVANCED ENERGY
DEVICES

23.  Advanced bipolar(Ligasure)
 Harmonic scalpel
 Thunderbeat S

24. LIGASURE

25. Uses heat and
pressure
Seal vessels up to 7
mm in diameter
Seal time 2-4 sec
2nd generation
Ligasure Ist
coagulate then cut
vessels

27. HARMONIC SCALPEL

28.  Works on ultrasonic
principle
 It utilises a hand-held
ultrasound transducer
and scalpel which is
controlled by a hand
switch or foot pedal
 It has a fixed blade
and an oscillatory
blade.
 It osscilates between
20000 to 50000 hz

29. TYPES

31. Advantage over Ligasure
 COAGULATION OCCURS WITHOUT HEAT
PRODUCTION
 So we can use it close to vital structures
and nerves
 It has a precise cut
 It can cut scar tissue as well
 use of the harmonic scalpel reduces
operative time and recovery is thus
enhanced.

32. SOME
MODIFICATIONS
OF ULTRASONIC
DEVICES:-

33. • CUSA(CAVITRON
ULTRASONIC SURGICAL
ASPIRATOR)
• LOTUS(LaprOscopic
dissection by Torsional
UltraSound)

34. CUSA:-
IT CAN ALSO SUCK OUT
WHAT IS BEING
PRODUCED LIKE SMOKE
USED IN NON CIRRHOTIC
LIVER RESECTION
LOTUS:-
IT HAS TORTIONAL
ULTRASOUND
MINIMISES DISTAL
DRILLING EFFECT

35. THUNDERBEAT S

36.  COMBINATION
OF LIGASURE
AND HARMONIC
SCALPEL
 RESPONCES TO
PRESSURE
CHANGES IN
TISSUE AND THUS
STOP EXCESS
DELIVERY OF
ENERGY
 SEAL AND
DIVIDES VESSELS
UPTO 7MM
 SEAL ONLY MODE
ACTIVATES
BIPOLAR
DIATHERMY ONLY

38. •The choice between which type of energy
and device to use comes down to surgical
preference, availability and cost.

39. COMPLICATIONS OF
ELECTROSURGICAL

40.  ACTIVE ELECTRODE
INJURY:-

41. INADVERENT ACTIVATION

42. GLOVE
BURN

43. • ELECTROSURGICAL
SMOKE:-
• SHORT ACTIVATION SEQUENCES
RESULT IN LESS CLOUDING OF THE
VISUAL FIELD

44.  DISPERSIVE ELECTRODE
INJURIES INCLUDE
APPLICATION SITE ISSUES
AND PARTIAL DETACHMENT

45.  CURRENT
DIVERSION:-
•INSULATION FAILURE
•DIRECT COUPLING
•CAPACITIVE

46.  INSULATION
FAILURE

47. Insulation failure may be a source of
electrosurgical injury during
laparoscopic procedures.
Therefore, active electrode
monitoring systems to screen
instruments for insulation breaks
have been designed.
The distal third of a laparoscopic
instrument is the most common site
of insulation failure.

48. DIRECT COUPLING

49.  Direct coupling occurs
when one conductive
element of the circuit
touches or arcs to an
instrument outside of
the intended circuit.
Direct coupling is often
intentionally utilized
intraoperatively for
coagulation purposes.
For example, a
monopolar
electrosurgical
instrument is held in
contact with a forceps
in order to coagulate
small bleeders

50. CAPACITIVE
COUPLING
• This is a phenomenon in
which a capacitor is created
by having an insulator
sandwiched between two
metal electrodes. This can be
created in situations where
there is a metal laparoscopic
port and the diathermy hook
is passed through it.

51. THE DANGER OF
CAPACITANCE
COUPLING CAN BE
PREVENTED BY
USING ENTIRELY
PLASTIC PORTS.

53. SUMMARY
A sound understanding of the principles of electrosurgery
and tissue energizers is essential for their safe use in the
operating theatre environment. The risks associated with
ESUs are multi- factorial and these should be stratified
according to individual patient conditions. A team-based
approach that involves all staff in the operating theatre
should be employed to minimize the risks of ESUs, but
ultimately it is the responsibility of the surgeon to ensure
their safe use.