1. The document discusses the history and evolution of energy sources used in laparoscopic surgery, from early monopolar electrocautery to newer bipolar and ultrasonic devices. 2. It describes several modern energy devices including Ligasure, Gyrus/Plasmacision, Enseal, Harmonic Scalpel, and Thunderbeat, comparing their features such as vessel sealing ability, thermal spread, and cost effectiveness. 3. The document emphasizes choosing the right energy device for each procedure to ensure the best surgical outcome, and advertises an upcoming endoscopy fellowship program by IAGES for training on various laparoscopic energy sources.

2. Consultant
- Dr.S.Easwaramoorthy
MS FRCS (England)FRCS (Glasgow) FRCS (Edinburgh)
Dept of Minimal Access Surgery
Lotus Hospital, Erode
Laparoscopic Energy Sources
Points for Practice!

3. History of Energy Sources
Harvey Cushing William Bovie
1928

4. Newer Energy Sources

7. Monopolar Electro surgeryMonopolar Electro surgery
•Active Electrode
•Return Pad
Patient is part of the
Circuit!
Current Density

8. Tissue Response Generator
Split return electrode pad
Active Electrode Monitoring
Voice Command System
Argon Plasma Coagulation
Advances in Electro surgeryAdvances in Electro surgery

9. Impedance Measurement

10. Factors Modifying the Tissue Effects
Current Density Vs Tissue Impedance
1. Size of active electrode
2. Cut or Coagulation mode
3. Power setting
4. Duration of exposure
5. Tissue Impedance

11. Tissue Impedance
Water Tank
(Voltage)
Flow of Water
(Current)
Outlet
(Impedance)Ohm’s Law: I=V/R

12. Tissue Responsive Generators

13. Split Pad

14. RReturneturn EElectrodelectrode MMonitoringonitoring

15. Electrosurgical Injuries during Laparoscopy
Electro surgical injuries are not always due to ‘Pilot’ error.
Zone 1
Insulation Failure
Conductive Coupling
Capacitive Coupling

16. Insulation FailureInsulation Failure
Zone 2 Injury

17. Prevention of Electrosurgical Injuries
Active Electrode
Monitoring Insuloscope

18. Bipolar Diathermy

20. Ligasure Vessel Seal SystemLigasure Vessel Seal System
Bipolar
Low Voltage High Current
Mechanical & Thermal Effect
Collagen/ Elastin welding
7mm vessel seal!

21. Gyrus/Plasmacision
 Gyrus 400 Generator/PK instruments
 Plasma Trissector & J hook
 Tissue Sealing & Bipolar cutting
Vapour Pulse Coagulation

22. Enseal Thermofusion
& Dissection
Smart Electrode Technology

23. Caiman: Aesculap
• Pulse wave form
modulation
• Least tissue charring
• Longer Jaws: 50mm
• Rotating jaws

25. Ultrasound as Energy Source
eg: Harmonic Scalpel
Ultrasonic Energy
55,000/Sec
Minimal Instrument Traffic
• Dissector
• Coagulates
• Cuts
80-100o
C
Minimal lateral Spread

26. Harmonic Scalpel
Effect:
•Blade configuration
•Sharp edge, Flat, and Blunt
•Power Level
•1 to 5
•Traction/Tension
Residual heat

27. Sonocision

28. Haemostasis Vs Dissection
ACE 7

30. Thunder beat

31. Energy Devices for MASEnergy Devices for MAS
Which is the best?!Which is the best?!
Ligasure Gyrus
Enseal Harnomic
Features
1 Maximum vessel burst
Pressure
2 Least thermal spread
3 Least amount of smoke
production
4 Fastest sealing time
Easy to handle
Reliable
Efficient
Cost Effective

32. You make the Choice!

33. Make the Right Choice
Ligasure Enseal Harmonic
Right equipment used for the right reason will ensure right result!

35. IAGES Endoscopy Fellowship
4 days of Didactic lectures, Hands on
endoscopy and Simulator training and
assessment
November 3rd
to 6th
2016 ( 4 days)
@ GI Unit, Lotus hospital, Erode, TN
Maximum of 50 candidates
For IAGES members only
Fee: 25000/-
See brochure/IAGES website
Contact : 098433 28928 for details.