Instruments that apply energy to cut, coagulate and dissect tissue with minimal bleeding facilitate surgery. The improper use of energy devices may increase patient morbidity and mortality.

2. Energy Sources In Surgery
Dr.Waqas Arshad
PGR(Surgery)

3. Electro surgery:
Use of radiofrequency alternative current to vaporize or coagulate
tissue.
Cautry ( Kauterion -Hot iron):
Destruction or denaturation of tissue by passive transfer of heat or
application of caustic substance

4. Key facts
• Technology Growth
• Effective use in Laproscopic surgery is greater then in
open surgery
• Thorough understanding & proper knowledge of usage for
safe surgery
• Wepons in unskilled hand

5. Energy Sources
• 1: Radiofrequency Electro-Surgery
Mono Polar Cautry
Bipolar Cautry
2:Ultrasonic Energy System
Harmoic scalpel
3:Laser
4:Argon Beam Coagulation

6. Basic principles of electricity
• Flow in path of low resistance.
• Always seeks to return to ground ( -ve Pole)
• Current:Measure of electron moment past a given point in
the circuit in a fixed period of time (Amperes)
• Voltage (V):Pressure with which the electron are pushed
through the tissue ( Volts)
• Resistance:Measure of the difficulty that a given tissue
presents to the passage of electrons (Ohm)
• Power(W):Capcity to do work per unit time ( Watts)

7. • Ohms `s Law :
I=V/R
Alternative current(AC): Is a type of electric current in which
the flow of electrons switches back and forth at regular
intervals or cycles
Direct Current (DC): Is electrical current which flow
consistently in one direction
Fulguration: The destruction of small growth or areas of
tissue by using diathermy

11. `

13. Biological effects of electric currents
• Electrolytic effect: low frequency AC & DC
• The phenomenon of electrolysis is an important chemical effect of electric
current. In a metallic conductor, the electric current is due to the drifting of
free electrons, there is no chemical or physical change, only the generation
of heat
• Faradic effect: high frquency AC upto 20KHz
Faradic current is a short duration interrupted direct current with a pulse
duration ranging from 0.1 to 1 ms with a frequency of 50 to 100 Hz. Faradic
current is surged to produce tetanic contraction and relaxation of the muscle.
Treatment with faradic current also known as faradism.

14. • Thermal effect : high frequency AC more then 300KHz
whenever an electric current is allowed to pass through a purely
resistive conductor, the energy of that current is entirely dissipated
in the form of heat energy, and as a result, the conductor tends to
get heated up. This is referred to as the thermal effect of electric
current.

32. Ligasur Vs Harmonic scalpel
• The LigaSure vessel sealing device utilizes both electrical energy and
pressure to liquefy and reform the collagen and elastin in vessel walls and
tissue up to 7mm in diameter to provide hemostasis
• The device has incorporated feedback control that automatically stops
further energy transmission once a seal has been achieved.
• In contrast, the Harmonic scalpel uses ultrasound technology to denature
proteins in vessel walls and tissues up to 5mm thick leading to coagulation

33. Benefit For Surgeon & Patients
• Reduce procedure upto 31 min shorter on average.
• Reduce recovery time
• Reduce patients stay at hospital
• Reduce blood loss upto 50 %

64. • The electrosurgical unit is a very useful tool widely used in different surgical
procedure to achieve hemostasis during surgery.
• Precautions are required when this technique is used in patients with
implantable electronic cardiac devices (IECD), such as pacemakers and
defibrillators, because electromagnetic interference produced by the tool may
cause such devices to malfunction.
• Before using electrosurgery in patients with IECDs, it is essential to ascertain
the type of implanted device and the patient's level of dependence on it. The
location of the skin lesion to be treated with respect to the device should also
be assessed. Bipolar pacemakers are more resistant to interference.
Appropriate monitoring and the use of bipolar forceps are recommended.