A brief ppt on surgical devices

1. SURGICAL DEVICES

2. DEVICE
● ‘a piece of equipment or a mechanism designed to serve
a special purpose or perform a special function’
( MERRIAM WEBSTER)

3. ELECTROSURGERY
● ELECTRICAL ENERGY→HEAT
(LAW OF CONSERVATION OF ENERGY)
● HIGH FREQUENCY ELECTRICAL
CURRENT → HEAT
● HEAT→ 1) COAGULATION
2) CUTTING
● INCISION, DISSECTION AND HEMOSTASIS

4. PRINCIPLE
● H= I2RT, R= RESISTANCE OF BODY, I= CURRENT, T= TIME
● HIGH FREQUENCY ELECTRIC CURRENT RESISTANCE OF BODY
● RESISTANCE HEAT TISSUE COAG AND CUTTING
● ELECTRICAL SURGICAL UNITS(ESU):
■ CONVERT LOW FREQUENCY AC ( 50 -60 Hz) TO
VERY HIGH FREQUENCY AC( 5 LAKH Hz TO 3
MILLION Hz)
● TYPES: 1) MONOPOLAR
2) BIPOLAR

5. MONOPOLAR CAUTERY
● BOVIE,1926, → MONOPOLAR
CAUTERY.
● W. HARVEY— THE FIRST
TO USE → REMOVED INOPERA-
ABLE BRAIN TUMOR
● REVOLUTIONIZED SURGERY
● 2 MM DIAMETER VESSEL EFFECTIVELY SEALED
WILLIAM HARVEY WILLIAM T. BOVIE

7. ELECTRICAL SURGICAL UNIT:
● CAUTERY PENCIL– HIGH FREQUENCY
AC PASSED–TIP OF PENCIL → SMALL
AREA→ HEAT CONCENTRATED→ TISSUE
EVAPORATES ( CUTTING) OR COAGULATES.
● CURRENT RETURNED BACK→
CAUTERY PLATE→ LARGE SURFACE AREA
→ NO OR LITTLE HEAT PRODUCED.

8. BIPOLAR CAUTERY:
● CONCEPT FIRST PROPOSED BY
GREENWOOD IN 1940
● COMMERCIALIZED BY MALIS IN
1960s
● CAN COAGULATE VESSELS UPTO
5 MM IN DIAMETER

9. ESU:
● TWO ACTIVE ELECTRODES→
TWO ARMS OF PRONG
● HEAT TRANSFERED →
TISSUE HELD BETWEEN THE PRONGS
● VERY LESS HEAT DISSIPATION AND NO
COLLATERAL DAMAGE.
● NS IRRIGATION IS REQUIRED
TO PREVENT TISSUE CHARRING AND
ADHERENCE OF TISSUE TO CAUTERY PRONGS.

10. CUT VS COAGULATE
CONTINUOUS CURRENT FLOW( 100% ALL TIME),
LOW VOLTAGE
INTERRUPTED( CURRENT FLOWS ONLY 6 % OF
TIME OF USE), HIGH VOLTAGE
TISSUE VAPOURIZATION→ RAPID TISSUE
HEATING
HEAT AND COOL CYCLE→ SLOW TISSUE
HEATING→ CELLULAR DEHYDRATION AND
PROTEIN DENATURATION→TISSUE
COAGULATION
MINIMAL LATERAL SPREAD EXTENSIVE LATERAL SPREAD
ENERGY CONCENTRATED OVER SMALL AREA ENERGY DISPERSED OVER LARGE AREA
CLEAN CUT USED COAG AND HEMOSTASIS→ COAG OF PLASMA
PROTEIN AND COAG CASCADE
HELD CLOSE TO TISSUE NO OR MIN TISSUE CONTACT

12. COMPLICATIONS
● BURNS:
■ MOST COMMON COMPLICATION(0.2 TO 0.5 %)
■ MONOPOLAR> BIPOLAR
■ INADEQUATE CONTACT WITH FOOT PLATE
■ PATIENT PART TOUCHING METALLIC OBJECTS
■ FAULTY INSULATION
■ CONTACT WITH METAL INSTRUMENTS
■ SURGEONS BURN : HOLE IN GLOVES
● ELECTROCUTION
● EXPLOSION:
○ IF INFLAMABLE ALCOHOL BASED SKIN PREP SOLUTIONS POOL AROUND PATIENT

13. ● CHANNELING:
○ BOTTLENECK EFFECT
○ TISSUE NARROW STALK → CURRENT GETS CONCENTRATED.
○ INJURY TO SPERMATIC CORD WHEN CAUTERY USED ON TESTIS
● INTERFERENCE WITH IMPLANTABLE ELECTRONIC DEVICES
● SURGICAL SMOKE
○ VIRAL PARTICLES
○ CARCINOGENS

14. SAFE ELECTROSURGERY PRACTICES
● CHECK DIATHERMY SETTING BEFORE USE
● LOWEST DIATHERMY CURRENT SETTING
● DONT TOUCH OTHER METALLIC INSTRUMENTS WITH CAUTERY
● INTERMITENT USE
● WHERE EVER POSSIBLE USE BIPOLAR AND ADVANCED VESSEL
SEALING DEVICES
● SMOKE EXTRACTORS USE

15. DIATHERMY BURNS IN LAP SURGERY
● DIATHERMY BURN→ HAZARD IN LAP SURGERY→ INSTRUMENTS NOT
VISUALIZED COMPLETELY
● CAUSES:
■ WRONG STRUCTURE
■ WRONG INSTRUMENT
■ WRONG TECHNIQUE
● CONTACT WITH OTHER INSTRUMENT
● WRONG STEP ON PADDLE
● RETAINED HEAT IN TIP
■ WRONG LUCK: CAPACITANCE COUPLING

16. ADVANCED VESSEL SEALING DEVICES
PRINCIPLE: SEAL AND CUT( UPTO 7 MM)
THREE TYPES:
● ADVANCED BIPOLAR ELECTROSURGERY
● HORMONIC SCALPEL DEVICE
● COMBINATION DEVICES

17. ADVANCED BIPOLAR DEVICE( LIGASURE SYSTEM)
● SEAL AND CUT PRINCIPLE
● COLLAGEN AND ELASTIN COAGULATED IN CONTROLLED MANNER →
PERMANENT SEAL
● PERMANENT SEAL→ WITHSTAND 3X SBP
● ONCE SEAL COMPLETE→ AUTOMATIC DISCONTINUATION OF ENERGY
● SEAL VESSELS UPTO 7 MM IN 2 TO 4 s
● DESIGNED TO BE ONLY TOOL A SURGEON NEED

19. HARMONIC SCALPEL DEVICE
● CUTS AND SIMULTANEOUSLY SEALS
● ULTRASOUND WAVES USED ( 20K-50K Hz)
● CUTS TISSUES FOLLOWED BY SEALING →
PROTEIN DENATURATION DUE TO VIBRATIONS
● LESS HEAT GENERATED→ LESS TISSUE DAMAGE→ LESS SWELLING AND
PAIN
● LESS SMOKE GENERATION, MORE PRECISE BUT MORE TIME REQUIRED.
CUT ALWAYS ASSOCIATED WITH COAGULATE. .

20. ● EQUALLY EFFICACIOUS AS COMPARED TO CONVENTIONAL KNOT TYING
UPTO 7 MM VESSEL ( SIPERSTEIN et al)

21. COMBINATION DEVICES
● COMBINE BOTH BIPOLAR AND ULTRASONIC MECHANISMS
● SEALS VESSELS UPTO 7 MM
● TWO MODES :
● SEAL AND CUT MODE
● SEAL MODE ONLY
● THUNDERBEAT S ( OLYMPUS)

23. STAPLING DEVICES
1. GASTROINTESTINAL STAPLERS:
● APPLY 2 ROWS OF STAPLES WITH OR WITHOUT CUTTING BOWEL→
ANASTOMOSIS
● SUPERIOR TO CONVENTIONAL HAND SEWN ANASTOMOSIS (Y A Shelygin ET AL )
● TWO TYPES:
○ LINEAR STAPLER
○ CIRCULAR STAPLER

24. LINEAR STAPLER
● TWO LIMBS WHICH ARE SEPARABLE
● USED FOR:
○ CLOSURE OF ENDS OF BOWEL
LOOP
○ SIDE TO SIDE ANASTOMOSIS
○ CREATION OF GASTRIC TUBES

25. CIRCULAR STAPLER
● USED FOR END TO END ANASTAMOSIS
● EXAMPLE;
■ COLORECTAL ANASTOMOSIS
■ OESOPHAGO-JEJUNAL ANASTOMOSIS

26. SKIN STAPLER
● EQUALLY EFFECTIVE AS
CONVENTIONAL SKIN SUTURES
● 10 TIMES FASTER CLOSURE
● 2 TIMES MORE COSTLY
( JITENDRA BATRA et al)

27. ENDOTHERMAL ABLATION DEVICES
● HEAT ENERGY USED FOR ABLATION OF SUPERFICIAL VENOUS SYSTEM
● MANAGES SUPERFICIAL VENOUS INCOMPETENCE
● REQUIRES TUMESCENT ANESTHESIA INJECTION.
● TYPES :
○ ENDOVENOUS LASER ABLATION( EVLA)
○ RADIOFREQUENCY ABLATION( RFA)

28. EVLA VS RFA
LASER ENERGY→ HEAT ENERGY ELECTROMAGNETIC ENERGY-HEAT
HEAT → TIP OF FIBRE HEAT → COIL( 3CM OR 7 CM)
60 TO 80 J/ CM ENERGY USED 120’ C FOR 20s ONE CYCLE
LARGER LUMEN OF
CATHETER(0.035)
SMALLER LUMEN CATHETER( 0.018)
TECHNICALLY MORE DEMANDING LESS DEMANDING AS CYCLE AND
ENERGY DELIVERY IS FIXED
VERY LARGE VEINS> 15 MM EVLA IS
BETTER
RFA MARGINAL DECREASED PAIN
AND BRUISING