SURGEONS INTEGRATED REVISION

COURSE
IN SURGERY
TOPICS

A.
B.
C.
D.

DIATHERMY
LASERS
CRYOSURGERY
THERMOTHERAPY
BY

Nonso MBAH. FWACS, FRCS Ed; FICS

ADDRESS: SURGERY DEPT, UDUTH, SOKOTO
DATE:
WED 21ST SEPT., 2005

DIATHERMY
OUTLINE:
DEFINITION
HISTORICAL PERSPECTIVE
COMPONENTS
TYPES & SETTINGS [OF THE EQUIPMENT]
CLINICAL USES
COMPLICATIONS / HAZARDS
CONCLUSION

DEFINITION

A METHOD OF ELEVATING LOCAL TISSUE

TEMPERATURE USING HIGH FREQUENCY CURRENT,
ULTRASOUND WAVES OR MICROWAVE RADIATION.
MEDICAL DIATHERMY = DIATHERMY OF MILD
DEGREE, PRODUCING NO TISSUE DESTRUCTION.
SURGICAL DIATHERMY = HIGH FREQUENCY
ELECTROCAUTERY PRODUCING LOCAL TISSUE
DESTRUCTION (FULGURATION) AND COAGULATION;
THE BRANCH UNDER CONSIDERATION.

HISTORICAL BACKGROUND

USE OF HEAT FOR TUMORS BY

EGYPTIANS (300Bc)

DIATHERMY COINED BY CZERNY

(1910)

WILLIAM BOVIE (1920) DEVELOPED

ESG (BOVIE UNIT).

COMPONENTS : 3
i.

The Generator: Transforms electricity from mains (50 Hz)

into high frequency electrical energy [30kHz to 3MHz]
- Also allows for variation in frequency and mode
setting.
-

ii.

The Active electrode (Diathermy point) delivers conc.

current to surgical site.
-

iii.

Fitted with audible & visible alarms.

Hand operated/foot activated.

The Return (Indifferent) Electrode A contact device.

-

Directs electro surgical current back.

TYPES
A. Unipolar (Monopolar) D. - Most Common.
- Active & Return electrodes separated by
patients body (volume conductor).
B. Bipolar D. - Active & Return electrode
incorporated in one hand held diathermy
forceps.
- Separated by only few mms.
- Low power used.

SETTING
1. Cutting C. -

Uses continuous wave form;

Produces extreme heating,
vaporization of intracellular
H2O & bursts cells.

2. Coagulation C. Uses more widely dispersed

intermittent bursts of current.
- Less heating; dehydrating
effect.

3. Blended C.

Combination wave pattern.

CLINICAL USES
Achieves a. Tissue fulguration (destruction and
necrosis).
b Electro coagulation
c. Electro dissection
Subspecialty Applications.
1. General surgery
- Endoscopic coagulation of bleeding DU
- Surgical dissection of GB from liver bed
during Lap. Cholecystectomy.
- Gastrotomy incision
- Colotomy incision
- Endoscopic excision of large int. polyp
- channelization of obstructing growths (Colon &

2. Urology
- TURP
- TURBT
- Excision of large hydrocele sac.
3. Vascular Surgery
- Endoluminal diathermy of long S.V.Varicose
veins.
4. Neurosurgery
- Haemostasis
- Tumor Excision
- Frontal leucotomy

- Electrocoagulation of the Gasserian Ganglion

in Trigeminal Neuralgia.
-

Electrocoagulation of choroid plexus (Infantile

Hydrocephalus).

Gynaecology
- Laparoscopic tubal sterilization
- Hysteroscopic fulguration of the uterine cornu
(sterilization).
- Treatment of cervical dysplasia.
- Lap. Treatment of peritoneal or ovarian
endometriosis.

COMPLICATIONS AND HAZARDS

1. Burns

To the Pt
Accidental; faulty cables; improper
placement of indifferent electrode.

2. Channelling Effect - for organs whose vessels

are carried on a narrow pedicle
(Testis, penis, digits).
- Bipolar diathermy safer.
3. Infections

Overzealous use -- Excessive

necrotic tissue.

4. 20 Haemorrhage

Excessive coagulation of
vessels with eventual
sloughing from large
vessel.

Ligature safer.

5. Poor wound healing & dehiscence Extensive

coagulation
6. Post op pain

Exposed nerve endings.

7. Perforation & fistulation of hollow organs

following tumor fulguration

8. Electrocution

9. Fire explosion -

of patient
of surgical staff
from faulty or cracked cables.
Concomitant use of volatile
flammable anaesthetic gases
eg. Cyclopropane, ether.
Contact with flammable bowel
gases (methane, hydrogen) eg.
In colonic obstruction.

PRECAUTION
1. Cardiac pacemaker - Risk of interference,
ventricular fibrillation or
damage.
-

Avoid monopolar D.

2. Metal prosthesis & Implants

- Risk of burns &
electrocution.
-

Avoid use in proximity.

CONCLUSION
- An indispensable surgical tool
- Facilitates fast, bloodless surgery
- Reduces No. of sutures & blood transfusion
- V. safe if adequate safety measures are taken.