"the cutting and coagulation of body tissue with a high frequency (i.e.

radio frequency) current

By Dr. Hope Niroopa M.B.B.S SRMC & RI

 Flow

of electrons excites the tissue molecules, notable water, creating heat energy which causes water evaporation and tissue coagulation Applied current can be varied from continuous sine wave to modulated to favour cutting or coagulation respectively. - monopolar - bipolar - quasi- polar

Monopolar diathermy involves the passage of a high frequency current tat dissipates into the receptive tissue and exits through the grounding pad. The 'live' electrode represents the diathermy instrument and the 'return' electrode, also known as the indifferent or patient electrode, represents the diathermy pad.
Monopolar electrocutting is achieved by the use of a continuous sine wave i.e unmodulated current of 200-500 volt to produce electric arcs at the tip of the active electrode causing immediate vaporisation of the tissue in contact.

Soft coagulation is the safest for both open and laparoscopic surgery
Voltage current used here is less than 200V, no electric arcs are generated between the coagulating electrode and the tissue during the entire process with elimination of tissue carbonization. In this mode they eliminate the risk of desiccation of the coagulum and its adherence to the electrode.

FORCED ELECTROCOAGULATION high peak voltages are used more than 500 V to generate electric arcs between the electrode and the tissue in order to obtain deep coagulation
COAGULATION non- contact mode where long electric arcs are intentionally generated by strongly modulated HF voltages to surface coagulate raw bleeding areas to achieve haemostasis

SPRAY

recent modification in monopolar electrocoagulation It utilises a plasma of argon gas to deliver the electrical current and can be directed in a focused beam to the desired target electric arc from this current produce conductive channel of ionized argon gas in the centre of the gas cone resulting in noncontact precise coagulation Advantages displacement of blood and debris by the gas spray thereby allowing for more direct application of current to the bleeding area and cooling the coagulation zone.

Bipolar diathermy- current crosses between the two prongs of the electrode and returns to the generator without any flow through the patient. No ground is needed and is safer than monopolar diathermy Heating is confined between the two ends of the probe Less amount of current is used during electrocoagulation Bipolar diathermy is often used when coagulation only is required or when very precise or "microcoagulation" is required.

 This

is designed to achieve electrocutting without the unmodulated current passing through the patient
although monopolar and bipolar generators are used, cutting probes which incorporate both active and return elements are employed to apply the unmodulated current.

Here,

Can interfere with pacemaker function Arcing can occur with metal instruments and implants Superficial burns if use spirit based skin preparation Diathermy burns under indifferent electrode if plate improperly applied Insulation failure Direct coupling (direct contact between an active electrode and another conducting instrument can establish an unnoticed and unwanted current path)

Always place monopolar electrode in an insulated sheath when not in use Always use isolated electrosurgical generator Always use split plate return electrode and check that it is properly applied Ensure no uninsulated metal comes into contact with the patient to provide potential alternative electrical pathways If the patient has a unilateral artificial hip joint then place the return electrode on the opposite side If the patient has bilateral artificial hips then place the return electrode on the back If the patient has a cardiac pacemaker, avoid use of monopolar diathermy Avoid placing return electrodes over a scar or a bony prominence Always use well insulated electrodes and check the insulation visually and by touch before and after surgery Avoid open circuit activation Only activate an electrode when its whole area which actively transmits current is in view Do not activate an electrode when it is in contact with another conductor Use all metal and all plastic trocars Use low voltage waveforms Use bipolar electrosurgery, wherever possible Surgical smoke can be hazardous and should be sucked out carefully

 Suturing Laser

(ligating vessels)

Harmonic

scalpel Topical oxidized regenerated cellulose absorbable haemostat

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