CONVENTIONAL AND NEWER ENERGY SOURCES
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The document discusses the history and development of electrosurgery and various energy sources used in medical procedures, detailing significant milestones from ancient Egyptian practices to modern advancements. It distinguishes between electrosurgery and electrocautery, explains different types of electrosurgical devices, and outlines their operational principles and effects on tissue. The importance of selecting the appropriate energy source and understanding the limitations and characteristics of these technologies is emphasized.
CONVENTIONAL AND NEWER ENERGY SOURCES
- 1. CONVENTIONAL AND NEWER ENERGY SOURCES
- 3. HISTORY • 3000 B.C- Egyptians used heat to treat tumour (Firedrill) • 1881: Morton- 100,000 Hz does not produce shock • Origin of Electrosurgery :Dr P Bozzini - Electrocauterization (1887) • First high frequency current used - 1893 • Dr William Bovie and Dr Cushing -Pioneer of Modern Electrosurgery(1926) Dr Bovie Dr Cushing
- 4. ENERGY SOURCES & ITS DEVICES Electrosurgery- 1)Monopolar 2)Bipolar i. Ligasure ii. Gyrus PK iii. Enseal iv. Caiman Ultrasonic - Harmonic ACE Integrated - Thunderbeat
- 6. PROPERTIES OF ELECTRICITY • Ohms Law V=I x R Where V=Voltage I=Current R=Resistance • The passage of high frequency electric current through tissue creates the desired clinical effect. •Current flows through Path of Least resistance
- 7. ELECTROCAUTERY ≠ ELECTROSURGERY • Electrosurgery is not synonymous with electrocautery, despite their mutual use of electrical current to deliver their respective treatment goals. • Electrocautery uses electrical current to heat a metal wire that is then applied to the target tissue in order to burn or coagulate the specific area of tissue. It is not used to pass the current through tissue, but rather is applied directly onto the targeted area of treatment. • Electrosurgery - Electrical current passes through tissue to accomplish a desired result. The electricity used is a form of alternating current similar to the that used to generate radio waves.
- 8. Two important parameters: • Size of contact • Impedance of applied surface
- 9. THE MORE CONCENTRATED THE ENERGY THE GREATER THE THERMODYNAMIC EFFECT
- 10. TISSUE EFFECTS WITH WAVEFORM MODIFICATION I) CUT WAVEFORM: • “On” time is high • Produces heat very rapidly • Cut tissues II) COAGULATION WAVEFORM • Modulated Intermittent-”On”time reduced • Less heat produced • Coagulum produced III) BLENDED CURRENT • Modulation of ≥2 waveforms • Intermittent bursts • Cut + Variable hemostasis
- 11. EFFECT OF TEMPERATURE ON TISSUE
- 13. BIPOLAR ELECTROSURGERY • The two tine (prongs) forceps functions as active and return electrodes • Grasped tissue completes the circuit • Coagulation • Less thermal injury
- 16. FACTORS MODIFYING THE TISSUE EFFECTS CURRENT DENSITY VS TISSUE IMPEDANCE • Size of active electrode • Cut or Coagulation mode • Power setting • Duration of exposure • Tissue Impedance
- 17. CAUTERY PAD
- 19. CAUTERY LIGASUR E HARMONIC • Ligasure • Plasma Kinetic Gyrus • Enseal • Caiman
- 20. LIGASURE • Advance Bipolar Device • Combination of Pressure and Energy • Feedback Controlled System
- 21. • Seal time: 2-4 seconds • Seals vessel upto 7 mm • Tolerates 3 times SBP • Max. Temperature 60-90⁰C • Thermal Spread 4.5 mm
- 22. ENSEAL • Only System Control energy deposition • Nonpolar thermostat in jaws • Adjusts energy according to tissue impedance • Less heat required: Tissue • Volume reduced by compression
- 23. • Seals vessel 1 to 7 mm • Tolerates 7 times SBP • Seal Temperature 100⁰C • Thermal Spread 1 mm
- 24. PLASMA KINETIC GYRUS • Plasmacision • Bipolar PK Technology • Serrated Jaw • No Feedback Controlled System but an audio alarm
- 26. CAIMAN • Tip first closure: Retains tissues within the jaws for improved compression • Advanced Bipolar Seal & Cut technology • 80⁰Articulating Jaw • Seals vessels 7 mm • Thermal spread <1mm
- 29. HARMONIC ACE • Ultrasonic Energy Mechanical Energy • Piezoelectric crystals: 55,000 vibrations per second • Adaptive Tissue Technology
- 33. • Cut and coagulate simultaneously • Uses ultrasonic vibrations instead of electric current • Cut through thicker tissues • Takes longer time • Hemostasis only along with cutting • Mist production affects visibility • Minimal energy transfer (1mm) to surrounding tissue so it cannot cause bowel injury!!
- 35. THUNDERBEAT • World’s 1st and only integrated energy system • Hybrid device • Combines ultrasonic and bipolar energies • Precise dissection • Best visibility • Fastest cutting speed • Minimal thermal spread (<1mm) • Only Cut • Only hemostasis without cutting also possible
- 37. ADVANCES IN ELECTRO SURGERY • Tissue Response Generator • Split return electrode pad • Active Electrode Monitoring • Voice Command System • Argon Plasma Coagulation
- 38. ELECTROSURGICAL INJURIES DURING LAPAROSCOPY Not always due to surgeon error!!
- 43. • Active Electrode Monitoring (AEM) Technology- System in which shielded and monitored instruments continuously direct stray energy, the cause of stray electrosurgical burns, away from the patient via a protective shield.
- 44. WHICH IS THE BEST…..!! Harmonic
- 45. MAKE THE RIGHT CHOICE
- 46. TAKE HOME MESSAGE • Making the correct choice of energy sources makes a lot of differences. • Not only the correct choice but understanding the limitations of these technologies is also essential. • Cost factor. • Thermal spread.