ENERGY SOURCES IN SURGICAL PRACTICE.pptx

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1. ENERGY IN SURGICAL PRACTICE BY EMERUWA JANE-FRANCES KELECHI 19/7/2024

2. OUTLINE INTRODUCTION TYPES OF ENERGY SOURCES RADIOFREQUENCY ELECTROSURGERY ULTRASONIC ENERGY SYSTEM LASER ARGON BEAM COAGULATION CONSIDERATION CONCLUSION REFERRENCE

3. INTRODUCTION The present day surgeon has a number of energy sources at his disposal, to help him to cut and coagulate tissues. These energy sources comes in different types, each with its own unique properties that determine its effectiveness and limitation when used during any kind surgery, including minimally invasive surgery. A complete understanding of the equipment, physics of energy sources, its potential hazards and limitation is essential, if energy related complications are to be reduced.

4. TYPES OF ENERGY SOURCES Radiofreqency Electro-surgery: Monopolar cautery Bipolar cautery Ultrasonic Energy system: harmonic scalpel Laser Argon beam coagulation

5. RADIOFREQUENCY ELECTROSURGERY INTRODUCTION This is the application of high frequency alternating polarity, electrical current to biological tissues as a means to cut ( vaporise ), coagulate, fulgurate, desiccate tissue Electro-cautery uses heat conduction from probe heated to high temperature by direct electrical current HISTORY In 1926 Harvey Cushing, consulted with a physicist connected with the Harvard cancer commission, William T Bovie . Together they worked to create the most effective circuits and electrodes, which were introduced into surgery in O ctober 1926.

6. BASIC PRINCIPLE OF ELECTROSURGERY Ohm’s law: I= V/R Current= I: Flow of electrons during a period time measured in amperes Resistance (impedance)= R : Obstacle to the flow of current Voltage =V: force pushing current through resistance (volts)

7. ELECTRIC CIRCUIT Has 3 major component: Electromagnetic generator AC current Tissue effect

8. ELECTROMAGNETIC GENERATORS: Are essentially of two types, grounded and isolated. The newer isolated generators eliminates the possibility of an alternate site burn by requiring the current to return to the generator. In the early grounded generators the current return to earth via any contact point and thus caused inadvertent alternate site burns. The electromagnetic generators takes 60Hz current and convert its frequency over 200,000Hz

9. ALTERNATING CURRENT: Here current flow in a sinusoidal fashion, there is no net flow of electrons through the patient, so less chance of electrocution. TISSUE EFFECT : the tissue effect is brought about by to and fro movement of electron, electrical energy is converted to kinetic energy which produces heat. Tissue effect varies and dependent on factors expressed as Thermal change=K x (J)²x Rx T J is current density= current/surface area R is resistance T is time Thus heat generated depends on: Power/ frequency setting of current Length of activation time Waveform: continuous/intermittent Contact area Manipulation of electrode Type of tissue

10. CUT: Low voltage + long duration, true cutting is a noncontact activity COAGULATION: High voltage+ short duration, non contact with tissue DESSICATION: low voltage + long duration, contact with tissue, cells dry out and form coagulum FULGURATION: High voltage coagulation is used Laparoscopic surgery: up to 30w of power can be used

11. DELIEVERY INSTRUMENTS: MONOPOLAR ELECTRO SURGERY : Has four components ; G enerator ( grounded or isolated electro surgical unit) Active electrode: to cut, coagulate, dessicate , fulguration or blend Patient Return electrode attached somewhere on patient.

12. BIPOLAR ELECTROSURGERY Electrons flow between two adjacent electrode. The electrodes is heated and desiccated. Less chances of cutting. Best used for coagulation of small vessels. Bipolar electrosurgery makes use of lower voltage so less energy is required ADVANTAGES Better control over the area being targeted, and helps prevent damage to other sensitive tissues The risk of patient burn is reduced significantly. Can be used in patient with implanted device to prevent electrical current passing through the device causing a short circuit or misfire Good for coaptive vessel sealng DISADVANTAGES Operational time is longer than monopolar electrosurgery Not as effective on small blood vessels

13. COMPLICATION Insulation failure: active electrode monitoring Direct coupling Capacitance coupling Alternate site injury Tissue injury at distal site Sparks Explosions PRECAUTIONS Inspect insulation carefully Use lowest possible power setting Use low voltage waveform Use brief intermittent activation Do not activate in open circuit Do not activate in close proximity or direct contact with another instrument use bipolar electro-surgery when appropriate

14. ULTRASONIC ENERGY SYSTEM

15. Employs compression and friction to deliver mechanical energy to tissue Amino acid unwind and hydrogen bonds break to form coagulation Ultrasonic shear contain piezoelectric discs, which convert electric energy to mechanical energy Instrument blade vibrates at 55000Hz Coagulates and transect vessels upto 3mm( recent instruments can do up to 5mm) ULTRASONIC GENERATOR Minimum setup: 1=50micron displacement: coagulate Maximum setup: 5= 100micron displacement: cut We can set up power from 1 to 5 TISSUE EFFECT Cutting Coagulation Cavitation drilling

16. LASER Laser means concentrated beam of light Amount of energy transmitted by the light waves are then absorbed by the tissue that produce heat according to amount of heat generated …. Tissue effect cut/ coagulate

17. AMOUNT OF HEAT PRODUCED DEPENDS ON: The power of intensity of a laser: measured in terms of irradiation defined as the ratio of power applied to the spot –size (cross section area) of the laser beam( W/m2) Time of expose Wave length(or frequency) EFFECTS Photothermal : Generates heat for destroying tumour Photochemical: amount of irradiance is so low instead of generating heat, it induces chemical reactions in the cell thus causing inactivity TYPES OF LASER Nd : YAG( 1064nm) Helium: Neon laser Argon laser Argon: floride (193nm)

18. ARGON BEAM COAGULATION

19. CONSIDERATION

20. CONT’D

21. CONCLUSION In present era, wide range of energy devices are available, which are appealing and also safe alternative for cutting, coagulation and dissection. Its use in surgical practice has increased the versatility of surgical procedure and decreased operating time.

22. REFERRENCE Mayer P, Energy sources in surgery, slide share, February 5, 2016. A ccessed July 17, 2024. www. Slideshare.net Shivaram H.V, Energy sources in surgery, slide share, June 8, 2021. Accessed July 17, 2024 Mohammed T, Energy sources, slide share, September 10, 2013. Accessed July 17, 2024 Rajeev S., Energy sources in surgical practice. Jaypeebrothers;2020 https://www.jaypeedigital.com

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