“Current thoughts” in electrosurgery

The ongoing desire to improve hemostasis and efficiency during surgery is manifested in the rapid development of electrosurgical technology. These changes have brought about a wide variety of devices available to the practicing surgeon during both open and endoscopic cases. Depending on the instrument chosen, various clinical effects ranging from simple coagulation to the sealing of large vascular bundles are obtained. However potential pitfalls or complications also exist. A thorough understanding of the pros and cons of these technological advancements can improve the operative experience for both surgeon and patient.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135307/1/ijgo245.pd

Laparoscopic Gynecology Procedures: Avoid the Risk

Laparoscopic approaches to gynecological surgery have been developed by an elite group of highly skilled surgeons. As these procedures become more prevalent in the general gynecological approach to disease and the general gynecologist's approach to treatment, the complication rate for these procedures is likely to increase. In an effort to assist in avoiding these complications, guidelines for the performance of laparoscopic gynecological procedures need to be established. This article presents approaches to the most common gynecological procedures that can assist in the prevention of complications

Use of Laparoscopic and Laparotomic J-Plasma Handpiece in Gynecological Malignancies: Results From A Pilot Study in A Tertiary Care Center

Introduction: The J-Plasma has recently been introduced into the surgical community with different intrinsic characteristics aimed to further reduce the thermal effect and enhance precision when compared to standard radiofrequency. This study aimed to investigate the role of this new technology in different conditions of gynecological carcinomatosis characterized by the indication for regional peritonectomy and/or ablation, either in laparotomy (LPT) or in laparoscopy (LPS), in the context of a modern personalized approach to the surgical management of gynecological malignancies. Material and Methods: From January 2019 to April 2019, 12 patients were selected for this prospective pilot study at the Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS in Rome. In this single surgeon experience, the inclusion criteria were: histologically proven advanced ovarian/endometrial cancer, primary or interval debulking surgery, and intraoperative indication for regional peritonectomy. Six patients were treated by LPS (Group 1) and 6 by LPT (Group 2). Results: In Group 1 the indication for debulking surgery was in 4 cases an interval debulking surgery and 2 advanced endometrial cancer. All patients in Group 2 underwent primary debulking surgery for advanced ovarian cancer. The whole cohort achieved a complete tumor excision after surgery. The median OT and median EBL were 195 min and 100 ml in Group 1, and 420 min and 500 ml in Group 2. The median hospital stay was 4 days in Group 1 and 13 days in Group 2, respectively. No intra and postoperative complications were registered within 60 days after surgery. Conclusions: J-Plasma allows to approach delicate maneuvers on viscera, mesentery, and blood vessels with a high degree of safety and precision thanks to its limited vertical and lateral thermal spread, favoring the surgeon to push ever higher the cytoreduction/morbidity tradeoff. The use of J-Plasma in cytoreductive surgery could also increase the range of possible minimally invasive procedures, narrowing the technical distance with the open technique and thus contributing to designing a personalized surgical strategy for each patient in different scenarios of peritoneal carcinomatosis

Indonesia

Electrosurgery Unit (ESU) is a medical surgical device that uses high frequency and high voltage with the aim that the patient does not experience excessive bleeding during the operation process. The development of electrosurgery unit technology evolves over time from monopolar to bipolar. However, in the development of the use of the tool, monopolar technology is always the most widely used in tissue surgery techniques. For this reason, this research was determined to use only the Monopolar principle. In Electrosurgery, the actual unit only uses one frequency selection, by changing (increasing or decreasing) the power value. With cases like this sometimes the user or equipment users will always change the power value during operation to determine the right power value. In this case, the author tries to make a prototype of an electrosurgery device with a frequency that can be selected (300, 350, 400, 450, 500, 550, 600 and 650 KHz) with a fixed power. By examining the results of the effectiveness of cutting (CUT) on tissue samples. It is hoped that it will be known which one is faster and more effective which can be used in cutting techniques (CUT) in surgery 

Dissection by Ultrasonic Energy Versus Monopolar Electrosurgical Energy in Laparoscopic Cholecystectomy

Ultrasonic dissection was found to be superior to monopolar electrosurgical dissection; however, the Harmonic dissecting unit was found to be more difficult to maneuver and cost more

Development of an Impedance-Controlled Hot Snare Polypectomy Device to Minimize Tissue Damage

This study explores the ability to measure the changing impedance, ex vivo, of a porcine colon sample while undergoing a high-frequency alternating current from an Olympus PSD-30 electrosurgical unit and stop the applied current before excessive tissue damage ensues. The causes of the thermal damage are first examined, followed by the construction and testing of the impedance-controlled feedback device. Perforation was observed to occur when the impedance of the tissue sample increased by 25% or more. Using this information, the device was tested for five power settings ranging from 10W-50W. In each trial, the feedback device stopped the applied current to the tissue samples when the measured impedance exceeded the cut-off threshold of a 25% increase from the starting impedance. The device was found to have an accuracy of ±5Ω. This successfully minimized undue tissue damage and proved able to prevent serious complications such as perforation from occurring

Principles and applications of oral ElectroSurgery

Electrosurgery is a good alternative to the scalpel or lasers for soft tissue management and would be the method of choice. Oral electrosurgery is widely accepted throughout the world and has a broad spectrum of clinical applications. Once the clinician understands the nature of the different waveforms and how electrosurgical technology relates to clinical results, a comfort level will be achieved making clinical applications safe, predictable and easy. Electrosurgery can be used instead of the scalpel to cut soft tissues, with the goal of reducing hemorrhage. Electrosurgery alludes to the delivery of thermal energy in the form of an alternating current in the radiofrequency range from an electrical generator to the probe tip and the tissues. The heat generated in the tissue depends on the current intensity, the distance from this tissue to the electrode tip, and the period during which the RF energy is delivered. Electrosurgery is the passage of high frequency radio waves (RF energy) into soft tissue resulting in a variety of clinical effects, including cutting, cutting and coagulation at the same time, coagulation or tissue destruction. Because of the resistance offered by the tissue to the incoming RF energy, the tissue heats up. The electrode tip never gets hot. In actuality, the water in the cells is boiled causing the cells to explode. Radiosurgery has also become an unofficial but accepted term referring to electrosurgery instruments that fall into the higher frequency range of 3-4 mHz (3-4 million cycles per second). Study by Maness et al. in 1978 concluded that higher frequency electrosurgical units produce less tissue alteration than those instruments with frequencies under 2 mHz. Higher frequency units produce less lateral heat and, therefore, less tissue alteration. The optimal frequency appears to be in the 3-4 mHz range. There are numerous indications for oral electrosurgery and some include bleeding control, cosmetic elongation of clinical crowns, soft tissue management during crown and bridge procedures, biopsies, frenectomies, pulpotomies, collecting tissue for gingival grafts, incisions or excisions and tissue contouring. The main goal of this study is to highlight the principles and benefits of electrosurgery application. Electrosurgery can never completely replace the scalpel, but it requires more knowledge, skill and complete understanding of the biophysical aspects of the interaction of electrosurgical energy and tissue. Continued research into the field of tissue interaction is promised and potential development of applications of electrosurgery. Key words: Electrosurgery, bipolar, incision, hemostasis, coagulation, soft tissue management, wound healing

Бесконтактный метод контроля температуры при высокочастотной сварке тканей

Запропоновано метод температурного контролю при високочастотному зварюванні м'яких живих тканин, який дозволяє досліджувати розподіл температурних полів в біологічних тканинах для врахування дії скін-ефекту при прохожденні струму в процесі електрохірургічних втручань. Моніторинг температури при з'єднанні живих м'яких біологічних тканин щляхом зварювання, дозволяє контролювати енергію, яку необхідно подавати в обсязі достатньому для формування постійної деструкції тканини міокарда.In the paper a method of temperature monitoring for high frequency welding of soft tissues is presented. The method enables to investigate the distribution of temperature fields in biological tissues. This allows to assess the influence of the skin effect on current passage in a process of electrosurgical interventions.The present paper describes an investigation of distribution of temperature fields in biological tissues affected by electrosurgery upon use of an infrared thermograph. In the experiment, the dynamics of temperature distribution in the tissue was registered upon using thermal imaging cameras FLIR i7. Ablation of the tissues by HF current was performed with ЕКВЗ-300 unit (E.O. Paton Electric Welding Institute). Most important result of application of the method of temperature monitoring is an establishment of the moment for removal of the electrodes that ensures an avoidance of carbonization of the cardiac tissues during their ablation.Предложен метод температурного контроля при высокочастотной сварке мягких живых тканей, который позволяет исследовать распределение температурних полей в биологических тканях для учета действия скин-эффекта при прохождении тока в процессе электрохирургических вмешательств. Мониторинг температуры при соединении живих мягких биологических тканей путем сварки позволяет контролировать энергию, которую необходимо подавать в объеме,достаточном для формирования постоянной деструкции ткани миокарда