1. Fundamental Use of Surgical Energy
Abul Fazal Ali Khan

2. The need to discuss this topic
Do you consider yourself an energy expert?
Can you assemble your favourite device?
Have you ever been associated with an injury from an energy device?
Have you ever used an energy device without prior training or reading the instruction manual?

3. Almost all surgical procedures include the use of energy device

4. Complications
Patient burns
OR fires
Interference with other devices

5. Basic Electrosurgical unit

6. ELECTROCAUTERY IS NOT ELECTROSURGERY
Electrocautery: use of electricity to heat an object that is then used to burn a specific site e.g. a hot wire
Electrosurgery: the electrical current heats the tissue. The current must pass through the tissue to produce the desired effect..

7. ELECTROSURGICAL TISSUE EFFECTS
Cutting: divide tissue with electric sparks that focus intense heat at surgical site -By sparking we achieve maximum current concentration
Fulguration: sparking with coagulation waveform -coagulates and chars the tissue over a wide area, result in coagulum -high voltage coag current is
Desiccation: occurs when electrode is in direct contact with the tissue --Achieved most efficiently with cutting current --by touching electrode to the tissue, current concentration reduced, result in less heat and no cutting action --cells dry out and form a coagulum

8. We can cut with coag current and coagulate with cutting current.
Benefit of coagulating with cutting current is that we use far less voltage. it has important implications in MIS

10. SAFETY CONSIDERATIONS
Direct Coupling
occurs when the active electrode touches another metal instrument.
This can also occur if an active electrode is activated while in contact with a metal clip.

12. INSULATION FAILURE
can occur when the insulation covering of an endoscopic instrument has been damaged allowing the electrical energy to escape and burn unintended tissue

13. Capacitive coupling
an inadvertent capacitor may be created by the surgical instruments
An electrostatic field created b/w two conductors, resulting induced current in second conductor
Hybrid cannula are worst , metal part will create a capacitor but plastic anchor will prevent the current from dissipating through abd

15. BIPOLAR ELECTROSURGERY
The two tines forceps function active and return electrodes.
Only the tissue grasped is included in circuit. No patient return electrode
Better hemostasis
Less thermal injury
Safer than monopolar

16. VESSEL SEALING TECHNOLOGY
Combination of pressure and energy to create a seal.
Feedback controlled output so reliable seal in minimal time
Seals vessels up to 7 mm with a single activation.
Seal strength comparable to sutures/clips, can withstand >3 times normal SBP

17. ULTRASONIC ENERGY DEVICES
employ both compression and friction to deliver mechanical energy to target tissue Amino acids unwind and reshape and hydrogen bonds break resulting in sticky coagulum Ultrasonic shears contain piezoelectric diskes, that converts electric energy into mechanical energy which is amplified by silicone element Instrument blade vibrate at hz along the long axis Safely coagulates and transect vessels upto 5 mm

18. ULTRASONIC ENERGY DEVICES
provide excellent hemostasis
efficient transection
minimal lateral thermal damage
low smoke generation
no risk of electrical current passage to the patient

19. Other Options
Thunderbeat
CUSA
Argon enhanced electrosurgery