Electro Surgery Unit

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Principles of operation
     function
     use
     scientific principles
 
construction
     components
     system diagram
     inputs/outputs
 
preventive maintenance
     replacing components
     calibrating
 
Troubleshooting
    identifying common faults
    replacing components
    rectifying faults
 
Safety considerations
   user and patient safety
   electrical safety
Performance monitoring
   calibration
   quality assurance and
control
?
  
 
What is ELECTROSURGICAL UNIT
Electro surgery  
is the application of a high-frequency
electric current to biological tissue as a means to cut, coagulate,
desiccate, or fulgurate tissue
.
Electrosurgical devices are frequently used during surgical
operations helping to prevent blood loss in hospital operating
rooms or in out patient procedure
Electro surgery allows the surgeons
to work faster as they do not have
to tie off (close) every vessel they
cut. The patient recovers better as 
there
is less blood loss and there is  more rapid
healing.
 
History of electrosurgical unit
For thousands of years human beings have used heat in the
form of cautery to treat trauma and disease. By the late
nineteenth century, as technology advanced, heat could be
produced by electric current. the first electrosurgical unit was
developed in 1926 by Dr. William T and Dr. Bovie
The term "diathermy" is derived from the Greek
words "dia" meaning "through" and "thermos"
meaning "heat."
SCIENTIFIC  PRINCIPALS
Electro surgery is accomplished by converting 
high frequency electrical
current 
into 
heat
, 
caused by the tissue resistance to the passage of
electrical current (the tip of the active electrode is not hot).
As current must pass through the body
, 
at 
l
east two electrical connections must be
made between the patient and the machine. The 
power needed is up to 
400 w
 
If the waveform is modulated it will coagulate
blood and stop bleeding (
coag 
setting).
If the waveform is unmodulated the tissue is cut
PARTS
Electrosurgical Generator
main control unit of the diathermy system.it houses the
electrical circuitry and controls the generation and
delivery of the high-frequency electrical current. Types 1 >
Monopolar Electrosurgical Generator. 2 > Bipolar
Electrosurgical Generator 3 > multipurpose electrosurgical
generator
Active Electrode/ hand piece /surgical pen
Return Electrode
Connecting Cables
Footswitch
Principal of electro surgery
When electric current flows through biological
tissue the following effects can be observed.
1.Thermic effect (heat )
2.Feradic Effect
3.Electrolytic Effect
Tissue is heated by electric current .
The heating is dependent  on the resistance of
the tissue ,The current density and duration of
application
1.Thermal
 Effect
HEAT = I
2
R
tissue
2.Faradic Effect
Electrically sensitive cell, such  as nerve and muscle cells
are stimulated by electric current.
It is Undesirable effect when  performing a radio frequency
surgery
Avoided by using alternating current of high frequency  of at
list 30kHZ  (high frequency surgery )
2.Electrolytic
 
effect
Electric current causes ion shift to occur in biological tissues.
The positively charged ions  would be shifted to the negative
pole ,cathode and  negative  to positive pole ,the anode
causing electrolytic damage to the tissue
Avoided  by using A.C  current of sufficiently high frequency
Selectable Modes on a Surgical Diathermy
Machine/Unit
:
1.
Cutting
2.
Coagulation
3.
Fulguration
4.
Desiccation
5.
TUR > Trans Urologic Resection
Fulguration
: 
This is carbonization/burning up / sparking on
tissue intentionally to 
destroy it. 
It is done at high voltage
about 2 Kv and the Active Electrode does not have contact with
the tissue.
Desiccation
: 
This is intentional slow dehydration of unwanted
intracellular fluids 
to dry out causing tissue shrinkage. This is
achieved by 
insertion
 of the Active Electrode Probe 
into tissue
 and
apply prolonged power till the intended tissue 
Evaporation is
complete
.
Cutting
/
Bisecting/Resecting > 
This is tissue cutting due
to rapid and continuous raptures of the cell membranes
Coagulation
:  
This is denaturation of Tissue Proteins resulting to
Thickening of Blood Density due to cutting electrode heat
dissipation/transfer.
TUR > 
Trans Urologic Resection 
: 
This is tissue cutting
under water” > cutting a fluid filled tissue, cutting a too
wet tissue
.
The success of desired surgical action depends on
1. Property of tissue
2. Shape of active electrode
3. Catting speed
4. Current intensity
5. Conductivity of active electrode
6. Depth of modulation
TYPES OF
ELECTROSURGICAL
TECHNIQUES
1. Monopolar
2.Bipolar
Active
Electrode
Dispersive
Electrode
Dispersive Electrode
Cable
Electrosurgical  Unit
Bipolar Coagulation
For 
bipolar 
electrosurgery, the  active and
return electrodes are
 
both held by the
surgeon in one combined pen.
 
Electrosurgical current in the patient is
restricted to a small
 
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The generating unit, 
It is generally a solid
state device that can produce 300 to 
3000
kilo Hertz.
 It breaks up the 50
 Hz from the wall into
high frequency required using a
transformer.
Activation of the electro surgery is done by
the surgeon Using either  a hand switch
on the pen or by stepping on a foot switch
 
 
High
frequency
generation
115v
60HZ
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The Bovie pen (ESU Pen) is held on the patient  by
 
the
surgeon.
The dispersive 
electrode can be a metal plate covered
with a conductive gel or saline soaked cloths.
 Many are
single use dispersive
 
electrodes.
Poor contact with the dispersive
electrode is the most common
cause of patient burns .the ESU
does not go on or gives an alarm
if the dispersive electrode has
no touch with the patient
Needle tip
Blade tip
Ball tip
SURGICAL NEUTRAL ELECTRODE PLATES
Different Names:
Patient Plate
Neutral Plate
Return Plate
Dispersive Plate
Passive Plate
Types of Neutral/Patient Materials:
Lead plate 3mm thickness
 – (
re-usable type).
Flexible metallic plates up to 2.5mm
 –e.g 
Phosphor ,Bronze
: (
re-usable type).
Stainless steel plate 0.8mm – reusable.
Carbon impregnated silicone rubber – (
re-usable type).
Aluminum Plate 1.5mm – (
Reusable “few/limited times”).
Aluminum foil neutral electrode 0.012mm thickness – (
one use /throw away type)
.
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The most common problems in electro surgery are:
burns, excessive tissue damage, damage to alternate sites (areas of the patient's
body other
 
than the target surgical site)
fires
interference with other devices.
Skin  burns are  the  most  frequently reported  of these problems, Usually
occurring at the return electrode  site. 
Partial or complete detachment of the electrode
pad from the patient 
is the most common cause.
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If the wire break is in the pen, the pen can be taken
apart, the wires reconnected and the pen glued together
The most important action in preventive maintenance is to keeping
 the
inside and outside the machine clean. Check the plate electrode
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be fully aware of the hazards,  understand the principles of operation
and
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abilities and limitations of their particular  unit (training  !)
The main risks associated with electrical surgery
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Sparks are a common
occurrence when electrosurgery is in use. When oxygen is being administered to
the patient, it may leak, creating an atmosphere where tires can quickly ignite.
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easily and efficiently through the use of an
You cannot test the device by performing the
Ohms would work, only a resistor with a very
operation on a resistor in most cases. Although 400
large power rating will survive the procedure. Such
large power resistors are generally not available in the developing world.
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In many cases, you will want a final test on meat. A reasonable final test is to cut a raw piece of chicken, pork
or beef. Both sides of
 The 
dispersive electrode must touch the meat to avoid an alarm!  It is best to
conduct the final test with the 
physician present. In this way, you can not only assure that the device is
operating, but you can 
also be sure that it is operating in a manner that satisfies the physician.
For more modern units, insure that the dispersive electrode alarm is working by disconnecting half of the
electrode from the meat, or pulling the dispersive electrode out of the machine.
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Learn about the principles of operation, function, and use of electro surgical units. Discover the history of this technology and its applications in surgical procedures.


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  1. Electro Surgery Unit Surgical Diathermy Machine Presented By : DAVIS WEKESA

  2. Principles of operation function use scientific principles Troubleshooting identifying common faults replacing components rectifying faults construction components system diagram inputs/outputs Safety considerations user and patient safety electrical safety Performance monitoring calibration quality assurance and control preventive maintenance replacing components calibrating

  3. ? What is ELECTROSURGICAL UNIT Electro surgery is the application of a high-frequency electric current to biological tissue as a means to cut, coagulate, desiccate, or fulgurate tissue. Electrosurgical devices are frequently used during surgical operations helping to prevent blood loss in hospital operating rooms or in out patient procedure Electro surgery allows the surgeons to work faster as they do not have to tie off (close) every vessel they cut. The patient recovers better as there is less blood loss and there is more rapid healing.

  4. History of electrosurgical unit For thousands of years human beings have used heat in the form of cautery to treat trauma and disease. By the late nineteenth century, as technology advanced, heat could be produced by electric current. the first electrosurgical unit was developed in 1926 by Dr. William T and Dr. Bovie The term "diathermy" is derived from the Greek words "dia" meaning "through" and "thermos" meaning "heat."

  5. SCIENTIFIC PRINCIPALS Electro surgery is accomplished by converting high frequency electrical current into heat, caused by the tissue resistance to the passage of electrical current (the tip of the active electrode is not hot). As current must pass through the body, at least two electrical connections must be made between the patient and the machine. The power needed is up to 400 w If the waveform is modulated it will coagulate blood and stop bleeding (coag setting). If the waveform is unmodulated the tissue is cut

  6. PARTS Electrosurgical Generator main control unit of the diathermy system.it houses the electrical circuitry and controls the generation and delivery of the high-frequency electrical current. Types 1 > Monopolar Electrosurgical Generator. 2 > Bipolar Electrosurgical Generator 3 > multipurpose electrosurgical generator Active Electrode/ hand piece /surgical pen Return Electrode Connecting Cables Footswitch

  7. Principal of electro surgery When electric current flows through biological tissue the following effects can be observed. 1.Thermic effect (heat ) 2.Feradic Effect 3.Electrolytic Effect

  8. 1.Thermal Effect Tissue is heated by electric current . The heating is dependent on the resistance of the tissue ,The current density and duration of application HEAT = I2Rtissue

  9. 2.Faradic Effect Electrically sensitive cell, such as nerve and muscle cells are stimulated by electric current. It is Undesirable effect when performing a radio frequency surgery Avoided by using alternating current of high frequency of at list 30kHZ (high frequency surgery )

  10. 2.Electrolyticeffect Electric current causes ion shift to occur in biological tissues. The positively charged ions would be shifted to the negative pole ,cathode and negative to positive pole ,the anode causing electrolytic damage to the tissue Avoided by using A.C current of sufficiently high frequency

  11. Selectable Modes on a Surgical Diathermy Machine/Unit: 1. Cutting 2. Coagulation 3. Fulguration 4. Desiccation 5. TUR > Trans Urologic Resection

  12. Fulguration: This is carbonization/burning up / sparking on tissue intentionally to destroy it. It is done at high voltage about 2 Kv and the Active Electrode does not have contact with the tissue. Desiccation: This is intentional slow dehydration of unwanted intracellular fluids to dry out causing tissue shrinkage. This is achieved by insertion of the Active Electrode Probe into tissue and apply prolonged power till the intended tissue Evaporation is complete.

  13. Cutting/Bisecting/Resecting > This is tissue cutting due to rapid and continuous raptures of the cell membranes Coagulation: This is denaturation of Tissue Proteins resulting to Thickening of Blood Density due to cutting electrode heat dissipation/transfer.

  14. TUR > Trans Urologic Resection : This is tissue cutting under water > cutting a fluid filled tissue, cutting a too wet tissue.

  15. The success of desired surgical action depends on 1. Property of tissue 2. Shape of active electrode 3. Catting speed 4. Current intensity 5. Conductivity of active electrode 6. Depth of modulation

  16. TYPES OF ELECTROSURGICAL TECHNIQUES 1. Monopolar 2.Bipolar Electrosurgical Unit Active Electrode Dispersive Electrode Dispersive Electrode Cable

  17. For bipolar electrosurgery, the active and return electrodes are both held by the surgeon in one combined pen. Electrosurgical current in the patient is restricted to a small volume of tissue in the immediate region of application of the forceps. Bipolar Coagulation

  18. Block Diagram/construction The generating unit, It is generally a solid state device that can produce 300 to 3000 kilo Hertz. It breaks up the 50 Hz from the wall into high frequency required using a transformer. Activation of the electro surgery is done by the surgeon Using either a hand switch on the pen or by stepping on a foot switch High frequency generation 115v 60HZ

  19. Electrosurgical machine: Construction r 'I Audio tone generator - - Power supply Logic/ Control Board Rely board -- ~ \.. r Main CPU - - . - Front panel ~ \. - - r . - ~ ~ ~ LED display 4 ,, \. , Power O/P or RF board - r "I Foot switch i r \.. h Patient return electrode ~ RF output I

  20. The Bovie pen (ESU Pen) is held on the patient by the surgeon. The dispersive electrode can be a metal plate covered with a conductive gel or saline soaked cloths. Many are single use dispersive electrodes. Needle tip Blade tip Ball tip Poor contact with the dispersive electrode is the most common cause of patient burns .the ESU does not go on or gives an alarm if the dispersive electrode has no touch with the patient

  21. SURGICAL NEUTRAL ELECTRODE PLATES Different Names: Patient Plate Neutral Plate Return Plate Dispersive Plate Passive Plate Types of Neutral/Patient Materials: Lead plate 3mm thickness (re-usable type). Flexible metallic plates up to 2.5mm e.g Phosphor ,Bronze: (re-usable type). Stainless steel plate 0.8mm reusable. Carbon impregnated silicone rubber (re-usable type). Aluminum Plate 1.5mm (Reusable few/limited times ). Aluminum foil neutral electrode 0.012mm thickness (one use /throw away type).

  22. Troubleshooting The most common problems in electro surgery are: burns, excessive tissue damage, damage to alternate sites (areas of the patient's body other than the target surgical site) fires interference with other devices. Skin burns are the most frequently reported of these problems, Usually occurring at the return electrode site. Partial or complete detachment of the electrode pad from the patient is the most common cause. The dispersive electrode should always be placed on an area of the body that has good blood flow and is not subject to high weight concentration. The side of the thigh is a very common location, under the buttocks is not a good location as it generally is a high weight bearing point.

  23. If the tip is dirty, there can be little, or no, current passing through the patient. The bovie pens are not intended to be reused. However, they are often reused In addition to problems with dirty tips, the wires become broken with reuse. They are simple wires which can be re-soldered for repairs. If the wire break is in the pen, the pen can be taken apart, the wires reconnected and the pen glued together The most important action in preventive maintenance is to keeping the inside and outside the machine clean. Check the plate electrode

  24. Electrosurgical machine: Safety considerations The ESU is inherently a potentially dangerous device. All members of the surgical team using an ESU must be fully aware of the hazards, understand the principles of operation and safe handling, and be familiar with the abilities and limitations of their particular unit (training !) The main risks associated with electrical surgery Burns Electrical interference with the heart muscle Explosion/fire caused by sparks and Electrical interference with pacemaker and other medical equipment. Sparks are a common occurrence when electrosurgery is in use. When oxygen is being administered to the patient, it may leak, creating an atmosphere where tires can quickly ignite.

  25. Electrosurgical machine: Performance monitoring An electrosurgery unit can be checked and calibrated electrosurgery tester. You cannot test the device by performing the Ohms would work, only a resistor with a very large power resistors are generally not available in the developing world. In most cases, a bar of soap or a fresh piece of citrus fruit (like an orange) can be used to do your initial testing. Be sure that both sides of the dispersive electrode are touching to prevent an alarm. easily and efficiently through the use of an operation on a resistor in most cases. Although 400 large power rating will survive the procedure. Such In many cases, you will want a final test on meat. A reasonable final test is to cut a raw piece of chicken, pork or beef. Both sides of The dispersive electrode must touch the meat to avoid an alarm! It is best to conduct the final test with the physician present. In this way, you can not only assure that the device is operating, but you can also be sure that it is operating in a manner that satisfies the physician. For more modern units, insure that the dispersive electrode alarm is working by disconnecting half of the electrode from the meat, or pulling the dispersive electrode out of the machine.

  26. END

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