Monopolar surgery

1. Monopolar surgery RF current flows through ESU and active electrode. Returns to ESU through return electrode . Used for cutting and coagulation.

2. Monopolar Cut 1 und Cut 2 monopolar Contact Coag and Spray Coag ME 82 ME 82 ME 82 Combined Power setting Bipolar Coagulation Combined One-pedal-Footswitch Connection for single and dual pad neutral electrodes Bipolar jack for Instruments Connection for monopolar handles

3. Monopolar Application: 2 cutting currents: Smooth cut without scab 80 Watt at 300 Ohm Cutting with some scab formation 70 Watt at 300 Ohm 2 Coagulation currents: Coagulation with deep effect when in 70 Watt at 200 Ohm contact with the tissue Spray Coagulation 60 Watt at 400 Ohm Coagulation current for superficial coagulation of tissue with sparks (Fulguration)

4. Monopolar Application: • Combined Rotary Knob • one rotary knob for all operating modes (also bipolar) • fast and easy power settings, no touch buttons! • technically simple; very easy to understand • power adjustment linear with angle of rotation • Monopolar HF power-output-jack • Big Coax-jack, suitable for : • handle with only one finger button • handle without finger button in combination with a foot switch

5. Monopolar Application: Always use with a neutral electrode! • 4 NE-Types can be connected and monitored: • one pad neutral electrodes disposable or • dual pad neutral electrodes reusable } Safety circuit of the NE: Dual pad NE Single pad NE Additional safety circuit thanks to PCS-function (Patient Control System) Application Monitoring The HF-current switches off automatically to prevent from burns if the circuit to the NE is interrupted

6. NE-Monitoring using dual-pad NEs: Monitor Output Signal ALARM „ON“ Alarm threshold ALARM „OFF“ time

7. Monopolar Application:Circuit mode BF Warning: Patient must be Insulated against earth-grounded metal parts of the OP-table!!! Optimal Setup: Patient Polster OP-Tisch

8. Surgical Effects of Electrosurgery: Coagulation effect: Cutting effect: A Contact Coagulation Active-electrode or instrument is in direct contact with physiological tissue Effect is achieved by conversion of electric energy into thermal energy ! No mechanical separation of tissue, The Cut-effect is achieved by high energy concentration at the tip of the active electrode B Spray Coagulation / Fulguration Active-electrode is not in contact with physiological tissue Superficial coagulation achieved by spark formation ! !

9. Surgical Effects of RF-Surgery Cutting effect: 40o C 1. Hyperthermia 2. Edema formation 3. Coagulation 4. Tissue cooking 5. Dehydration 6. Tissue burns 7. Formation of Burn Scabs 8. Carbonisation

10. Monopolar Application: Attention! Always insulate patient towards grounded metal parts! RF-Unit = Generator Neutral-Electrode large contact area Active-Electrode small contact area Floating Output RF-leakage Current Ideal Set-up: Patient Drapes Film OP-Table Isolatr HF-Current ! The Application of the Neutral Electrode must be correct, otherwise there is a risk of burns!!!

11. Monopolar Current Forms 7 different Current modes for most surgical indications Monopolar- Cut 1 Pure Cutting Current allowing smooth cuts; with optional integration of an overshoot cut pulse Contact Coagulation 1 Coagulation current with very deep reaching effects; to be used in direct contact with the tissue Monopolar- Cut 2 Cutting current blended with coagulation current. Contact Coagulation 2 Coagulation current with deep reaching effects; to be used in direct contact with the tissue. Suitable for TUR. Monopolar Cut Uro 1 Cutting Current allowing smooth cuts in liquid media (e.g. TUR) with optional integration of an overshootcut pulse Spray Coagulation Non-contact surface coagulation (fulguration). Under liquid media in contact useful for staunching the blood flow when small-surface electrodes are used in TUR Monopolar Cut Uro 2 Cutting current blended with coagualtion current to be used in liquid media, e.g. Papillectomy

12. Current Form URO = Applications under Water URO Cut 1 Cutting current allowing smooth cuts in liquid media (e.g. TUR); with optional integration of a overshoot pulse URO Cut 2 Cutting current blended with coagualtion current to be used in liquid media, e.g. Papillectomy

13. Five current modes: Cut I : Unmodulated HF-current for smooth cutting (and contact coagulation if necessary) Cut II : Modulated HF-current for cutting with scab formation in tissue or fat tissue that is usually heavily bleeding Contact Coag : Strongly modulated HF-current for contact coagulation of already bleeding tissue Spray Coag : Coagulation current superficial coagulation with sparcs (Fulguration). Bip. Koagulation : The HF-current is adjusted to the different conditions of the bipolar technology Optional activation per hand or footswitch Safety circuit for the neutral electrode

14. Keys / Explanation of symbols Neutral electrode connector / floating output. The neutral electrode is fully isolated from ground, at high as well as low frequencies. Symbol denoting class of equipment; CF = cardiac floating. The system is defibrillator-proof, which means that it can be used directly on the heart. WARNING! Means "Observe Operating Instructions!" WARNING - HIGH-FREQUENCY CURRENTS CAUTION - HIGH VOLTAGES!