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ENDOTHERAPY ESG-100 TRAINING. January 2008. Contents. Handout Principles of Electrosurgery ESG-100 Diathermy Unit Competition Supporting Materials Package Part Summary Hands On. HANDOUT. PRINCIPLES OF ELECTROSURGERY. Historical Background. Papyrus Edwin Smith (2800 B.C.).

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    1. ENDOTHERAPY ESG-100 TRAINING January 2008

    2. Contents • Handout • Principles of Electrosurgery • ESG-100 Diathermy Unit • Competition • Supporting Materials • Package Part • Summary • Hands On

    3. HANDOUT


    5. Historical Background Papyrus Edwin Smith (2800 B.C.)

    6. Historical Background • 2800 B.C. “Papyrus Edwin Smith“ first reference to use of heat as healing medium (glowing wood) • 400 B.C. Hippokrates: glowing iron to open abscesses and stop bleeding • Approx. 1790 Galvani: basics of electro physiology • Approx. 1850 Introduction of galvano cautery (hot platinum wire) • Approx. 1890 Tesla and D‘Arsonval investigated nerve stimulation by high frequency AC • 1907-1912 Therapeutic use of HF current: diathermy, electro- coagulation, HF cutting, fulguration • 1920 – 1930 Intro of tube generators for electrosurgery (Bovie) • Approx. 1970 Use of transistor generators

    7. Historical Background “Bovie“ electrosurgical generator (until 1950)

    8. Principles of Electrosurgery • The effects of electric current on biological tissue Electric Current Faradic effect Thermal effect Electrolytic effect

    9. Principles of Electrosurgery Electrolytic effect Direct current is not suitable for Electrosurgical procedures. In addition to the desired thermal effect, is the undesirable electrolytic effect, producing acids, and bases at the electrode poles. Danger of corrosive/acid burns.

    10. Principles of Electrosurgery Faradic effect Alternating current with low frequencies which are normally used in every household (50-60 Hz) is not suitable for electrosurgical procedures. In addition to the desired thermal effect, is the undesirable faradic effect resulting in neuromuscular stimulation. Danger of muscle contractions and cardiac arrest.

    11. Principles of Electrosurgery • Faradic Effect The sensitivity of the nervous system to electricity decreases with increasing frequency (from a certain frequency onwards). The current (I) that is necessary to cause a neuromuscular stimulation increases with frequency (f). Above approx. 100 -200 kHz of electric current, there is no noticeable nerve stimulation.

    12. Principles of Electrosurgery • Thermal Effect The electrolytic and faradic effect can be avoided by using high frequencies of approx. 100 – 200KHz 100 – 200Khz = Thermal Effect

    13. Principles of Electrosurgery • The Thermal Effects depends on temperature: Up to approx. 40°C: No significant cell damage. Above approx. 40°C: Reversible cell damage, depending on duration of exposure. Above approx. 49° C: Irreversible cell damage (denaturation). Above approx. 60-70°C: Coagulation (clotting). Collagens are converted to glucose. Above approx. 100°C: Phase transition from liquid to vapor of cellular water. The tissue rapidly dries out: desiccation (dehydration). Above approx. 200°C: Carbonisation (carbo = coal). Medical pathological burns of the 4th degree.

    14. Thermal Tissue Effects  Coagulation (Clotting)  Vaporization (Boiling)  Carbonization (Charring)

    15. Coagulation Temperatures of 60 – 70°C lead to a slow boiling of the cellular fluid through the cell membrane and collagens convert to glucose. As a result of these effects, the cell shrinks and several cells link to form chains. A "welding effect" is initiated which stops the bleeding.

    16. Vaporisation Temperatures of above 100°C lead to the rapid evaporation of the fluid within the cell membrane. As a result, the cell membrane ruptures forming vapor around the electrode, which in turn involves other cells lying in the path of the electrode as it moves.

    17. HF Cutting The thermal effect of the cutting procedure depends on: • Cutting speed • Shape/size of electrode • Spark intensity • Condition of electrode • Tissue properties

    18. HF Cutting Cutting Speed The thermal effect decreases with increasing cutting speed.

    19. HF Cutting Electrode Shape The thermal effect increases with increasing surface of the electrode.

    20. HF Cutting Voltage Level (Effect) The thermal effect increases with increasing voltage level.

    21. Carbonization Carbonization is the result of further heating of desiccated tissue. The solid contents of the tissue are reduced to carbon.


    23. HPCS High Power Cut Support

    24. Features & Benefits • High Power Cut Support (HPCS) • Optimises cutting procedures by applying high power to support immediate spark without initial delays and reduces the risk of mechanical cutting • Leads to higher effectiveness of cutting procedures

    25. High Power Cut Support (HPCS) very high power within 3 ms Duration of HPCS: until spark is detected; max. 50 ms HPCS in PulseCut mode All cutting modes are supported by the high power cut support

    26. FSM Fast Spark Monitor

    27. Features & Benefits • Fast Spark Monitor (FSM) • Allows the application of output powers that are as low as possible and as much as necessary • Significantly reduces leakage currents, optimises tissue effects and protects ET instruments

    28. Cs HF generator HF current Control cutting direction Signalprocessing DC voltage measurement Set value (Cut 1,2,3) sparks Fast Spark Monitor (FSM) When cutting tissue, an electric arc is generated between the tissue and the electrode. This arc generates a DC voltage across the capacitor (Cs). This DC voltage is used to control the output voltage.

    29. LPS Leakage Protection System

    30. Features & Benefits • Leakage Protection System (LPS) • Permanently measures the leakage current to earth • S-cord obsolete i.e. simpler handling and cost-savings • Equals highest safety to user and patient • Produces an optic and acoustic signal if the current is too high

    31. Leakage Protection System (LPS) Measurement ofdifference betweenIin and Iout

    32. CQM Contact Quality Manager

    33. Features & Benefits • Contact Quality Manager The Contact Quality Monitor (CQM) analyses continuously the contact resistance of the neutral electrode (split type), ensuring a safe application and minimising the risk of thermal injuries to the patient. The Contact Quality Monitor status is continuously displayed by optical indicators.

    34. ESG-100 Modes • Monopolar Cutting: - Cut 1 / Cut 2 / Cut 3 - PulseCut slow / PulseCut fast • Monopolar Coag: - SoftCoag - ForcedCoag 1 / ForcedCoag 2 • Bipolar Cutting: - Cut 1 / Cut 2 / Cut 3 • Bipolar Coag: - SoftCoag - RFCoag / RFCoag + RCAP

    35. Monopolar Cut Cut 1 / Cut 2 / Cut 3 Max. output power 120 W Characteristics: Continuous cutting procedures Dissection of tissue structures Technical features: Thermal effect to tissue increases from Cut 1 to Cut 3 HPCS, FSM

    36. Monopolar Cut PulseCut fastPulseCut slow PulseCut slow: 800 ms, PulseCut fast: 550 ms Max. output power 120 W Characteristics: Cut with alternating cutting and coag phase with long pulse delay Technical features: HPCS, FSM

    37. Monopolar Coagulation SoftCoag Max. output power 120 W Characteristics: Tissue coagulation and haemostasis Technical features: Reduced carbonization and adhesion

    38. Monopolar Coagulation ForcedCoag 1ForcedCoag 2 Max. output power FC 1: 50 W, FC 2: 120 W Characteristics: FC 1 - Fast and effective superficial coag, FC 2 - Fast and effective coag with increased power capabilities (up to 120 W) - Cutting with very effective haemostasis Technical features: - Spark allows coagulation also with relatively small electrodes

    39. Bipolar Cut Cut 1 / Cut 2 / Cut 3 Max. output power 120 W Characteristics: All bipolar cutting procedures Dissection of tissue structures Technical features: Thermal effect to the tissue increases from Cut 1 to Cut 3 HPCS

    40. Bipolar Coagulation SoftCoag Max. output power 120 W Characteristics: Soft coag with enhanced denaturation area Technical features: Low carbonization Reduced adhesion

    41. Bipolar Coagulation RFCoagRFCoag + RCAP RFCoag Max. output power 40 W Characteristics: Deep tissue coagulation RFITT (Radiofrequency induced Thermotherapy)  Tissue/Tumor ablation Technical features: Acoustic feedback Automatic detection of end of procedure Premature tissue desiccation is effectively avoided by Resistance Controlled Automatic Power (RCAP) Cooling of applicators with the peristaltic pump unit possible (AFU-100)

    42. ESG-100 Safety Patient Plate • Choose a muscular site well supplied with blood vessels and adjacent to the surgical field (for GI procedures: thigh) • Always shave area where patient plate electrode will be sited • Site patient plate electrode on the patient with the longestedge facing towards the surgical site • Ensure all the conductive area of patient plate electrode is in contact with patient’s skin (small areas can cause burns) • Ensure the surface under the patient plate electrode is clean Please read instructions for use of the neutral electrode!

    43. ESG-100 Safety Patient Plate DO NOT APPLY OVER: • Bony protuberances, metal implants, folds of skin, scar tissue, hairy areas, any form of skin discoloration, an injury or to limbs with a restricted blood supply, adjacent to ECG electrodes •  Please read instructions for use of the neutral electrode!

    44. ESG-100 Safety Cardiac pacemakers & implanted defibrillators Electrosurgical applications on patients with cardiac pacemakers or implanted defibrillators (ICD) may induce ventricular arrhythmias and fibrillation or may cause malfunction or damage of the implanted devices. Follow technical information 

    45. ESG-100 Safety Metal Parts Electrically conductive (metal) parts within or at the body could cause burns due to current concentration


    47. ERBE • German company • Established 1847 • 520 employees worldwide • 320 Germany

    48. ERBE • 24 sales agents • ERBE Medical UK Ltd • Collaboration with Olympus on PSD-60 development

    49. ERBE ICC200

    50. ERBE ICC200