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Complication laparoscopic electrosurgery

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laparoscopy and minimal invasive surgery is modern gyn surgical tool tool it is wise to know some basics about electro- cauterization … and how to avoid its dangers.

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Complication laparoscopic electrosurgery

  1. 1. Complications of laparoscopic electro surgery Dr. Mohammed Abdallah Domiat general hospital
  2. 2. why we are rushing towards minimally invasive surgery? less disruptive to tissues. patients generally recover faster with less pain. fewer wound problems. less scarring .
  3. 3. In operative laparoscopies we often use electricity either to cut, desiccate or coagulate. But major catastrophes my arise if non targeted tissue is injured.
  4. 4. Most of the complication in Laparoscopic surgery is due to use of energized instrument
  5. 5. So before we use this tool it is wise to know some basics about electro- cauterization … and how to avoid its dangers.
  6. 6. Electricity almost always search for a conductor to reach the ground
  7. 7. Alternating current 60 HZ House hold current Faradic effect resulting in cardiac arrest Below 100 KHz Neuromuscular stimulation Above 350 KHz Radio frequency and used in ESU thermal effect
  8. 8. convert standard electrical frequencies from the wall outlet, which are 50 to 60 Hz, to much higher frequencies, 500,000 to 3,000,000 Hz Electrosurgical unit
  9. 9. Monopolar Electrosurgery dispersive pad
  10. 10. Current path is confined to tissue grasped between forceps blades. Bipolar Electrosurgery
  11. 11. currentR heat Increased resistance TISSUE IMPEDANCE Eschar buildup Any current with this frequency meet resistance produce heat 0 20 40 60 80 100
  12. 12. current Patient Return Electrodes
  13. 13. current Patient Return Electrodes
  14. 14. Patient Return Electrodes •It should be applied to a wide area of electrically more conductive tissues like muscles. •Don't use Metal plates •Use Large Silicon rubber plates
  15. 15.   The large surface area of the dispersive pad results in low current density at the attachment site if the dispersive pad becomes loose with only partial skin attachment, or of surface area the current density increases at the attachment site
  16. 16. • the patient plate should be placed such that the longer edge points to the active electrode.   Patient Return Electrodes
  17. 17. To avoid Burn at Pad site • Well vascularized muscle mass Choose • Vascular insufficiency Irregular body contours Bony prominences Avoid • Incision site Patient position Other equipment on patient Consider
  18. 18. • The use of the hook can be summarized as HOOK LOOK COOK
  19. 19. By varying the voltage, current or waveform tissue can be cut cleanly (“pure cut”),  coagulated to achieve haemostasis (“coag mode”) or  a “blend cut” that combines these two functions can also be produced. Finally, a dispersed coagulation mode known as fulguration, allows coagulation of diffuse bleeding.
  20. 20. Variables changing the tissue effects of electro-surgery
  21. 21. Frequency: • a low voltage and a high continuous frequency produce cut effect. • high voltages applied with an intermittent frequency produce coagulation effect. Area: • a thin, needle-shaped electrode will produce a high power density (cut effect). • a wider electrode (spatula-shaped),with same energy in contact with the tissue, will dilute the electron density on its end, temperature will increase more slowly and gradually, obtaining coagulation effect.
  22. 22. • some tissues (i.e., veins) explode, giving an effect opposite to the desired one. In these cases it is necessary to use a lower power and to grip with the forceps a bigger tissue mass. • the longer the energy application time, the greater the risks at a distance from the coagulation or cut point .
  23. 23. Three factors lead to stray energy burns direct coupling. capacitive coupling . insulation failure.
  24. 24. direct coupling
  25. 25. the higher the peak voltage, the greater the chance for capacitive discharge A capacitor creates an electrostatic field between the two conductors capacitive coupling
  26. 26. • The low voltage “cut” mode exhibits less capacitive coupling than coag. does. • Surgeons must recognize that open circuit activation (electrode not touching tissue) dramatically increases voltage and the possibility of capacitive coupling . • It is desirable to use as low wattage as possible and to limit noncontact activation of the generator.
  27. 27. insulation failure insulation defects can range from normal wear and tear, to stress placed on the electrode from high voltages. the smaller the defect, the higher the current density transferred
  28. 28. • When possible, place the long edge of the dispersive pad closest to the surgical site and on the same side of the body as the incision if it is a sided procedure . • Choose a well vascularized muscle mass . • Avoid areas of vascular insufficiency, irregular body contours, bony prominences .
  29. 29. • Remove excessive hair . • Check equipment before each use • Patient skin is not in contact with metal or, if so, these areas are Insulated .
  30. 30. • Solutions are not stored on top of power unit . • Power cord, dispersive pad cord, and cautery pencil cord are carefully placed to avoid possibility of being tripped . • It is recommended that Cords not be wrapped around metal instruments Cords not be bundled together
  31. 31. •Foot pedal is dry . •Power unit is operated at lowest possible setting . •Flammable substances are used with care when power unit is in operation .
  32. 32. • Inspect insulation carefully • Use a low voltage waveform (cut ( • Use brief intermittent activation vs. prolonged activation
  33. 33. • Do not activate in open circuit . • Do not activate in close proximity or direct contact with another instrument .
  34. 34. • Use bipolar electrosurgery when appropriate • Select an all metal cannula system as the safest choice. Do not use hybrid cannula systems that mix metal with plastic . 
  35. 35. •Activate the electrode only when touching tissue. •Clean the active tip routinely during surgery to prevent eschar buildup, which can cause tissue to stick and set up resistance to current flow. •Visually inspect instruments throughout each procedure.
  36. 36. • Utilize available technology, such as a tissue response generator to reduce capacitive coupling or an active electrode monitoring system.
  37. 37. • Terminate current at the end of vapor phase • Apply current in pulsatile fashion • Alternate between desiccation and incision Bipolar surgery
  38. 38. TAKE HOME point Injuries related to stray currents (insulation failure, capacitive coupling, and direct coupling) are most effectively eliminated with actively monitored electrodes, metal cannulas, and an informed surgeon .
  39. 39. Thank you
  • MenawarDajenah1

    Jun. 15, 2021

laparoscopy and minimal invasive surgery is modern gyn surgical tool tool it is wise to know some basics about electro- cauterization … and how to avoid its dangers.

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