Diathermy in surgery

By
Dr Osagie O. E.
Registrar, Dept of surgery
JUTH

Outline
Introduction

Definition
Historical perspective

Components
Classification
Principles

of action
Effect on tissue
Uses

Outline
Dangers

/ complications
Safety measures / precautions
Alternatives
Future trends
Conclusion

Introduction
Use

of electricity as an alternating current to

cut, coagulate, incise, divide or otherwise
deal with tissue during a surgical procedure
Uses high frequency alternating current to
generate deep heat for use in cutting
coagulation or fulguration

Introduction
History

300BC Egyptians used to treat tumors

Hippocrates in 460 used heat to treat suprapubic
abscesses
In AD1 Celsius used cautery for haemostasis
WJ Morton applied the principle of electricity to
medicine
Nagelschmidt in 1910 coined the term

Classification
Based

on the number of electric poles at the

site of application

Monopolar active electrode held by the surgeon

and indifferent electrode attached to a point on
the body of the patient
Bipolar active and indifferent electrodes
incorporated in one unit
Quasi-polar standard bipolar set up with
specially designed active and return electrodes to
apply unmodulated current

Components
Active

electrode needle, blade, forceps)

Generator high frequency current
generated here. Can be

Grounded return current passes through the

generator
Isolated which could be earthed (primary) or not
earthed (secondary)

Indifferent

electrode
Connecting cables

Principles
Radio

frequency electric current produced in

the range of 0.3 3MHz
At 50-60Hz

1mA = threshold for muscle activation

5mA = pain
15mA = let go
50mA = respiratory muscle spasm
80-100mA = ventricular fib
>1A = sustained myocardial contraction

Principles
>4MHz

inductance takes place with

capacitance coupling and harmful effects reintroduced
Passage of current through a tissue leads to
a heating effect beneath each electrode
i.e. Current (I2) *resistance (ohms)
Active electrode has a small cross sectional
area so heat is concentrated in the immediate
vicinity of this electrode

Principles
In

monopolar systems the indifferent

electrode has a wide cross sectional are so
heating effect is reduced and dissipates fast
The amount of heat produced depends on
the following

Intensity of the current High voltage (200-500V

for cutting and low voltage (<200V) for
coagulation
Wave form which could be

Principles

An unmodulated continuous sine wave with a duty

cycle of 100% for cutting
Unmodulated low frequency for soft coagulation
Unmodulated high frequency for force coagulation
Modulated high frequency for spray coagulation

Electric

properties of tissue
Relative size of the electrode

Principles
Duty

cycle is the duration of time current is

active during application

For pure cutting = 100% and pure coagulation is

6%
Cycle can thus be blended based on duty cycle at
80%, 60% 50% and 25% to have both cutting
and coagulation activity

Principles
Bipolar

diathermy has a reduced risk of

collateral damage and so is safer
Heat passes thru tissue held in the tines of
the forceps
Minimum power settings can be used
Cannot be used for cutting

Effects on tissue
Cutting

Vaporization of tissue in contact by bursting cells,

evaporating water and pyrollization of proteins
Achieved by a very hot cutting arc produced by a
smooth sine wave
Most of the heat produced is used up at the point
so charring of adjacent tissue does not take place

Coagulation

Effects on tissue

Most widely used function

Direct application of heat to vessels leads to
Coagulation of blood proteins
Drying up off vessel walls
Shrinkage and retraction of vessel ends
Thrombus formation

Achieved

by an interrupted burst of current

Coagulation could be
Soft coagulation safest for laparoscopy

Effects on tissue

Force coagulation

<200V needed
No arcs between electrode and tissue
Dessication of tissue occurs but no shrinkage
Peak voltage >300V
Electric arcs generated
Needed for vascular areas with an increased risk of
collateral damage

Spray coagulation electrode and tissue not in

contact so inaccessible tissue can be coagulated

Effects on tissue
Fulguration

Destructive coagulation with charring of adjacent

tissue
Accompanied by sparks and sounds
Achieved by high intensity current
Used for destroying small tissue

Uses
General

surgery

Haemostasis
Gall bladder dissection
Gastrostomy
Colostomy
Haemmorhoidectomy

Urology

TURP/ TURBT
Coagulation of bladder growths

Uses

Excision of hydrocele sacs

Neurosurgery

Haemostasis
Excision of CNS tumours
Stereotactic surgery for dyskinesias
Frontal leucotomy and choroid plexectomy
Treatment of paroxysmal trigeminal neuralgia by
Gasserian ganglion coagulation

Plastic

wart excision

Uses
Minimal

access surgery

Cholecystectomy
Bleeding PUD
Excision of Schatzki ring
Thoracic sympathectomy
Clearing of stents infiltrated by tumours

ENT

Turbinectomy
Tonsillectomy

Dangers and complications

Patient

Burns to skin or cavities

Improper placement of indiff electrode

Used close to skin
Disconnection

Explosion due to reaction with volatile gases

Channeling effect
Infection
Secondary haemorrhage

Dangers and complications

Poor

wound healing
Post operative pain
Perforation of hollow viscera
Electrocution
Necrotizing granuloma of peritoneum
Adductor spasm
Production of gases which include

Dangers and complications

Hydrocarbons

Nitrites

Pyrole, 6 emthylindole, indole

Aldehydes

3 butenenitrene, benzonitride, 2 propelenenitrene

Amines

2,3, dihydromdene, 1 decene 1 undecene 6 ethyl benzene,

ethyl benzene

3 methyl propanolol, benzaldehyde

Miscellaneous - 5 dimethylfuran, hexadecanoic acid

Dangers and complications

To

Surgeon

Burns
Electrocution

Safety measures / precautions

Pre

operatively

Do not prepare bowel with manitol

Shave skin at site for indifferent electrode
Check equipment regularly
Alarm systems must be functional
Staff should understand the mode of operation

Intra

operatively

Prevent patient contact with metal parts of couch

and drip stands

Safety measures / precautions

Place

active electrode in a quiver

Allow alcohol disinfectant to dry before use
Apply indifferent electrode to dry flat skin
bearing no scars
Allow at least 50cm b/w diathermy and
anaesthetic machine
DO NOT USE in the presence of ether
Place struct at risk for channeling on the ant
abdominal wall

Safety measures / precautions

Choose

If

the appropriate mode

ineffective
Check for faulty connections
Check the active electrode
Check indifferent electrode
Increase power

Alternatives
LASER

Less tissue damage

No smoke produced

Harmonic

scalpel

Uses USS energy converted to a frequency of

55.5Hz
No risk of electrocution

Future trends
Development

machines

of micro-chip diathermy

Conclusion
An

important addition to the armamentarium

of a Surgeon diathermy confers proven
advantages that aids in the simple, cost
effective, user friendly and relatively safe
delivery of health services

THANK
YOU ALL