BMEE 5108 MAINTENANCE III NYINGCHU@2023/24

Electro-surgical unit
Working of the device

Electrosurgical units are instruments that are used during surgery that depend on the heating effect of
electric current to cut or coagulate the human tissue. When high frequency current flows through the
sharp part of the instrument, a high density of current builds up. The tissue at that location is heated to
such an extent that the cells are torn apart because of the evaporation of their cellular fluid. The
indifferent electrode establishes a large area of contact with the patient and the RF current is therefore
dispersed, so that very little heat is developed at this electrode. This type of tissue separation forms the
basis of electro-surgical cutting.
You can also coagulate (similar to welding) two tissues with this technique. The heating effect that is
generated for coagulation is different from the heating needed for the cutting. The same instrument can
alter between the two modes of cutting and coagulation.

Electro-surgical coagulation of tissue is caused by the high-frequency current flowing through the tissue
and heating it locally so that it coagulates from inside. The coagulation process is accompanied by a
grayish-white discoloration of the tissue at the edge of the electrode.

The term ‘fulguration’ refers to superficial tissue destruction without affecting deep-seated tissues. This
is undertaken by passing sparks from a needle or a ball electrode of small diameter to the tissue. When
the electrode is held near the tissue without touching it, an electric arc is produced, whose heat dries out
the tissue. Fulguration permits fistulas and residual cysts to be cauterized and minor haemorrhages to be
stopped.

In desiccation, needle-point electrodes are stuck into the tissue and then kept steady. Depending upon
the intensity and duration of the current, a high local increase in heat will be obtained. The tissue
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changes due to drying and limited coagulation.

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The tissue is heated to such an extent that the cells which are immediately under the electrode, are torn
apart by the boiling of the cell fluid. The indifferent electrode establishes a large-area of contact with the
patient and the RF current is, therefore, dispersed so that very little heat is developed at this electrode.
This type of tissue separation forms the basis of electro-surgical cutting.

History and working principle of ESU

https://youtu.be/KNmQCQi-fnE

The heart of the system is the logic and control part which produces the basic signal and provides
various timing signals for the cutting, coagulation and haemostasis modes of operation. An astable
multi-vibrator generates 500 kHz square pulses. The output from this oscillator is divided into a number
of frequencies by using binary counters. These are the frequencies that are used as system timing
signals. A 250 kHz signal provides a split-phase signal to drive output stages on the power output
circuit.

In order to facilitate the identification of each mode of operation, the machines incorporate an audio
tone generator. The tone signals are derived from the counter at 1 kHz (coagulation), 500 Hz (cutting)
and 250 Hz (haemostasis).

The RF generator provides an undamped high-frequency current (typically 1.75 MHz) which is suitable
for making clean cuttings. The spark-gap generator produces a damped high-frequency current which is
specifically suitable for the coagulation of all kinds of tissues. The mixing of both these currents
signifies one of the most important possibilities for use in electro-surgery. By blending the currents of
the tube and spark-gap generator, the degree of coagulation of wound edges may be chosen according to
the requirements.

The concurrent use of continuous radio-frequency current for cutting and a burst wave radiofrequency
for coagulation is called Haemostasis mode.

Summary
This is an electrosurgical unit, this is a device that uses high-frequency (HF) electrical currents to cut or
coagulate tissue during surgery. It consists of an electrosurgical generator
that transforms electrical energy into HF current and it is operates using a specific control
that can be seen on the front part of the device.
Electrical current is delivered and received through cables and electrodes.
The electrodes may be activated by either a handpiece switch or a footswitch the ESU may use a
monopolar or a bipolar mode. These systems include an electrosurgical generator that is power supply
worked from a generator and a hand piece including one or several electrodes. In monopolar
electrosurgery, tissue is cut and coagulated by completing an electrical circuit that includes a high
frequency oscillator and amplifiers within the ESU, the patient, the connecting cables, and the
electrodes. In most applications, electric current from the ESU is conducted through the surgical site
with an active electrode. The electrosurgical current exits the patient through a often called patient plate.
The dispersive electrode is usually placed on the patient at a site remote from the surgical site. In bipolar
electrosurgery, two electrodes generally, the two tips of a pair of forceps or scissors serve as the
equivalent of the active and return electrodes in the monopolar mode. Most of the problem in
electrosurgery unit occurs due to the problem in the electrodes, some time the problem can be as simple
as loose connection and at other times the electrodes can be defective. In modern machine the proper
connection of dispersive electrode or patient plate is displayed by the device too. Other problem in
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Electrosurgical unit may require replacement of parts or electronic components hence in such situation
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intervention from trained engineer or person having expertise is recommended.

BMEE 5108 MAINTENANCE III NYINGCHU@2023/24

Preventative maintenance ESU

Testing of ESUs can be done on sophisticated testing equipment that is developed to specifically inspect
the performance od individual waveforms and the efficacy of the different modes. In the absence of such
sophisticated equipment, testing can be carried out by performing the operation on resistor mats.
Although 400 ohms would work, only a resistor with a very large power rating will survive the
procedure. Such large power resistors are generally not available in the developing world. In these cases,
a bar of soap or a fresh piece of citrus fruit (like an orange), or a piece of meat can be used to do your
initial testing. Be sure that both sides of the dispersive electrode are touching to prevent an alarm. The
patterns and the effects on the testing piece of each of the modes and equipment are clearly distinct from
one another and can give a rough idea about the quality of the active electrode. Any deviation from
normal would indicate a problem with the electrodes or the waveform pulse. Different modes can be
tested and the patterns on the orange can be analyzed. Coagulation pulses should coagulate the tissue
properly and cutting electrodes should cut the tissue properly. If any of the reusable electrodes show any
problems with respect to cutting or coagulation, the electrodes must be replaced.

Given below is an additional video that details the patterns of different modes that you'll be able to
observe if you use the electrodes on an orange and a lightbulb.

Additional video: Electro-surgery on an orange

As highlighted in the recap video, the electrodes can be monopolar or bipolar. In the case of a
monopolar electrode, a return electrode is needed. The resistivity values of the return electrode dictate
the spray pattern of the pencil electrode. In cases where the return electrode pad is damaged or worn out
the resistivity values may change. In such cases, the ESU raises an error. The ESU will notify the
operator that the return electrode that they have just connected has registered a higher resistance than the
specified level. A preventive maintenance routine should always check if this alarm is functional as
using a return electrode with a higher resistance value is hazardous to the patient. This can be done with
the use of a resistance box. Select a value on the resistance box that is higher than the resistance value
tolerated by the ESU (usually around 10 ohms) and check if the device shows the error signal.

Burns:

The predominant hazard associated with electro-surgical units is burns caused by excess current density
at a rate other than that at which it is meant to be present. The burn usually occurs at the dispersive
electrode because of failure to achieve adequate contact. The injury can also occur because an
unintended current pathway may be created. In the latter case, the lesion usually occurs at a point where
the patient is inadvertently touching a grounded object, and contact is made over a small area of skin.
The risk of burns also exists in the presence of moisture, i.e., the accumulation of prepping agents,
blood, or other fluids around the indifferent electrode can give rise to small, highly conductive areas.
Burns resulting from small conductive areas between the limbs can be prevented by means of dry cloth
placed between them. During surgery, the output power of the electrosurgical unit should not be
increased if the desired surgical effect is not obtained. Abnormal power settings indicate that something
is wrong and that the fault must be identified. In particular, the indifferent electrode and all cables and
connectors should be thoroughly checked. It is advisable to carry out surgical work with the power
setting as low as possible, to reduce the risk of burns.
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Electrocution:
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Another serious hazard associated with the use of electrosurgical machines is the possible electrocution
of the patient from faulty mains operated equipment when one side of an electrical circuit is connected
to the earth. In order to provide protection against mains current electrocution, a capacitor (RF earthed)
is generally included between the indifferent lead and earth. Modern solid-state machines usually have
RF isolated patient circuits. This implies that ideally, RF current may take only one path, i.e. from active
electrode through the patient to the indifferent electrode. Since there is no earth connection, there is no
propensity for the RF current to take any earth pathways which may unintentionally develop. However,
due to RF leakage pathways inherent in the equipment and leads, no machine can be considered as
completely isolated. The degree of RF leakage current is thus a measure of the degree of isolation of a
particular machine. The lower the leakage current, the better the isolation.

Explosion:

In operating theatres, danger zones can develop through the use of cleansing agents such as ether and
alcohol, and by using explosive anesthetic gas or mixtures with oxygen. The sparks associated with the
use of surgical diathermy can cause a dangerous explosion if proper precautions are not taken.

Troubleshooting and repair

Refer to the manufacturer's manual to effectively troubleshoot the problems encountered. Given below
are a few common problems encountered and the underlying causes of such problems.

1. Check for visible signs of power reaching the device. Lights, sounds, audible motor whirring, etc are
all signs that the device is receiving power.

2. Inspect AC adapter cable and pins for cuts, broken wires, and replace if necessary.

3. Inspect the condition of Fuse

1. Ensure proper placement of a ground electrode on the patient.

2. Ensure low patient impedance.

3. Inspect cable connecting the ground electrode to ESU for cuts, broken wires, damage

4. If the return electrode is made up of 2 sections, use a multimeter to measure the resistance or voltage
drop between the two parts of the electrode. There should be no short circuit. replace return electrode if
the resistance is found to be below the level specified by the manufacturer.

5. If the active electrode is bipolar, check if it is properly insulated.

Use a multimeter to measure the resistance or voltage drop between the two sections.

The return electrode must be flat in order to function properly. Check if it is flat.

Replace return electrode if necessary.

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