Diathermy in Surgery

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

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

To
Surgeon
Burns
Electrocution

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

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

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

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Diathermy in surgery

of electricity as an alternating current to

300BC Egyptians used to treat tumors

on the number of electric poles at the

Monopolar active electrode held by the surgeon

electrode needle, blade, forceps)

Grounded return current passes through the

frequency electric current produced in

1mA = threshold for muscle activation

inductance takes place with

monopolar systems the indifferent

Intensity of the current High voltage (200-500V

An unmodulated continuous sine wave with a duty

cycle is the duration of time current is

For pure cutting = 100% and pure coagulation is

diathermy has a reduced risk of

Vaporization of tissue in contact by bursting cells,

Most widely used function

by an interrupted burst of current

Spray coagulation electrode and tissue not in

Destructive coagulation with charring of adjacent

Excision of hydrocele sacs

Dangers and complications

Burns to skin or cavities

Improper placement of indiff electrode

Explosion due to reaction with volatile gases

Dangers and complications

Dangers and complications

Pyrole, 6 emthylindole, indole

3 butenenitrene, benzonitride, 2 propelenenitrene

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

3 methyl propanolol, benzaldehyde

Miscellaneous - 5 dimethylfuran, hexadecanoic acid

Dangers and complications

Safety measures / precautions

Do not prepare bowel with manitol

Prevent patient contact with metal parts of couch

Safety measures / precautions

active electrode in a quiver

Safety measures / precautions

the appropriate mode

Less tissue damage

Uses USS energy converted to a frequency of

important addition to the armamentarium

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