ELECTROSURGERY IN ENDOSCOPY - PowerPoint Presentation

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ELECTROSURGERY IN ENDOSCOPY

THE FACTS ABOUT ELECTRICTY

1. Always seeks ground

2. Always seeks the path of least resistance

*Electricity always seeks the path of least resistance to

ground

*The path is not always straight. It can be compared to water running down a hill.

The water may take multiple pathways to reach the bottom of the hill. The path may include the endoscopic team (touching patient).

THE FACTS ABOUT ELECTRICTY

54-880 MHz

60

Hz

100 kHz

350kHz-3MHz

ESU’s

550-1550 kHz

Household

AM Radio

TV

*NMS still occurs in small percentage of procedure…demodulation

COMMON USES IN ENDO

Polypectomy

Papillotomy/Sphincterotomy (ERCP)

Endoscopic Mucosal Resection (EMR)

Contact Bleeding Control (Tamponade)Non-Contact Bleeding Control (APC)

Ablation (APC)

COMMON USES IN ENDO

monopolar

electrosurgery

bipolar

electrosurgery

COMMON USES IN ENDO

*The smaller the active electrode, the more concentrated the energy

*The grounding pad is a neutral electrode dispersing the energy over a larger surface area

*That is why proper grounding pad placement is so important

IMPORTANCE OF GROUNDING

UNDERSTANDING DISPERSIVE ELECTRODES

Boney prominences

Scar tissue – including Tattoos

Skin/Scars over an implanted metal prosthesis Hairy surfaces Lotions or oils on skinThe Dispersive Electrode Should

NOT Be Placed Over:

POWER VS VOLTAGE

Regulation of Power Output

The power output is dynamically regulated within the pre-set limits.

With Power Regulation, surgical/tissue effect

is consistent (independent) of:

the cutting electrode

the direction of the cut

the tissue

New Generation Generators: control

V (I) = doses

power output= controls (

predicts)

tissue effect

CLINICAL SAFETY

Incomplete Preps or enema-only preps for Flexible Sigmoidoscopy increases

the

risk for bowel explosions.Bowel explosions can occur with ANY monopolar electrosurgery (e.g. snare, APC, hot biopsy) when combined with hydrogen and methane gases in a dirty colon.Patients should be fully prepped.

The Importance of Bowel Preps…

CLINICAL SAFETY

Avoid

activation

in close proximity of metal objects

The

active probe

should not be activated if the tip is

close to or touching metal objects

Unintended thermal injury of the surrounding tissue may

occur

Metal objects may receive unintentional damage.

Exceptions - “trimming” of migrated metal stents.

Important Considerations for Endoscopy

CLINICAL SAFETY

Observe skin touching conductive objects - IV poles, metal bed rail parts

Watch for fingers, toes, ankles, and elbows touching metal

Check for arms over bedrails and hands grasping

handrails

Separate all wires, including heart monitor wires from active cords and dispersive electrode cordsElectricity Always Seeks Ground….

Alternate Site Burns

THERAPEUTIC WAVERFORMS IN GI

Endo Cut

™

(ERBE only)

YELLOW pedal

- NO TAPPING

Mode

Setting

Hemostasis Output

Effect

Intensity of

Coag

Effect 1

Cut only

Effect 2

Minimal

Coag

i.e

Soft

Coag

Effect 3

Moderate

Coag

Effect 4

Marked

Coag

THERAPEUTIC WAVERFORMS IN GI

Endocut I & Q

ENDOCUT



is a proprietary cutting output that can be very effectively used in polypectomy and papillotomy.

ENDOCUT



measures resistance variables 1000 times per second via feedback between target tissue electrode and return electrode (grounding pad). Variables would include amount of wire in contact with tissue (i.e., amount of tissue being resected every millisecond), tissue resistance (

i.e

, fibrous versus vascular), pressure exerted on snare, etc.

Cut Effect

Cut

Interval

Cut Duration

ENDOCUT

Effect

–

Level of hemostasis for bleed

control.

ENDOCUT Cut Duration

– the

length of

the cutting phase.

The

higher the

value

, the longer the cutting

phase lasts

.

ENDOCUT Cut Interval

– the

cut &

coag

cycle.

The lower the

number

, the faster the cut. Longer cut intervals results in slower, more controlled cutsOnce set, the Cut Duration and Cut Interval may not alwaysbe displayed on the screen.

ARGON PLASMA COAGULATION (APC)

APC is a non-contact monopolar application

for

hemostasis and thermal destruction

ARGON PLASMA COAGULATION (APC)

ARGON PLASMA COAGULATION (APC)

ARGON PLASMA COAGULATION (APC)

ERBE Electrosurgery &

Interventional Endoscopy

THANK YOU!