When we come to the medical field,
surgical Generator is a key surgical tool that is widely used in various surgical procedures. It is a special electrotherapy device that uses high-frequency current to cut tissue and control bleeding at the same time to promote the smooth progress of the surgical process.
1. Basic components of surgical Generator
The surgical Generator is composed of a host machine, an electrosurgical pen, patient plates, plate connection cables, bipolar forceps, bipolar forceps cables, foot switches and other accessories.
2. Basic working mode of surgical Generator
Monopolar electrosurgery (monopolar cutting, unipolar coagulation)
Bipolar electrosurgery (bipolar electrocoagulation)
3. Safe use of monopolar electrosurgery
a: Composition of monopolar electrosurgery
Unipolar electrosurgery generally consists of an electrosurgical host, an electrosurgical pen, a foot switch and a negative plate (wire).
b: Working principle of monopolar electrosurgery
It uses 300-500HZ high-frequency current to release heat energy and discharge to cut the tissue and stop bleeding. The current forms high temperature, heat energy and discharge at the tip of the electrosurgical knife, causing the contacted tissue to quickly dehydrate, decompose, evaporate, and coagulate blood, achieving tissue decomposition and coagulation to achieve the purpose of cutting and hemostasis.
c: Application scope of monopolar electrosurgery
Monopolar electrosurgers are widely used in surgery, dermatology, and dentistry, and can be used to cut different tissues according to their functions.
(1) Pure cutting function: mainly used for clear, precise and damage-free cutting of any tissue.
(2) Mixed cutting function: used for cutting any tissue and has good coagulation function.
(3) There are generally three types of coagulation functions:
a. Low-pressure contact coagulation (desicate/low): generally used for laparoscopic surgery and fine tissue coagulation.
b. Non-contact coagulation (fulgurate/med): effective for most tissues and suitable for most surgeries.
c. Spray coagulation (spray/high): used for large-area tissue oozing and forming a very shallow tissue coagulation layer.
d: Operation steps
1. Connect the power cord and negative plate circuit.
2. Turn on the power, perform self-test, and select the appropriate output power according to the instructions and procedures.
3. The negative plate is pasted on the appropriate part of the patient's muscles.
4. Connect the electrosurgical pen line and use the hand control or foot control switch.
5. After use, turn off the power of the host first, and then unplug the power plug.
e: Notes
1. High-frequency electrosurgical devices should be operated by trained medical personnel. Even before using a new electrosurgical device, the instruction manual should be read carefully to prevent safety issues caused by misoperation.
2. Selection of negative plates: Hard negative plates are less safe than soft negative plates. Double-circuit negative plates are safer than single-circuit negative plates. Pay attention to observation during use.
3. When the output power reaches 100~700W, it is extremely easy to cause burns or interfere with other electronic equipment.
4. Negative plate area: required to be greater than 100c㎡. It is generally required that the effective conductive area of the negative plate for children is 65c㎡. The effective conductive area for adults is 129c㎡. Once the effective contact area is reduced and the resistance increases to an unsafe level, the machine will automatically alarm and stop output. If the plate temperature exceeds the skin temperature by 6°C, burns may occur.
f: Selection of placement location of negative plate:
①Unsuitable parts: bony protrusions, scars, skin folds, fat tissue or thick fat, epidermis, weight-bearing parts, parts where fluid may accumulate, metal implants or near pacemakers.
② Suitable parts: easy-to-observe parts, flat muscle areas, shaved skin, clean and dry skin. The negative plate should be more than 15cm away from the ECG electrode; try to be as close as possible to the surgical incision site to reduce the current loop, but because first Consider ideal sticking sites such as: calves, inner and outer thighs, buttocks, waist, back, abdomen, upper limbs; try to avoid current loops passing through grafts, pacemakers, ECG electrodes, hearts, etc.; the long side of the negative plate Perpendicular to the direction of high-frequency current.
③Infant negative electrode plate: Choose flat muscle areas such as thighs, back, and abdomen. Children under 15 kg should choose infant negative electrode plates.
g: Precautions for using disposable flexible negative plates:
① It should be kept flat and cutting and folding are prohibited.
② Single use, no reuse: After use, the conductive adhesive on the surface of the negative plate adheres to dander and hair, and its physical and chemical properties change, resulting in poor conductivity, reduced safety performance, and an increased possibility of burns to the patient. Negative plates used at the same time may contain bacteria, HIV, HBV, etc. or dander from patients with skin diseases. Cross-infection may occur if the same negative plate is used repeatedly between different patients.
③When removing the negative plate, remove it slowly from the edge along the direction of the skin lines to avoid mechanical damage caused by excessive speed and excessive force.
7. Note during use: Remove the eschar on the electric knife head in time to maintain good conduction function. It is prohibited to scratch the surface of the electric knife head with sharp objects. Use a special electric knife wiper or moist saline gauze to wipe it off; if it is not used temporarily, When using the electrosurgery, it should be placed in an insulated container and should not be placed in areas that hinder the doctor's operation or on the patient's exposed body surface to avoid causing burns to medical staff and patients.
8. Patients with pacemakers are prohibited from using high-frequency monopolar electrosurgery.
9. Avoid direct contact between the patient's limbs and metal during use. An insulation layer of at least 4 cm thick should be maintained between the patient and the metal bed. If necessary, cloth or hand pallets can be used to fix the limbs.
10. The electrosurgical pen is a one-time use item and must be destroyed after use.
4. Safe use of bipolar electrosurgery
a: Structure and accessories
Bipolar electrosurgery generally consists of a main unit, bipolar forceps and a foot switch, and does not require a negative plate.
b: working principle
Bipolar electrosurgery is an electronic radiofrequency current generator. The bipolar forceps are in good contact with the tissue. The current passes between the two poles of the bipolar forceps. Its deep condensation spreads radially, and the relevant tissue turns into light brown small eschar, which is no longer visible. A significant arc will form. Since the two poles of the electrodes form a circuit, there is no need for a negative plate. Bipolar electrosurgery basically has no cutting function and mainly has coagulation function. The coagulation speed is slow, but the hemostatic effect is reliable and has minimal impact on surrounding tissues.
c:Application scope
Bipolar electrosurgery is mainly used for coagulation. It is also used to separate tissues, electrocautery the tumor capsule to make it contracture, and electrocautery the aneurysm pedicle to make it narrow and facilitate closure. It is widely used in neurosurgery, maxillofacial surgery, plastic surgery, orthopedic spine or spinal cord surgery, etc. It can also be used in patients with cardiac pacemakers.
d: Operation steps
1. Turn on the power, connect the pedal, and place it under the operator’s feet.
2. Perform power-on self-test and set the output power according to the requirements of the surgery and the surgeon.
3. Connect the bipolar coagulation wire plug.
4. After clamping the tissue or bleeding point with bipolar forceps, step on the foot pedal to coagulate to stop bleeding, and then release the foot pedal.
5. After use, turn off the host switch first, and then pull out the power plug.
e: Notes
1. Select the appropriate bipolar forceps and output power. Choose a forceps tip of 0.3-1.0mm according to the operation and tissue properties.
2. Continuously rinse with normal saline during use to keep the tissue moist and tension-free; keep the surgical field clean; avoid high temperature from affecting surrounding important tissues and structures; and reduce the adhesion of tissue eschar and electrocoagulation forceps.
3. Each electrocoagulation time is 0.5 seconds and can be repeated multiple times until the electrocoagulation effect is achieved. Intermittent electrocoagulation is more effective than continuous electrocoagulation in preventing eschar on the forceps tips and tissues.
4. Remove the eschar on the electrocoagulation forceps in a timely manner: Use wet gauze or a special non-damaging cloth to wipe the eschar on the electrocoagulation forceps. Do not use sharp tools to scrape off, otherwise it will damage the silver-copper alloy at the tip of the forceps.
5. The tips of the tweezers should be kept at a certain distance and should not touch each other to cause a short circuit. Loss of electrocoagulation.
6. When electrocoagulation is performed near important tissue structures (hypothalamus, brainstem, etc.), the electrocoagulation output should be as small as possible.
7. The foot control board should be put on a waterproof plastic cover before use to prevent the blood and flushing fluid during the operation from getting wet on the foot control board, making it difficult to clean, or causing circuit failure or short circuit.
8. The tips of the tweezers are fine. When using, cleaning, and placing them, pay attention to protecting the tweezers tips and put on protective covers. Do not put them together with other heavy objects. It is forbidden to scratch them with sharp objects.
5. Main differences between single and bipolar electrosurgery
Monopolar electrosurgery:
Monopolar electrosurgery uses a circuit to cut and coagulate tissue. This circuit consists of a high-frequency oscillator and amplifier in the surgical Generator, the patient, connecting wires and electrodes. In most applications, active wires and electrodes are used to output current to the surgical site. Unipolar has a large range of damage and is not suitable for delicate operations.
Bipolar electrosurgery:
Bipolar electrocoagulation provides high-frequency electric energy to body tissues through the two tips of bipolar forceps, causing the blood vessels between the two ends of the bipolar forceps to dehydrate and coagulate, thereby stopping bleeding. Its range of action is limited to the two ends of the forceps, and the degree of damage and impact on body tissue is much smaller than that of the monopolar method. It is suitable for sealing small blood vessels (diameter <4mm) and fallopian tubes. Therefore, bipolar electrocoagulation is mostly used in more delicate surgeries such as brain surgery, microsurgery, ENT, obstetrics and gynecology, and hand surgery. The safety of bipolar electrocoagulation is gradually being recognized, and its scope of use is gradually expanding.
As an important tool in the modern medical field, surgical Generator plays a key role in surgery. Its developments and innovations make surgery safer, more efficient and lead to faster recovery for patients. However, when using surgical Generator, medical staff need to fully understand its working principle and operation method to ensure the success of the operation and the safety of the patient.
