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Energy sources for laparoscopic surgery

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use of energy sources for laparoscopic surgery

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Energy sources for laparoscopic surgery

  1. 1. Consultant - Dr.S.Easwaramoorthy MS FRCS (England)FRCS (Glasgow) FRCS (Edinburgh) Dept of Minimal Access Surgery Lotus Hospital, Erode Laparoscopic Energy Sources Points for Practice!
  2. 2. History of Energy Sources Harvey Cushing William Bovie 1928
  3. 3. Newer Energy Sources
  4. 4. Monopolar Electro surgeryMonopolar Electro surgery •Active Electrode •Return Pad Patient is part of the Circuit! Current Density
  5. 5. Tissue Response Generator Split return electrode pad Active Electrode Monitoring Voice Command System Argon Plasma Coagulation Advances in Electro surgeryAdvances in Electro surgery
  6. 6. Impedance Measurement
  7. 7. Factors Modifying the Tissue Effects Current Density Vs Tissue Impedance 1. Size of active electrode 2. Cut or Coagulation mode 3. Power setting 4. Duration of exposure 5. Tissue Impedance
  8. 8. Tissue Impedance Water Tank (Voltage) Flow of Water (Current) Outlet (Impedance)Ohm’s Law: I=V/R
  9. 9. Tissue Responsive Generators
  10. 10. Split Pad
  11. 11. RReturneturn EElectrodelectrode MMonitoringonitoring
  12. 12. Electrosurgical Injuries during Laparoscopy Electro surgical injuries are not always due to ‘Pilot’ error. Zone 1 Insulation Failure Conductive Coupling Capacitive Coupling
  13. 13. Insulation FailureInsulation Failure Zone 2 Injury
  14. 14. Prevention of Electrosurgical Injuries Active Electrode Monitoring Insuloscope
  15. 15. Bipolar Diathermy
  16. 16. Ligasure Vessel Seal SystemLigasure Vessel Seal System Bipolar Low Voltage High Current Mechanical & Thermal Effect Collagen/ Elastin welding 7mm vessel seal!
  17. 17. Gyrus/Plasmacision  Gyrus 400 Generator/PK instruments  Plasma Trissector & J hook  Tissue Sealing & Bipolar cutting Vapour Pulse Coagulation
  18. 18. Enseal Thermofusion & Dissection Smart Electrode Technology
  19. 19. Caiman: Aesculap • Pulse wave form modulation • Least tissue charring • Longer Jaws: 50mm • Rotating jaws
  20. 20. Ultrasound as Energy Source eg: Harmonic Scalpel Ultrasonic Energy 55,000/Sec Minimal Instrument Traffic • Dissector • Coagulates • Cuts 80-100o C Minimal lateral Spread
  21. 21. Harmonic Scalpel Effect: •Blade configuration •Sharp edge, Flat, and Blunt •Power Level •1 to 5 •Traction/Tension Residual heat
  22. 22. Sonocision
  23. 23. Haemostasis Vs Dissection ACE 7
  24. 24. Thunder beat
  25. 25. Energy Devices for MASEnergy Devices for MAS Which is the best?!Which is the best?! Ligasure Gyrus Enseal Harnomic Features 1 Maximum vessel burst Pressure 2 Least thermal spread 3 Least amount of smoke production 4 Fastest sealing time Easy to handle Reliable Efficient Cost Effective
  26. 26. You make the Choice!
  27. 27. Make the Right Choice Ligasure Enseal Harmonic Right equipment used for the right reason will ensure right result!
  28. 28. IAGES Endoscopy Fellowship 4 days of Didactic lectures, Hands on endoscopy and Simulator training and assessment November 3rd to 6th 2016 ( 4 days) @ GI Unit, Lotus hospital, Erode, TN Maximum of 50 candidates For IAGES members only Fee: 25000/- See brochure/IAGES website Contact : 098433 28928 for details.