Use of energy

About electrosurgery:

Voltage is the force that causes the movement of positrons

The possible effects of applying current to tissue are fulguration, desiccation/coagulation, or vaporization/ablation

In monopolar energy, the current only goes through the tissue between the two electrodes of the instrument

In bipolar energy, the current go through the patient to complete the electrical cycle

On regard to bipolar energy, a return electrode (dispersion pad) is necessary for the current to exit the body
Concerning electrosurgery:

Nerve and muscle stimulation occurs at electrical currents above 10,000 Hz.

Electrosurgery refers to the cutting and coagulation of tissue using low-frequency electrical current.

Electrosurgical units used in operating rooms convert standard electrical frequencies from the wall outlet, which are 500,000
to 3,000,000 Hz, to much lower frequencies, 50 to 60 Hz.

Electrosurgery refers to the cutting and coagulation of tissue using high-frequency electrical current.

Electrical current is created by the motion of positrons.
To avoid electrosurgical injuries with bipolar cautery:

Terminate current at the end of vapor phase.

Do not apply current in pulsatile fashion.

Use an in-line ammeter.

Do not alternate between desiccation and incision.

Use a return electrode monitoring system.
Regarding the use of monopolar energy, select the correct answer:

It is not recommended in laparoscopy.

To have a cutting effect, it is necessary to touch the tissue before applying energy.

To have a cutting effect, it is necessary to activate energy before touching the tissue.

Both strategies have the same cutting effect.

There is no risk of thermal spread to adjacent tissues.
The following instruments are alternatives for tissue morcellation.
Please choose the incorrect answer:

Cold scissors.

Bipolar energy.

Ultrasonic energy.

Monopolar energy.

Chardonnens knife.
Choose the incorrect answer concerning safety rules for the use of
monopolar energy in laparoscopy?

Avoid the application on functional organs such as tube and ovary.

Short application.

Do not touch other instruments.

Press as hard as you can.

Avoid bowel lesions.
Concerning energy effects:

The cut mode on the electrosurgical unit generates a continuous, high-voltage current, dispersed over a large
surface area.

The coagulation mode on the electrosurgical unit generates an interrupted, low-voltage current, concentrating the
energy over a small area.

Fulguration and vaporization are direct contact methods of monopolar electrosurgery, while
desiccation/coagulation is a non-contact method of monopolar electrosurgery.

Vaporization results from rapid heating in the coagulation mode with intense vibration and heat within the cells,
which cause the cell to explode and form smoke (plume).

Fulguration is caused by an interrupted current (coagulation mode), generating slower tissue heating and less-
focused tissue effect.
What is the most important reason for bipolar use of high
frequency surgery in gynaecology?

It is not necessary to apply the neutral electrode.

This physical principle provides greater safety.

There are better bipolar electrodes available on the market.

Only bipolar technologies provide automatic control.

Greater power output is provided.
When we talk about electrosurgical systems:

The energy generated by an electrosurgical system is continuous and can be low or high frequency.

The energy generated by the electrocoagulation system has three principal effects, thermal, electrolytic and
faradic, and the three of them are useful for their application in surgery.

Thermic lesion in the tissue is reversible if the rise in temperature is not higher than 55C.

Monopolar coagulation energy is made by a continuous wave form and has a high voltage, power so it is
considered to be more dangerous.

In monopolar cut mode, a continuous current creates a higher tissue temperature in a shorter time period, leading
to a rapid expansion of the intracellular contents and explosive vaporization.

Regarding electrosurgery in laparoscopic surgery:

Bipolar electrodes are better in vaporizing tissues.

Fulguration is synonymous with spray coagulation and results in a lower risk of inadvertent injury.

The cutting current is characterized by an interrupted waveform.

Power density and output mode (continuous or interrupted) are the most critical parameters in determining tissue
effect.

Given the same power output, the tissue effect is independent of the area of the dispersive electrode placed on
the patients body.
Concerning electrosurgery complications:

Capacitive coupling results from inadvertent contact of two noninsulated instruments (such as a metal trocar and a metal
grasper)

Capacitive coupling occurs with bipolar electrosurgery

Direct coupling is the ability of two conductors to transmit or receive electrical flow while separated by an insulator

The advantage of capacitive coupling is that energy may be transferred to intraperitoneal tissues such as bowel and cause
inadvertent burn

In direct coupling the electrical current flows from the primary to the secondary instrument, which acts as a second
conductor
About the application of energy:

Looking at the bubbles that form during heating of tissue does not help to guide the application of energy.

Bubbles represent CO2

Whitening of tissue surrounding the tip of the electrosurgical instrument suggests thermal spread.

The disappearance of water vapor is not a good indication to decide when to stop the application of bipolar
electrosurgical energy.

Thermal spread never causes tissue necrosis at the site of application.
To avoid electrosurgical injuries with monopolar cautery:
- Use the highest power setting
- Use a high voltage waveform (cut)
- Use brief, intermittent activation
- Activate in open circuit
- Activate in close proximity or direct contact with another instrument
Which temperature range produces tissue coagulation?

37-43 degrees.

43-45 degrees.

45-60 degrees.

70-90 degrees.

>100 degrees.