It uses a complete circuit to cut and coagulate tissues, which consists of a high-frequency generator, a patient electrode plate, connecting wires and electrodes in a high-frequency electrotome. In most applications, current flows through the patient through effective wires and electrodes, and then returns to the generator of the high-frequency electrotome from the patient's electrode plate and its wires.

Use skills

1. Don't turn it too big. The actual energy output of each instrument or the same electrotome is different in different states. Generally, electric cutting and electrocoagulation do not exceed 40 watts. Principle: Adjust to the minimum power that can complete the operation. For the operation of liver metastasis in ovarian cancer reduction surgery, coagulation of liver tissue can generally be performed to 100 watt.

2. An electric scalpel is not a knife. The principle of electric cutting is electric spark cutting caused by intermittent discharge, so the electric knife can't be regarded as a knife. Keep the electrotome at a short distance from the tissue to produce even a small spark. But we can't press the electrotome hard on the tissue, causing tissue damage.

3. Tissue traction is very important. Be sure to lift the flap at a 45-degree angle so that there is a certain gap between the tissues. The electrotome walks in the gap, so the anatomical level is clear.

4. Speed control of electric knife. Too slow, damage the tissue; Too fast, it will damage important tissues.

5. Use electrocoagulation when stopping bleeding. Generally, it is effective to lift the vascular clamp to stop bleeding.

6. Patients with subcutaneous fat hypertrophy should use electrotome less to avoid tissue liquefaction and necrosis leading to wound healing.

7. Because the electrotome works at the place with the greatest contact resistance, it should be reliably contacted (the area should be as large as possible) to avoid poor contact between the ground wire and the skin, so as to avoid burns!

8. Don't try to cut the specimen, because there is no circulation and no reaction. If there is a response, it is the performer himself, and then the performer will be shocked!

9. For some muscle-rich places, if you want to cut off the muscle, electrocoagulation will cut less bleeding, because electrocoagulation will not cut too fast, the current is small, and there is enough time to carbonize the muscle to stop bleeding. When there are too many tissues in the forceps that need electrocoagulation, electrocoagulation will get good results in hemostasis.

10. If electrotome is used in deep tissue, use electrotome with long handle as far as possible, and only the tip of the knife is exposed to prevent the exposed metal cutter from damaging adjacent structures such as blood vessels and nerves.

1 1. Be careful not to let the electric knife injure the epidermis by mistake. Try not to cut the subcutaneous tissue with an electric knife, cut the subcutaneous tissue with a scalpel, and then use electrocoagulation to stop bleeding. In some areas with little bleeding, scissors or The Lancet can be used instead of electrotome.

12. Don't touch the internal fixator when taking it, especially the spinal internal fixator. Electrified electrotome can damage dura mater, nerve root or spinal cord-causing nerve spinal cord injury and paraplegia.

Note: Monopolar electrosurgical excision procedure can not directly coagulate the blood vessels of uterus and ovary, which may easily lead to bleeding. After bleeding, unclear anatomical structure will damage adjacent tissues such as ureter, bladder and intestine. The blood vessels of uterus and ovary can be treated by bipolar electrocoagulation or suture.

Characteristics of common bipolar electrocoagulation:

1. There is no need for body form circuit with the patient, only the function of electrocoagulation to stop bleeding, but no function of cutting.

2. The part of blood coagulation is between two electrodes.

3. Compared with the electrocoagulation function of unipolar electrotome, it is safer and has better coagulation effect.

4. When dealing with uterine blood vessels or pelvic infundibular ligament, it is better to temporarily block blood flow with vascular clamp or vascular clamp before electrocoagulation.

5. Note that intermittent electrocoagulation is better than continuous electrocoagulation.

Ligasure ligature vascular closure system

Ligasure: You can call it intelligent bipolar plus cutting blade, or computer feedback control bipolar electrosurgical system. Ligasure is the result of improving the common bipolar electrosurgical system. Although the voltage between blades passing through Ligasure is much lower than that of traditional bipolar electrosurgical resection, the contact area between Ligasure blades and tissues is obviously larger than that of traditional bipolar electrosurgical resection, so more current can be allowed to pass through.

The host can feel the electrical impedance of the target tissue between the blades through the feedback control system. When the tissue is solidified to the best degree, the system will automatically turn off the power supply, and there will be a prompt to remind you that the solidification is complete. Ligasure cutting and closing system uses real-time feedback and intelligent host technology to output high-frequency electric energy, combined with the pressure between electric blades, so that the collagen and fibrin to be cut melt and denature, and the vascular wall fuses to form a transparent band, resulting in permanent closure of the lumen.

Ligasure ligature vascular closure system is different from ordinary bipolar system in that it has a blade switch, which can push out its own blade to cut off coagulated tissue.

The advantages of Ligasure are:

1. Close blood vessels within 7 mm in diameter (theoretical value only);

2. There is no need for excessive separation when closing the blood vessels in the tissue;

3. The formed closed band can resist the pressure of more than three times the normal systolic pressure;

4. The closing speed is fast, there is no smoke, and the surgical field of vision is not affected;

5. There is no peculiar smell and carbonization when it is closed, so foreign bodies such as seamless lines and titanium clips remain after it is closed;

6. When closed, the local temperature is not high, the heat diffusion is less, and the heat conduction distance is only 1. 5~2 mm, and no damage to surrounding tissues.

Ligasure is more effective than traditional bipolar electrotomy, especially suitable for laparoscopic and open tumor surgery, which greatly improves the safety of surgery.

note:

The clamped tissue is much less, and the length of the cutting head should be 1/2 to 3/4. The pelvic infundibular ligament should be solidified twice before cutting. If the uterine blood vessels are exposed, the blood flow can be temporarily blocked by vascular clamp or vascular clamp, which can be coagulated at one time. Of course, the operation should be handled according to the actual situation of the patient.

ultrasound knife

The application principle of ultrasonic scalpel is to convert electric energy into mechanical energy through a special conversion device, and the mechanical energy transmitted in the form of sine wave acts on the metal cutter head at the front end, so that the cutter head produces 50 ~ 100? M-amplitude mechanical oscillation, due to friction heat generated by tissue tension and shearing force to both sides, vaporizes water in the contacted tissue cells, breaks protein hydrogen bonds, denatures protein, and the tissue is cut after solidification. The application of ultrasonic scalpel in laparoscopic surgery has obvious advantages.

The damage of ultrasonic scalpel to surrounding tissues is far less than that of electric scalpel. Its precise cutting function enables it to safely separate and cut important organs and great vessels. Less smoke and eschar make the vision of laparoscopic surgery clearer and shorten the operation time. No current passes through the human body, which makes the operation safer and reduces the occurrence of complications.

It is difficult and time-consuming to treat abdominal lamellar adhesion and mesentery with electrotome. With the ultrasonic scalpel, it becomes easier to handle, reduces the difficulty of operation and the amount of bleeding during operation, and is more in line with the principle of tumor-free surgery.

When in use, the tip temperature of the ultrasonic scalpel is lower than 80℃, the surrounding propagation distance is less than 5 microns, there is almost no smoke, eschar and electric spark, and there is no electrophysiological interference to the body. Compared with the electric scalpel commonly used in general surgery, the ultrasonic scalpel has the advantages of accurate cutting, firm hemostasis, strong controllability, better safety and effectiveness, so it is more advanced.

Influencing factors of hemostatic effect of ultrasonic scalpel cutting;

1. Ultrasonic knife working gear: high-grade cutting; Low-grade condensation; Solidification before cutting;

2. Tissue tension during ultrasonic knife cutting: no vascular tissue, increased tension and fast cutting speed. Rich in vascular tissue, reducing tension and good coagulation effect;

3. The pressure of the ultrasonic knife to clamp the tissue: high pressure-fast cutting; Low pressure-good hemostasis;

4. Selection of working face of ultrasonic scalpel: sharp face-fast cutting; Blunt face. -Stop the bleeding.

5. Try to clamp the tissue with the first 1/3 ~ 1/2 of the ultrasonic cutter head, so as to stop bleeding and cut off the jaw tissue at one time.

Li Guoxin, a general surgery teacher in Southern Hospital of Southern Medical University, summarized the nine-character tactics of ultrasonic scalpel. There are related resources on the website of Lilac Garden. If you are interested, you can download and study it.

Common improper or wrong operation of ultrasonic scalpel

Non-direct vision surgery;

Operation of the working cutter head close to important organs: fully stir the tissue, and the working surface is far away from the tissue, or the non-working surface is close to the important tissue;

Large clamping tissue: fast, easy to bleed, slow, foggy, unable to dissect carefully;

Contact with metal or bone when excited; Leading to cutter head fracture or tissue damage;

Long-term excitation: Try to excite once.

Clamping a small amount of tissue: when testing, the cutter head is separated and the clamping tissue is moderate;

Dealing with scabies for a long time.

Note: When the ureter is separated by ultrasonic scalpel or common monopolar electrotome, it is dissected outside the sheath, and when lymph nodes are cleaned, it is dissected inside the sheath.

It is every surgeon's lifelong goal to understand the principle of weapon use, combine previous experience with his own reality, operate like an anatomist, minimize injury and pursue bloodless surgery. Finally, don't forget:

The safest knife is The Lancet!

Don't panic if you bleed during the operation. It is very important to stop bleeding by compression. Seeing the bleeding point clearly can be stopped by bipolar electrocoagulation, but the best hemostasis scheme is suture!

When using energy equipment, it is best to let the assistant work with the aspirator at the same time, which can effectively expose the field of vision of the operation area!

Any instrument that uses electric energy will generate a lot of heat during use, so remember that these energy instruments must always be in your field of vision during the operation, so as to avoid leaving your field of vision during the operation and not being discovered, causing burns to tissues such as intestines!