A range of energy sources are used in gynecologic laparoscopy. These energy sources include monopolar electrosurgery, bipolar electrosurgery (including “advanced bipolar” devices that incorporate tissue feedback monitoring), and various types of laser and ultrasonic technologies

1. CONVENTIONAL AND NEWER ENERGY
SOURCES

3. HISTORY
• 3000 B.C- Egyptians used heat to
treat tumour (Firedrill)
• 1881: Morton- 100,000 Hz does
not produce shock
• Origin of Electrosurgery :Dr P
Bozzini - Electrocauterization
(1887)
• First high frequency current
used - 1893
• Dr William Bovie and Dr Cushing
-Pioneer of Modern
Electrosurgery(1926)
Dr Bovie
Dr Cushing

4. ENERGY SOURCES & ITS DEVICES
Electrosurgery- 1)Monopolar
2)Bipolar
i. Ligasure
ii. Gyrus PK
iii. Enseal
iv. Caiman
Ultrasonic - Harmonic ACE
Integrated - Thunderbeat

5. ELECTRO SURGERY CIRCUIT

6. PROPERTIES OF ELECTRICITY
• Ohms Law V=I x R
Where V=Voltage
I=Current
R=Resistance
• The passage of high frequency
electric current through tissue
creates the desired clinical
effect.
•Current flows through Path of
Least resistance

7. ELECTROCAUTERY ≠ ELECTROSURGERY
• Electrosurgery is not synonymous with electrocautery, despite their mutual
use of electrical current to deliver their respective treatment goals.
• Electrocautery uses electrical current to heat a metal wire that is then applied
to the target tissue in order to burn or coagulate the specific area of tissue. It
is not used to pass the current through tissue, but rather is applied directly
onto the targeted area of treatment.
• Electrosurgery - Electrical current passes through tissue to accomplish a
desired result. The electricity used is a form of alternating current similar to
the that used to generate radio waves.

8. Two important parameters:
• Size of contact
• Impedance of applied surface

9. THE MORE CONCENTRATED THE ENERGY THE
GREATER THE THERMODYNAMIC EFFECT

10. TISSUE EFFECTS WITH WAVEFORM
MODIFICATION
I) CUT WAVEFORM:
• “On” time is high
• Produces heat very rapidly
• Cut tissues
II) COAGULATION WAVEFORM
• Modulated Intermittent-”On”time reduced
• Less heat produced
• Coagulum produced
III) BLENDED CURRENT
• Modulation of ≥2 waveforms
• Intermittent bursts
• Cut + Variable hemostasis

11. EFFECT OF TEMPERATURE ON
TISSUE

12. MONOPOLAR ELECTROSURGERY

13. BIPOLAR ELECTROSURGERY
• The two tine (prongs) forceps
functions as active and return
electrodes
• Grasped tissue completes the
circuit
• Coagulation
• Less thermal injury

16. FACTORS MODIFYING THE TISSUE EFFECTS
CURRENT DENSITY VS TISSUE IMPEDANCE
• Size of active electrode
• Cut or Coagulation mode
• Power setting
• Duration of exposure
• Tissue Impedance

17. CAUTERY PAD

18. VESSEL SEALING DEVICES

19. CAUTERY
LIGASUR
E
HARMONIC
• Ligasure
• Plasma Kinetic
Gyrus
• Enseal
• Caiman

20. LIGASURE
• Advance Bipolar Device
• Combination of Pressure and Energy
• Feedback Controlled System

21. • Seal time: 2-4 seconds
• Seals vessel upto 7 mm
• Tolerates 3 times SBP
• Max. Temperature 60-90⁰C
• Thermal Spread 4.5 mm

22. ENSEAL
• Only System Control energy deposition
• Nonpolar thermostat in jaws
• Adjusts energy according to tissue
impedance
• Less heat required: Tissue
• Volume reduced by compression

23. • Seals vessel 1 to 7 mm
• Tolerates 7 times SBP
• Seal Temperature 100⁰C
• Thermal Spread 1 mm

24. PLASMA KINETIC GYRUS
• Plasmacision
• Bipolar PK Technology
• Serrated Jaw
• No Feedback Controlled System but an audio
alarm

26. CAIMAN
• Tip first closure: Retains tissues within
the jaws for improved compression
• Advanced Bipolar Seal & Cut technology
• 80⁰Articulating Jaw
• Seals vessels 7 mm
• Thermal spread <1mm

28. ULTRASONIC DEVICES

29. HARMONIC ACE
• Ultrasonic Energy Mechanical Energy
• Piezoelectric crystals: 55,000 vibrations per second
• Adaptive Tissue Technology

32. SETTINGS OF HARMONIC
SCALPEL

33. • Cut and coagulate simultaneously
• Uses ultrasonic vibrations instead
of electric current
• Cut through thicker tissues
• Takes longer time
• Hemostasis only along with cutting
• Mist production affects visibility
• Minimal energy transfer (1mm) to
surrounding tissue so it cannot
cause bowel injury!!

35. THUNDERBEAT
• World’s 1st and only integrated energy
system
• Hybrid device
• Combines ultrasonic and bipolar energies
• Precise dissection
• Best visibility
• Fastest cutting speed
• Minimal thermal spread (<1mm)
• Only Cut
• Only hemostasis without cutting also
possible

37. ADVANCES IN ELECTRO SURGERY
• Tissue Response Generator
• Split return electrode pad
• Active Electrode Monitoring
• Voice Command System
• Argon Plasma Coagulation

38. ELECTROSURGICAL INJURIES
DURING LAPAROSCOPY
Not always due to surgeon error!!

39. INSULATION FAILURE

42. PREVENTION OF ELECTROSURGICAL
INJURIES

43. • Active Electrode Monitoring (AEM) Technology-
System in which shielded and monitored instruments
continuously direct stray energy, the cause of stray
electrosurgical burns, away from the patient via a
protective shield.

44. WHICH IS THE BEST…..!!
Harmonic

45. MAKE THE RIGHT CHOICE

46. TAKE HOME MESSAGE
• Making the correct choice of energy sources makes a lot of
differences.
• Not only the correct choice but understanding the limitations
of these technologies is also essential.
• Cost factor.
• Thermal spread.