The laparoscopy is a procedure that allows the surgeon to visualize the organs of the abdomen, like intestines, stomach and biliary vesicle, and in women the pelvic organs, like the ovaries and in some cases to practise an operation in the above mentioned organs. The laparoscopy is a diagnostic skill and of treatment based on special systems of vision and manipulation got in the abdominal cavity across incisions puntiforme.
The laparoscope consists of a tube that is inserted through a punctiform hole in the abdominal cavity. The tube includes a lighting system with a cold light source (through fiber optic systems), optical instruments for visualization and recording of images, an inert gas vent (CO2, nitrogen) and a distending cavity facilitating the vision, Washing and aspiration systems and instrumental pathways.
The Electroscalpel is an electrical apparatus that converts electric energy into heat with the aim of cutting, eliminating or coagulating soft tissue like meat, thanks to currents that are above 200,000 Hz.
The operation of the electric scalpel is as follows:
circulates high frequency current and moderate or elevated intensity between two electrodes applied to the body. This causes heat to be generated in the applied place and to be cut (electrosecting) or clot (electrocoagulation) the tissue.
Currents can be of two types: direct current or alternating current.
In direct current, also called Galvanic current, there is a continuous exchange of electrons and in a single direction between two opposite poles.
The surgical units have two modes of operation: Monopolar mode and bipolar mode.
The differences between them are minor. The two modes make electrosections (pure and combined) and electrocoagulation. Both work with power between 50 and 100 W.
to differentiate one mode from another, you have to look at a single accessory.
Below we will explain the operation and differences between the two types of electroscalpels.
The Monopolar Electroscalpel has a large surface electrode, called a return electrode, and a small one called active electrode. The current density generated at the contact point of the active electrode is high, so a large amount of heat is concentrated in it.
According to the shape of this electrode, one effect or another on the tissue is obtained.
If the contact surface is lower, the current density increases, and with it the heat generation at the place of contact, which derives in a cut.
on the other hand, a larger contact surface is used to coagulate the tissue.
Normally come with two buttons, which are used to change the electrode mode between cutting and coagulation.
may also have identifying colors : For the cut the yellow color is used, whereas for the coagulation the blue is used.
The return electrodes have a low contact impedance with the skin, have a large surface that goes from 100 to 200 cm ² and are very adhesive.
can be of two types: solids, which have a continuous conductive surface, or split, which consists of two pieces to be able to monitor the contact between the electrode and the skin.
should be placed in muscular masses with good vascularization, preventing parts of the body with irregularities and a lot of bone.
In case it is placed preventing good contact between the electrode and the skin, it can cause an increase of the contact impedance and lead to Burns.
A system is responsible for measuring the impedance using electrodes divided into two pieces. If it is within a given range, energy is delivered, but if it is out of range, it does not allow activation of the active electrode.
The bipolar Electroscalpel applies the current between the two tips, an instrument, usually tweezers or scissors. The current generated between the two ends causes heat to be generated, which is delivered to the fabric.
The bipolar electrosurgical units have a lower power density than the monopolar ones, and this causes them to not be able to produce cuts in the tissue (except for some exceptions).
With them you can perform hemostasis using current modulated or unmodulated. It is frequently used in endoscopic applications or to seal cups.
Block diagram
Waveforms
COAGULATION MODE
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