Energy Devices
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Energy devices are among most important tools in the transplant operating room. We advise our new residents and OR nurses to take a look at this page at the beginning of their rotation.
Electrocautery
Monopolar and Bipolar Electrocautery Instruments are connected to an Electrosurgical Unit (ESU) which uses High-Frequency (Radio Frequency, RF) Electrical Alternating Current (AC) for cutting and coagulation of tissues. Electrosurgical units convert standard electrical frequencies of 50 to 60 Hz to much higher frequencies of 500,000 to 3,000,000 Hz. For cutting, a continuous single frequency Sine Wave is employed which causes rapid tissue heating and vaporization. There are two types of cutting: Pure Cut and Blended Cut. Blended cut has some hemostatic effect. In Coagulation Mode, Sine Wave is turned on and off in rapid succession and as a result there is a slower heat generation and coagulation. There are two types of Coagulation: Coagulation (Pinpoint) and Fulguration (Spray).
Force Triad Energy Platform manufactured by Covidien (Medtronic) offers Cut, Coag, and Valleylab Modes. Valleylab Mode is a new Monopolar modality with an optimal combination of division and hemostasis and allows consistent hemostatic division of tissue with lower power settings and thermal spread. It helps with nerve sparing procedures. There is additional Foot Pedal for V-Mode. Force Triad Energy Platform also support Valleylab LigaSure.
The Grounding or Return Pad should be placed over a large muscle with adequate blood supply on the same side of surgery and as close to the surgery site as possible. Placement of the Pad over bony prominences should be avoided if possible. Be advised that severe burns can occur in Monopolar Mode if the contact with the return electrode is insufficient, or when a patient comes into contact with metal objects. If there is any metal in the body of the patient, the return Pad should be placed on the opposite side of the body and be placed between the metal and the operation site. Pad should not be placed over a Tattoo.
If the patient has Implantable Cardioverter-Defibrillator (ICD) and/or Pacemaker, a cardiologist needs to program the device before the surgery and reprogram it back to the desired settings following the procedure. Position the Grounding Pad in a place where so the current pathway does not pass through or near the ICD or Pacemaker. Use Bipolar Mode when possible. When you need to use Monopolar Mode, avoid direct contact between the Electrocautery Instrument and the Pulse Generator or Leads and use short, intermittent, and irregular bursts at the lowest possible energy levels. Always have Temporary Pacing, and External Defibrillation equipments available.
An Abrasive Scratch Pad can be used for cleaning the Monopolar Electrocautery Tip. If a Non-Stick Tip is used, a wet sponge should be used instead.
Argon Plasma Coagulation
Argon plasma coagulation (APC) or Plasmasurgery is a non-contact Monopolar Electrosurgical Technique for coagulation. It is not a laser. With this technique, ionized argon gas is used to conduct the current to the target tissue. The APC Applicator is placed at some distance from the bleeding site. The argon gas is emitted, and then ionized by a high-voltage discharge. It delivers the thermal energy with a depth of penetration of roughly 2 to 3 mm. The most important factors on coagulation depth in order of priority are: application duration (especially for static application), power setting. probe distance (working distance), static/dynamic application.
LigaSure
Valleylab LigaSure manufactured by Covidien (Medtronic) is an advanced Bipolar Device which works with Force Triad Energy Platform and provides a combination of pressure and energy to create Vessel Fusion of vessels up to and including 7 mm and, lymphatics. Tissue Fusion is a new and improved form of Tissue Sealing which is done with Force Triad Energy Platform.
ENSEAL
ENSEAL G1 Tissue Sealer, manufactured by Ethicon (Johnson & Johnson), is an advanced Bipolar Device that works with the Ethicon Generator G11 which supports HARMONIC® Ultrasonic and ENSEAL® Advanced Bipolar Devices. ENSEAL seals vessels up to 7 mm and lymphatics.
In contrast with ENSEAL G2 Laparoscopic Tissue Sealer, ENSEAL G1 Tissue Sealer which is used for open surgeries has 2 Buttons: Seal Button, and Cut Button. Bipolar Energy is delivered when Seal Button or Min Food Pedal is pressed. Tone One will be heard. When activation cycle is complete, you will hear Tone Two. Be advised that there are 3 Tones when you use Laparoscopic ENSEAL G2 Tissue Sealer. To learn more, refer to our Robotic Surgery Info Website.
Harmonic Focus + Shears
Harmonic Focus + Shears, manufactured by Ethicon, is used for soft tissue incision when we coagulation is needed and we want to have minimal thermal injury. It works with the Ethicon Generator G11. For greater tissue cutting speed use a higher generator power level, and for greater coagulation use a lower generator power level. The Proximal Hand Control Button activates Min and Distal Hand Control Button Activates Max.