Specialized Surgical Equipment PDF

Specialized Surgical Equipment Electro surgery, Microsurgery and Integrated Technology  Learning Outcome 1. Describe the principles of Electrosurgery 2. Contrast between Monopolar and Bipolar ESU 3. Explain general safety factor of electrosurgery 4. Identify the advantages and ge...

Specialized Surgical Equipment Electro surgery, Microsurgery and Integrated Technology  Learning Outcome 1. Describe the principles of Electrosurgery 2. Contrast between Monopolar and Bipolar ESU 3. Explain general safety factor of electrosurgery 4. Identify the advantages and general consideration of microsurgery Active tip/ Diathermy pencil/ ELECTROSURGICAL Positive pole UNIT (ESU) MONOPOLAR ELECTROSURGERY Inactive dispersive pad/ Pts return pad/ adhesive pad/ negative pole Electrosurgery 1. Principles of Electrosurgery (ESU) Electric current is used to cut and coagulate most tissue Coagulating of large vessels can cause extensive burn and necrosis Burning can devitalize tissue creating a barrier for wound healing and may provide a medium for infection ESU is not used to incise the skin but can be used on fat, fascia, muscle, internal organs and vessels The current can be passed through tissue without causing stimulation of muscles or nerves Electrosurgery Electrosurgical unit (ESU) Generator Foot pedal Cords Active electrode Designed to safely Inactive dispersive return deliver electric current electrode through tissue Electrosurgery ESU Generator Cutting Coagula The generator produces the te electrical current in three forms. 1. Coagulating Current: Intense heat produce to seal small to moderate vessels 2. Cutting Current: Constant flow of high energy output with out gaps of time that causes the tissue to separate 3. Blended Current: Both coagulating and cutting currents are produced at the same time in modified cycles. Small vessels are sealed as the tissue divides Blend  Electrosurgery Active Electrode The sterile active electrode directs flow of current to the surgical site It is attached to a conductor cord, which is connected to the generator The cord for the active electrode is passed off the field by the scrub person and attached to the generator by the circulating nurse Sterile cord should not be secured to the field by metal instrument Hand piece and active tip should be kept in a holder Do not scrape off the char with scalpel it cause discharge of debris to the atmosphere The use should minimize damage to adjacent tissue Active electrode hand piece and cord are disposable if it is to be use again it should be inspected Electrosurgery Patient Return Electrode Electrosurgery precaution to prevent injuries: Close as possible to the site of active electrode to minimize current through the body Electrode should be place on a large muscle mass after patient has been positioned to prevent it becoming dislodged and integrity of adhesive will be altered Avoid placing electrode pad on hair or scar tissue as it acts as an insulator to electricity Electrosurgery 1. Monopolar Electrosurgery Monopolar units the current flows from the generator to the active electrode, through the patient to return electrode and return back to the generator. Generator returns the currents to ground and any breakage with the current the alarm will sound for safety feature. The surgeon give the current and power setting to the circulating nurse to set. Electrosurgery Patient Return Electrode Monopolar electrosurgery the current is returned to the generator through an inactive return electrode attached to the patient. Electrode adhesive pad is placed on patient skin area must exceed 100mm² and diameter greater than 1.2 cm Electrosurgery Patient Return Electrode Electrosurgery precaution to prevent injuries: The return electrode should not be placed on skin over a metal implant as current could be diverted to the implant causing excessive heat Check the integrity of the package before use, do not use if damage Do not put safety belt over electrode or cord Connection between the return electrode and generator should be secure. If faulty the current will have alternative pathway that may cause danger within the operating environment There should also be documentation done Positive and Negative tip/ pole on the same forcep. Electro -surgery 2. Bipolar Electrosurgery Bipolar electrosurgery the current is directed from the generator to a special forceps with one active tip and one inactive tip. Current flows from generator to the active tip and returns to the generator to the through the inactive tip. Does not flow through the body as monopolar electrosurgery. It is safer to use in cases in which electrical current passing through the body could cause disruption in implantable devices such as pacemakers or internal defibrillators Electrosurgery Generalized Safety Factors for the Use of Electrosurgery Electrosurgery should not be used in the mouth, trachea, around the head or pleural cavity there is high concentration of oxygen that sets a combustible situation it can cause fire Electrocardiogram electrodes should be place away from surgical site to avoid burns Rings and other jewellery should be removed to avoid burns from diverted current Electrosurgery Generalized Safety Factors for the Use of Electrosurgery Electrical burn through the patient’s skin is the greatest hazard of electrosurgery Burns are deeper than flame burns, causing widespread tissue necrosis and deep thrombosis to the extent the debridement and grafting may required Electrosurgery Generalized Safety Factors for the Use of Electrosurgery For safety of patient and personnel, follow instruction for use and care on the manufacture manual is important Any malfunction ESU should be labelled as not function and should be sent for service Patient and personnel should be protected form inhaling smoke generated during electrosurgery a suction can help evacuate Inspect insulated instrument for breaks as current can leak and create a thermal burn Microsurgery Microsurgery is a procedure of direct viewing of the surgical field under magnification that affords surgeons greater visual acuity of small structures Microsurgical instrumentation and techniques needs a formerly learning. Handling of instruments, sutures and tissue are different, precise and timing consuming  Microsurgery Technique of Microsurgery The most common manoeuvres for placing and manipulating instruments involve a combination of several basic movements: 1. Compression-decompression 2. Rotation 3. Push-pull, direct, or linear Surgeons and assistants do no manual labour for at least a day before operating Drinking coffee in the morning may decrease steadiness in some individuals Microsurgery Advantages of Microsurgery Microsurgery provides unique advantages in restoration of wholeness and body function such as: Hearing Vision Tactile sensation Circulation Motion Microsurgery Advantages of Microsurgery Microsurgery allows the following: Dissection and repair of fine structure through better visualization Adaptation to surgical procedure especially variation in anatomic landmarks is more distinct with magnification Less surgical trauma and complication Superior focal lighting of the surgical field, particularly in deep areas Microsurgery Operating Microscope Operating microscope is a compound binocular instrument. The objective lenses combined with eyepieces allow a wide range of magnification and working distances adjustable to the surgeon’s needs Understanding of parts and their function is very important: Optical Lens System Enlarge an image or it has the magnifying power Microsurgery Components The centre body of the optical system which contains objective lens and binocular oculars both determines magnification of the microscope Magnification The ability of the microscope to magnify depends on design and quality of the parts addition to the resolving power Microsurgery Focus Focus is accomplished manually or by a foot-controlled motor that raises and lowers the body of the microscope to the desire distance from the object to be viewed Microscope Drape The entire working mechanism and support arm of the entire microscope are encased in a sterile drape. Drape should be heat resistant, lint free and non-reflective. Non- heat resistant can build up heat that can damage the microscope Microsurgery Care of the Microscope Care of microscope depend on the manufacture’s manual Microscope should be damped-dusted before use. Lenses should be cleaned according to the manufactures recommendations only The circulating nurse should prepare the microscope Do not drop or finger print lenses Should know where extra lamp bulbs are stored and how to change them Check electrical connection or power cable Knobs of accessories are secure Microscope and accessories should be properly stored in areas that are closed  Microsurgery General Consideration in Microsurgery Patient Patient is prepared as for a standard surgical procedure Position comfortably and safely with the operating bed locked in position The surgical site is immobilized if possible Anaesthesia Is inform on the type of microsurgery to decide which anaesthetic drug to be given Patient should be monitored and prevented from moving General Consideration in Microsurgery Stability of the surgical field A vital factor for successful microsurgery is stability of: Surgical field Microscope Surgeons chair Duties of the scrub person Cooperate and coordinate duties to prevent surgeon’s distraction from the surgical field Set up the mayo stand and instrument table without touching the tips of instrument Handle instruments with care when passing Place instrument on the mayo stand in anticipated order of use Keep debris away from the tips of the instrument by a gentle wipe Assist efficiently upon surgeon’s request Good team work provide a successful microsurgery outcome Integrated Technologies Several Technologies may be used for minimal invasive surgical procedure. Video-assisted laser endoscopy allow the surgeon to remove organs and tumours without making major incision Other instrumentation may be introduced through small incisions for dissection, ligation and suturing by using endoscope or monitor Computer can automatically scan tissue to select target tissue for the laser beam  Summary Question 1. What are two principles of electrosurgery? 2. What is the difference between monopolar and bipolar? 3. Explain three general safety factors of electrosurgery 4. Describe three general consideration of microsurgery  Reference List Phillips, N. (2013). Berry & Kohn's Operating Room Technique. St. Louis; Missouri: Elsevier Mosby.