WEST AFRICAN COLLEGE OF SURGEONS INTEGRATED REVISION COURSEIN SURGERYTOPICS-A.DIATHERMY-B.LASERS-C.CRYOSURGERY-D.THERMOTHERAPY

BYNonso MBAH. FWACS, FRCS Ed; FICS

ADDRESS:SURGERY DEPT, UDUTH, SOKOTODATE:WED 21ST SEPT., 2005

DIATHERMYOUTLINE: DEFINITION HISTORICAL PERSPECTIVE COMPONENTS TYPES & SETTINGS [OF THE EQUIPMENT] CLINICAL USES COMPLICATIONS / HAZARDS CONCLUSION

DEFINITION A METHOD OF ELEVATING LOCAL TISSUE TEMPERATURE USING HIGH FREQUENCY CURRENT, ULTRASOUND WAVES OR MICROWAVE RADIATION. MEDICAL DIATHERMY =DIATHERMY OF MILD DEGREE, PRODUCING NO TISSUE DESTRUCTION.

SURGICAL DIATHERMY = HIGH FREQUENCY ELECTROCAUTERY PRODUCING LOCAL TISSUE DESTRUCTION (FULGURATION) AND COAGULATION; THE BRANCH UNDER CONSIDERATION.

HISTORICAL BACKGROUND USE OF HEAT FOR TUMORS BY EGYPTIANS (300Bc) DIATHERMY COINED BY CZERNY (1910) WILLIAM BOVIE (1920) DEVELOPED ESG (BOVIE UNIT).

COMPONENTS : 3The Generator: Transforms electricity from mains (50 Hz) into high frequency electrical energy [30kHz to 3MHz]-Also allows for variation in frequency and mode setting.-Fitted with audible & visible alarms.

The Active electrode (Diathermy point) delivers conc. current to surgical site.

-Hand operated/foot activated.

The Return (Indifferent) Electrode A contact device.

-Directs electro surgical current back.

TYPESUnipolar (Monopolar) D. - Most Common.-Active & Return electrodes separated by patients body (volume conductor).

Bipolar D. - Active & Return electrode incorporated in one hand held diathermy forceps.

-Separated by only few mms.

-Low power used.

SETTINGCutting C.-Uses continuous wave form; -Produces extreme heating, vaporization of intracellular H2O & bursts cells.

Coagulation C.Uses more widely dispersed intermittent bursts of current.-Less heating; dehydrating effect.

3.Blended C.-Combination wave pattern.

CLINICAL USESAchievesa.Tissue fulguration (destruction and necrosis).bElectro coagulationc.Electro dissectionSubspecialty Applications.General surgery-Endoscopic coagulation of bleeding DU -Surgical dissection of GB from liver bedduring Lap. Cholecystectomy. - Gastrotomy incision-Colotomy incision-Endoscopic excision of large int. polyp -channelization of obstructing growths (Colon & Esophagus).

2.Urology-TURP-TURBT-Excision of large hydrocele sac.

3.Vascular Surgery-Endoluminal diathermy of long S.V.Varicose veins.

4.Neurosurgery-Haemostasis-Tumor Excision-Frontal leucotomy

-Electrocoagulation of the Gasserian Ganglion in Trigeminal Neuralgia.

-Electrocoagulation of choroid plexus (Infantile Hydrocephalus).

Gynaecology-Laparoscopic tubal sterilizationHysteroscopic fulguration of the uterine cornu (sterilization).Treatment of cervical dysplasia.Lap. Treatment of peritoneal or ovarian endometriosis.

COMPLICATIONS AND HAZARDSBurns-To the Pt-Accidental; faulty cables; improper placement of indifferent electrode.

ChannellingEffect - for organs whose vessels are carried on a narrow pedicle (Testis, penis, digits).-Bipolar diathermy safer.

3.Infections-Overzealous use -- Excessive necrotic tissue.

20 Haemorrhage-Excessive coagulation of vessels with eventual sloughing from large vessel.

-Ligature safer.

Poor wound healing & dehiscence Extensive coagulation

Post op pain-Exposed nerve endings.

7.Perforation & fistulation of hollow organs following tumor fulguration

Electrocution-of patient-of surgical staff-from faulty or cracked cables.

Fire explosion-Concomitant use of volatile flammable anaesthetic gases eg. Cyclopropane, ether.

-Contact with flammable bowel gases (methane, hydrogen) eg. In colonic obstruction.

PRECAUTIONCardiac pacemaker-Risk of interference, ventricular fibrillation or damage.

-Avoid monopolar D.

Metal prosthesis & Implants-Risk of burns & electrocution.

-Avoid use in proximity.

CONCLUSIONAn indispensable surgical tool

Facilitates fast, bloodless surgery

Reduces No. of sutures & blood transfusion

V. safe if adequate safety measures are taken.