Consultant

- Dr.S.Easwaramoorthy

MS FRCS (England)FRCS (Glasgow) FRCS (Edinburgh)Dept of Minimal Access SurgeryLotus Hospital, Erode

Laparoscopic Energy SourcesPoints for Practice!

History of Energy Sources

Harvey Cushing William Bovie

1928

Newer Energy Sources

Monopolar Electro surgeryMonopolar Electro surgery

•Active Electrode•Return Pad

Patient is part of theCircuit!

Current Density

Tissue Response GeneratorSplit return electrode padActive Electrode MonitoringVoice Command SystemArgon Plasma Coagulation

Advances in Electro surgeryAdvances in Electro surgery

Impedance Measurement

Factors Modifying the Tissue EffectsCurrent Density Vs Tissue Impedance

1. Size of active electrode2. Cut or Coagulation mode3. Power setting4. Duration of exposure5. Tissue Impedance

Tissue Impedance

Water Tank(Voltage)

Flow of Water(Current)

Outlet(Impedance)Ohm’s Law: I=V/R

Tissue Responsive Generators

Split Pad

RReturn eturn EElectrode lectrode MMonitoringonitoring

Electrosurgical Injuries during Laparoscopy

Electro surgical injuries are not always due to ‘Pilot’ error.

Zone 1Insulation Failure

Conductive CouplingCapacitive Coupling

Insulation FailureInsulation Failure

Zone 2 Injury

Prevention of Electrosurgical Injuries

Active Electrode Monitoring Insuloscope

Bipolar Diathermy

Ligasure Vessel Seal SystemLigasure Vessel Seal System

BipolarLow Voltage High CurrentMechanical & Thermal EffectCollagen/ Elastin welding7mm vessel seal!

Gyrus/Plasmacision

Gyrus 400 Generator/PK instruments Plasma Trissector & J hook Tissue Sealing & Bipolar cutting

Vapour Pulse Coagulation

Enseal Thermofusion & Dissection

Smart Electrode Technology

Caiman: Aesculap

• Pulse wave form modulation• Least tissue charring• Longer Jaws: 50mm• Rotating jaws

Ultrasound as Energy Sourceeg: Harmonic Scalpel

Ultrasonic Energy55,000/SecMinimal Instrument Traffic

• Dissector• Coagulates• Cuts

80-100oCMinimal lateral Spread

Harmonic Scalpel

Effect:•Blade configuration

•Sharp edge, Flat, and Blunt•Power Level

•1 to 5•Traction/Tension

Residual heat

Sonocision

Haemostasis Vs Dissection

ACE 7

Thunder beat

Energy Devices for MASEnergy Devices for MASWhich is the best?!Which is the best?!

Ligasure Gyrus

Enseal Harnomic

Features1 Maximum vessel burst

Pressure2 Least thermal spread3 Least amount of smoke

production4 Fastest sealing time

Easy to handleReliableEfficientCost Effective

You make the Choice!

Make the Right Choice

Ligasure Enseal Harmonic

Right equipment used for the right reason will ensure right result!

IAGES Endoscopy Fellowship 4 days of Didactic lectures, Hands on

endoscopy and Simulator training and assessment

November 3rd to 6th 2016 ( 4 days)@ GI Unit, Lotus hospital, Erode, TNMaximum of 50 candidates For IAGES members onlyFee: 25000/- See brochure/IAGES websiteContact : 098433 28928 for details.