POWERED INSTRUMENTS

ELECTRIC INSTRUMENTS


SURGICAL CAUTERY

In surgery we require to burn tissue with heat, cautery serves this limited purpose well.
With battery power it can be used at home or in the office

- An electric cautery consists of a platinum wire loop or point which becomes red hot when a current is passed through it by an electrode.
- This heated cautery point is then applied to the tissue area to cause tissue death through coagulation.
- The current source may be a low-voltage battery or a transformer connected to the mains; the transformer is preferable, as the output is more constant than that of a battery.
- The cautery must not be used any hotter than at red heat, as too high a current will cause rapid burning out of the cautery wire.
- The cautery Point are of various sizes and shapes and are mounted on a heat-resistant handle to which are connected to wires.
- The cautery must be connected to the cautery terminals.
- After connecting the wires the transformer may then be switched on.
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POWERED INSTRUMENTS

Electric Instruments

Mono-polar diathermy(cont)


The purpose of the indifferent large surface electrode in mono-polar diathermy, is to provide a surface of sufficient area to avoid any heat effects at this site.

- This is because the indifferent electrode is in contact with hundreds and thousands of more cells than the live electrode which results in a lower density of current in each of these cells.
- If the electrode is applied correctly as described below; little heat is generated in this area.
- The commonest type of indifferent electrode is a flexible metal plate. The thin flexible metal plate electrode can either be placed under the patient’s body (sacrum) or carefully bandaged round the thigh to ensure even contact with the skin.
- It is necessary to use electrode jelly, if the patient is hairy, shaving beforehand is advisable as hair acts as an electrical resistance.
- If the patient’s skin is dry as in our dry climate, moistening with water or saline can be used with advantage before applying the plate. The plate can be wrapped in a moist sheet.
- Replace a plate electrode which becomes uneven, otherwise areas of irregular contact with the skin result, which could allow points of high current density and risk of burns.
- The electrode is connected to the high frequency electrosurgical unit indifferent or earth terminal by a heavy insulated wire.
- Risk of accidents is possible.
Bipolar diathermy is a safer alternative.


With a bipolar system the surgeon’s instrument, usually in the form of a forceps, Combines both electrodes so that current flows down both limbs of the forceps
Only the tissue gripped between the tips of the forceps receives the current.
Eliminating the need for an indifferent electrode.
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POWER INSTRUMENTS IN SURGERY

ELECTRIC INSTRUMENTS


Diathermy
Diathermy machines generate high frequency electric current.
This energy can be used by the surgeon to cut skin and deeper tissues.
It can also be used to coagulate tissue to limit bleeding.
These effects are the result of heat generated in the tissues



Surgical diathermy is frequently used in surgery to limit bleeding..
- When this current is passed through the patient’s body between two electrodes, the effect is to produce a concentration of current at the smaller electrode in the hand of the surgeon.
- As the surgeon applies his live (small) electrode to the tissues, the current passes through the touched tissue cells and owing to the tissue’s electrical resistance, heat is generated at this contact point.
- The effect is localized because with mono-polar system the current from the live (small) electrode spreads out in the patient’s body and travels to the indifferent electrode which is a large electrode placed in contact with the patient’s body (thigh or sacrum).
- A high density of current occurs only immediately beneath the live electrode because further away (except under fault conditions) the current density is too small to have any heating effect.
- Fault conditions are produced by the contact of patients body with the metallic table
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THE FINAL SCENE

We show here some views thru the endoscopes
The upper GI endoscopy shows views of stomach mucosa
The lower GI shows colon and removal of polyps






WHAT ARE THE DIFFERENT GASTROINTESTINAL FIBRESCOPES (INCLUDING GASTRSCOPES, DUODENOSCOPES AND CLONOSCOPES)?

Based on the angle of view are three types of instruments:-

1. Forward or oblique (for oblique) viewing for examination and
biopsy(a)
This is suitable for examining the oesophagus, most of the
stomach and the upper part of the duodenum
2. Side or lateral viewing for examination, biopsy and operative
procedures in the duodenum(b)
This is needed when full examination of oesphagus, stomach,
duodenum and biliary system is required. This includes the
fundus of the stomach and the duodenal bulb
3. Forward viewing with two channels for complex operative
procedures.
This is generally larger in diameter than the previous two and
has suitable dimension channels incorporated for operating
instruments. A wide range of procedures can be undertaken(c)

All three types of instruments can be obtained from several
manufacturers
Any questions be sent to drmmkapur@gmail.com
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