ECHV-devices are high-frequency electrosurgical devices used to cut tissues and quickly stop bleeding. The devices are widely used in medicine - surgery, gynecology, laparoscopy, thoracoscopy, neurosurgery and other fields.
Monopolar coagulation
There are two main methods of medical manipulation with a coagulator: monopolar and bipolar.
The monopolar method is most common in open surgeries. It allows operations to be carried out at greater depths compared to the bipolar device. This method is simple, safe, effective for both incision and coagulation.
Monopolar electrosurgical coagulators have one electrode that produces local dissection and coagulation of tissues at the site of contact.
Current flows in a vicious circle fromworking tool to the second neutral electrode - a plate that provides wide contact through the entire body of the patient. The tool electrode is called the active electrode, and the plate is called the passive electrode.
The effect of coagulation is in the section of the circuit with the highest concentration of current. This should be between the instrument of the surgical coagulator and the patient's body, however, there may be violations of the conditions for the passage of current, which will lead to undesirable effects in other parts of the circuit, which will manifest itself as complications after the operation.
Therefore, when carrying out the procedure with a monopolar surgical electrocoagulator, it is necessary to take into account all the risks and follow the rules of electrical safety.
Complications and side effects of monopolar electrocoagulation
Loose fit of the surgical coagulator plate leads to a decrease in the area of its contact with the patient's body, as a result, this passive electrode turns into an active one. This will lead to thermal damage to the skin and underlying tissues up to the development of III-IV degree burns.
To improve contact, sometimes a napkin moistened with saline is placed under the plate. However, when the cloth begins to dry, the concentration of current increases in its remaining wet areas, which again is fraught with burns.
Current moves through the patient's body along the path of least resistance. If there are metal objects on its way, the current is concentrated in them. Such metal objects can be seam clips, the current accumulates inthem, causing tissue coagulation around the staple, resulting in suture failure. Therefore, coagulation should not be carried out near the staple line.
Coagulation should not be carried out near implanted metal joints. The current accumulates in them, warming up the prosthesis. Under the action of the heated metal of the prosthesis, the proteins of the bone on which this prosthesis is fixed are denatured. As a result, the joint becomes loose.
In the case of a procedure performed with a poor quality electrosurgical coagulator or an unskilled specialist, a capacitive breakdown is possible. Under certain conditions, the patient's tissues may stop conducting current. For example, when tissue dries out during prolonged coagulation of one area. In this case, a dielectric appears between the two electrodes and the whole system becomes an electric capacitor. Charge accumulates on the electrodes as on the plates of a capacitor. There is no coagulation effect, which may prompt the surgeon to increase the power of the device, the charge on the plates will increase until a breakdown occurs through the patient's tissues. The current strength at this moment is huge and causes a severe burn along the entire path of the electric discharge.
Types of monopolar coagulators
Monopolar coagulators are of two types:
- contact (incision-coagulators);
- non-contact (spray coagulators).
The active electrode of the contact device has the shape of a needle, loop or lancet. As a result of his work, a clean wound suitable for biopsy is formed, or a woundwith a thin layer of coagulation.
When the incision-coagulator works, the result of contact between the electrode and tissue is the formation of a scab that adheres to the electrode and breaks off when it is removed.
The non-contact method is used when it is necessary to influence large areas of the body. During the operation of the spray coagulator, an electric arc is created, which causes the “evaporation” of the cell plasma locally at the point of contact. Such a point effect avoids local heating and damage to adjacent tissue areas.
The non-contact method is less traumatic, but not always safe. To obtain a spark, it is necessary to increase the power of the device, as a result, leakage currents increase and there are risks of breakdown. To prevent possible complications, a special prefix is used that supplies argon.
Argon plasma coagulator
Argon plasma or argon coagulator includes a generator, an argon tank and an applicator that combines both gas and charge. Under the influence of electricity, argon produces a plasma, which becomes a conducting medium. The current acts through the plasma, the electrode is 1.5-2 cm away from the patient's tissue, so the device tip does not stick to the tissue. In addition, argon does not interact with the patient's tissues at elevated temperatures, which eliminates their charring and ensures smokelessness and wound poisoning by combustion products.
Argon-enhanced coagulation is very superficial. Coagulative necrosis penetrates the tissue only by tenths of a millimeter. Therefore, argon devices are used to processlarge surfaces with diffuse bleeding, for example, parenchymal organs. But this device will not be able to stop bleeding from a large vessel.
The device is very expensive. If the price of a bipolar coagulator is about 500 euros, then an argon coagulator is about 6500 euros.
Bipolar Coagulation
The bipolar electrosurgical coagulator has two active jaws. The current flows only through the area of tissue between them and does not go through the patient's body. Therefore, all risks associated with the use of monopolar surgical electrocoagulators are excluded.
The bipolar coagulation method is more advanced. This type of exposure is safer, since only local action is performed and only in coagulation mode. Therefore, burns and capacitive breakdowns are excluded. However, the device works due to complex electrodes, so its price is higher.
Also, bipolar coagulators are not capable of cutting tissue, with the exception of the Trimax device, which cuts tissue with a conventional scalpel after coagulation. In addition, to obtain the effect of coagulation, it is necessary to capture the tissue with branches, which is not always possible.
However, a bipolar electrosurgical coagulator is indispensable when long-term local coagulation is needed. Bipolar devices are commonly used in respiratory operations, in urology and arthroscopy, and in pediatric surgery. It is convenient, for example, to carry out coagulation of the cervix or the wide ligament of the uterus, capturing the entire anatomical structure with branchesinstrument and coagulating it to the full depth, without touching the surrounding tissues.
Popular models of coagulators
The cost of the device depends on the rated output power for each individual tool, the number of modes, the availability of additional features.
EHVCh device "FOTEK"
The FOTEK electrosurgical apparatus is made in Russia. The device has several modifications that have their differences and their price.
Now the models "FOTEK 80-03, 350-01, 350-02, 350-03" are on the market. These devices, depending on the modification, can operate in different modes:
- cutting without coagulation (biopsy);
- monopolar cutting with coagulation;
- cutting with coagulation - used in a humid environment, used in gynecology, urology;
- micro-cutting (micro-operations);
- smooth coagulation;
- accelerated coagulation (removal of pathologies of the upper layers of tissues);
- monopolar non-contact (spray) coagulation (extensive capillary bleeding);
- monopolar vaporization;
- bipolar coagulation;
- bipolar cutting with coagulation.
The price of the device, depending on the modification, is from 125 to 190 thousand rubles.
EHVCh apparatus "MEDSI"
MEDSI devices have several modifications used for different purposes:
- "MEDSI 20" is an inexpensive device (about 20 thousand rubles), which is usedin beauty salons for electrolysis and removal of non-cancerous formations.
- "MEDSI 20 Ophthalmology". Operates in mono- and bipolar modes. Used for micro-operations on the conjunctiva, eyelids, blood vessels. Price - 35-40 thousand rubles.
- "MEDSI 50 epilator, coagulator". Used to remove neoplasms on the female genital organs, skin. Price - 35 thousand rubles.
- "MEDSI 50 coagulator-fulgulator". Works in several modes: cutting, coagulation, spray. It is purchased in beauty salons, veterinary clinics. Price - 40 thousand rubles.
- "MEDSI 50 spray coagulator". Used for non-contact removal of defects in the upper layers of the skin or mucous membranes.
- "MEDSI 50 Dental". Used to treat pathologies of the teeth and oral cavity.
- "MEDSI 50 block r/c". Used by oncodermatologists for biopsy. The device operates in 5 modes.
- "MEDSI 75". Works in mono- and bipolar modes. It is used in neuro-, microsurgery, veterinary medicine. Price - 65 thousand rubles.
- "MEDSI 100". Its main difference from previous modifications is the high power of each tool, which allows you to work on large volumes of pathology. Used in gynecology, otorhinolaryngology, veterinary medicine. Price - 90-115 thousand rubles.
- "MEDSI 150". Work in the modes of mono-, bipolar coagulation, cutting. Optionally, the kit can be supplemented with a spray coagulation tool. Used in hospitals for treatmentENT diseases, gastrointestinal tract, pathologies of the female genital organs. Price - from 115 thousand rubles.
Coagulation in gynecology
Currently, the method of coagulation of the cervix with electrocoagulators is considered obsolete. With this method of removing pathologies, rough scars remain, which can interfere with the normal course of childbirth. Therefore, cryodestruction or radio wave coagulation is now being used.
Coagulation in ophthalmology
In ophthalmology, coagulation is prescribed for neoplasms on the mucous membrane of the eyeball, eyelid skin, purulent corneal ulcer, retinal detachment, improperly growing eyelashes and other pathologies. Currently, coagulation of the retina and other procedures are carried out with a laser. Electrocoagulation is not used. The purpose of the retinal coagulation operation is to cauterize the detached areas of the cornea.
Coagulation in dermatology
Electrocoagulation is used to remove warts, papillomas, moles and other defects. Depending on the shape and localization of the defect, mono- or bipolar modes of operation are used.
Maintenance
To ensure the long-term operation of the device, it is necessary to follow the rules for the maintenance of medical equipment. A regular check of the technical condition of the device is necessary:
- Checking performance and technical specifications - once a year;
- completeness check - once a month;
- Check output power, general performance - before the procedure.
ForTo protect against dust, a non-working machine and LEDs should be covered with a dust-proof cloth.
Periodically, it is necessary to disinfect the outer surfaces of the device body with a 3% hydrogen peroxide solution, adding 0.5% detergent. Do not use detergents containing organic solvents.
Maintenance of medical equipment and repairs are en titled to be carried out by specialists of repair organizations authorized by the manufacturer.
Most often, when using coagulators, connectors for connecting accessories and tools fail. If the coagulator fails to turn on before or during the procedure, you must first check the fuse box, which is usually located in the network cable connector. If the fuses are intact, you need to check the main power supply. To do this, the device is disassembled, the lines are checked by a tester.
