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Coagulator: application and basic functions

There are two main methods of medical manipulation using a coagulator: monopolar and bipolar.

The monopolar method is most common with open operations. It allows for operations at a greater depth compared with a bipolar device. This method is simple, safe, effective for both incision and coagulation.

Monopolar electrosurgical coagulators have one electrode, producing local dissection and coagulation of tissues at the point of contact.

The current flows in a closed circle from the working tool to the second neutral electrode, a plate that provides wide contact through the patient’s entire body. The tool electrode is called the active electrode, and the plate is passive.

To improve contact, sometimes a napkin moistened with saline is placed under the plate. However, when the napkin begins to dry, the concentration of current in its remaining wet areas increases, which again is fraught with burns.

The 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 in them, causing coagulation of tissues around the clip, which leads to failure of the seam. Therefore, it is impossible to conduct coagulation near the staple suture.

It is impossible to conduct coagulation near the implanted metal joints. Current accumulates in them, heating the prosthesis. Under the action of the heated metal of the prosthesis, the proteins of the bone on which this prosthesis is attached are denatured. As a result, the joint becomes loose.

If the procedure is performed by a poor quality electrosurgical coagulator or an unqualified specialist, capacitive breakdown is possible. Under certain conditions, the patient’s tissues may stop conducting. For example, when the fabric dries out during long-term coagulation of one area. In this case, a dielectric appears between the two electrodes and the whole system becomes an electrical capacitor. The electrodes accumulate charge on the plates of the capacitor. There is no coagulation effect, which may induce the surgeon to increase the power of the device; the charge on the plates will increase until breakdown occurs through the patient's tissue. The current at this moment is huge and causes a severe burn all along the path of the electric discharge.

Types of monopolar coagulators

Monopolar coagulators are of two types:

  • contact (incision-coagulators),
  • contactless (spray coagulators).

The active electrode of the contact device has the form of a needle, loop or lancet. As a result of his work, a clean wound suitable for biopsy is formed, or a wound with a thin layer of coagulation.

When a cut-coagulator is in operation, the contact between the electrode and the tissue is the formation of a scab, which sticks to the electrode and comes off when it is removed.

The contactless method is used when it is necessary to affect large areas of the organ. When a spray-coagulator is in operation, an electric arc is created, which causes the cells to “evaporate” locally at the point of contact. Such a point effect avoids local heating and damage to adjacent tissue sites.

The contactless 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, use a special prefix that supplies argon.

Argon plasma coagulator

Argon plasma or argon coagulator includes a generator, a tank with argon and an applicator that combines both gas and charge. Under the action of electricity, argon produces a plasma that 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 tip of the device 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 smokeless and poisoning of the wound by burning products.

Argon-enhanced coagulation is very superficial. Coagulative necrosis penetrates the tissue only a few tenths of a millimeter. Therefore, argon devices are used for treating large surfaces with diffuse bleeding, for example, parenchymal organs. But to stop the bleeding from a large vessel with this device will not succeed.

The device is very expensive. If the price of a bipolar coagulator is about 500 euros, then argon is about 6,500 euros.

Bipolar coagulation

Bipolar electrosurgical coagulator has two active branches. The current flows only through the tissue between them and does not flow through the patient’s body. Therefore, all risks possible with the use of monopolar surgical electrocoagulators are excluded.

The bipolar coagulation method is more progressive. 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 at the expense of complex electrodes, so its price is higher.

In addition, bipolar coagulators are not able to cut tissue, with the exception of the Trimax instrument, which cuts tissue with a normal scalpel after coagulation. In addition, to obtain the effect of coagulation, it is necessary to capture the tissue with the branches, which is not always possible.

However, bipolar electrosurgical coagulator is indispensable when long-term local coagulation is necessary. Bipolar devices are commonly used in operations on the airways, in urology and arthroscopy, as well as in pediatric surgery. It is convenient, for example, to coagulate the cervix or wide ligament of the uterus, capturing the entire anatomical structure with the branches of the instrument and coagulating it to the full depth, without touching the surrounding tissue.

Device EHVCH "FOTEK"

The electrosurgical apparatus "FOTEK" is produced in Russia. The device has several modifications that have their differences and their price.

Now the model "FOTEK 80-03, 350-01, 350-02, 350-03" are on the market. Depending on the modification, these devices can function in different modes:

  • cutting without coagulation (biopsy),
  • monopolar cutting with coagulation,
  • coagulation cutting - used in a wet environment, used in gynecology, urology,
  • microcutting (micro-operations),
  • smooth coagulation
  • accelerated coagulation (removal of pathologies of the upper layers of tissues),
  • monopolar contactless (spray) coagulation (extensive capillary bleeding),
  • monopolar vaporization,
  • bipolar coagulation,
  • bipolar cutting with coagulation.

The price of the device, depending on the modification - from 125 to 190 thousand rubles.

Device EHVCH "MEDSI"

Medsi devices have several modifications used for different purposes:

  • "MEDSI 20" is an inexpensive device (about 20 thousand rubles), which is used in beauty salons for electrolysis and removal of non-cancerous formations.
  • "MEDSI 20 Ophthalmology". It functions in mono and bipolar modes. Used for micro-operations on the conjunctiva, eyelids, vessels. Price - 35-40 thousand rubles.
  • "MEDSI 50 epilator, coagulator". Apply to remove tumors on the female genital organs, skin. Price - 35 thousand rubles.
  • "MEDSI 50 coagulator-fulgulator". Works in several modes: cutting, coagulation, spray. It is acquired in beauty salons, veterinary clinics. Price - 40 thousand rubles.
  • "MEDSI 50 spray coagulator". Used for contactless removal of defects in the upper layers of the skin or mucous membrane.
  • "Medsi 50 dental". Used for the treatment of pathologies of the teeth and oral cavity.
  • "MEDSI 50 block r / k". Used onkodermatologi for biopsy. The device works in 5 modes.
  • "MEDSI 75". Works in mono and bipolar modes. Used in neuro, microsurgery, veterinary. Price - 65 thousand rubles.
  • "MEDSI 100". Its main difference from the previous modifications is the high power of each instrument, which makes it possible to influence large volumes of pathology. Applied in gynecology, otolaryngology, veterinary medicine. Price - 90-115 thousand rubles.
  • "MEDSI 150". Work in the modes of mono-, bipolar coagulation, cutting. At will the set can be added with the tool for spray coagulation. Used in inpatient facilities for the treatment of ENT diseases, gastrointestinal tract, diseases 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 removal of pathologies, severe scars remain, which can interfere with the normal flow of labor. Therefore, cryodestruction or radio wave coagulation is now used.

Coagulation in ophthalmology

In ophthalmology, coagulation is prescribed for tumors on the mucous membrane of the eyeball, skin of the eyelids, purulent corneal ulcer, retinal detachment, abnormally growing eyelashes, and other pathologies. Currently, retinal coagulation and other procedures are performed with a laser. Electrocoagulation is not applicable. The purpose of retinal coagulation surgery is to cauterize the detached cornea.

Maintenance

To ensure long-term operation of the device, you must follow the rules of maintenance of medical equipment. A regular check of the technical condition of the device is necessary:

  • check of operational and technical characteristics - once a year,
  • completeness check - once a month,
  • verification of output power, general performance - before the procedure.

To protect against dust, the idle unit and the LEDs must be covered with a dust-proof cloth.

Periodically, it is necessary to disinfect the outer surfaces of the instrument housing with a 3% hydrogen peroxide solution, adding 0.5% detergent. Do not use detergents containing organic solvents.

Maintenance of medical equipment and repairs are authorized 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 the procedure or during it, 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.

Complications and side effects of monopolar electrocoagulation

Incomplete fit of the surgical coagulum plate leads to a decrease in the area of ​​its contact with the patient's body, as a result, this passive electrode becomes active. This will lead to thermal damage to the skin and underlying tissues until the development of III-IV degree burns.

To improve contact, sometimes a napkin moistened with saline is placed under the plate. However, when the napkin begins to dry, the concentration of current in its remaining wet areas increases, which again is fraught with burns.

The 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 in them, causing coagulation of tissues around the clip, which leads to failure of the seam. Therefore, it is impossible to conduct coagulation near the staple suture.

It is impossible to conduct coagulation near the implanted metal joints. Current accumulates in them, heating the prosthesis. Under the action of the heated metal of the prosthesis, the proteins of the bone on which this prosthesis is attached are denatured. As a result, the joint becomes loose.

If the procedure is performed by a poor quality electrosurgical coagulator or an unqualified specialist, capacitive breakdown is possible. Under certain conditions, the patient’s tissues may stop conducting. For example, when the fabric dries out during long-term coagulation of one area. In this case, a dielectric appears between the two electrodes and the whole system becomes an electrical capacitor. The electrodes accumulate charge on the plates of the capacitor. There is no coagulation effect, which may induce the surgeon to increase the power of the device; the charge on the plates will increase until breakdown occurs through the patient's tissue. The current at this moment is huge and causes a severe burn all along the path of the electric discharge.

Electrosurgery Features and principle of operation of RF coagulators and radio coagulators.

Electrosurgery - this definition in modern medicine appeared relatively recently. Only with the invention and introduction of modern devices, EHVCh - coagulators, it became possible to carry out surgical interventions using current.

Electrosurgery - This is a method of surgical treatment with high frequency current. Electrosurgery divided into electrotomy (tissue dissection) and electrocoagulation (cauterization of tissues).

Domestic and foreign devices are offered in our market a lot. So what is worth paying attention when choosing a coagulator surgeon? The main parameters that doctors currently pay attention to are power and frequency. There is an equally important parameter - the dependence of the output power on the resistance (Ohms). For the concept of the importance of this parameter, it suffices to recall Ohm's law I = U / r. The resistance of the tissues in our body lies in the range from 100 to 1800 ohms.

The techniques carried out with the help of EHF devices presented by Uni-Tech LLC are different and are used in such fields of modern medicine as laparoscopy, thoracoscopy, urology, gynecology, proctology, otorhinolaryngology, arthroscopy, phlebectomy and cosmetology.

Electrosurgical high-frequency apparatuses are used to dissect vascularized tissues that do not contain large vessels. Using radio coagulants, adhesions and adhesions in the abdominal and chest cavities, serous and muscular membranes of the stomach and intestines are dissected in the high-frequency cutting mode, and coagulation of the vessels in the submucosal layer is produced during the formation of the anastomosis. Developed methods of endoscopic papillotomy, polypectomy, stop bleeding by argon vascular coagulation in the edges of the stomach or intestines. In urology, a method is used for transurethral electroresection of prostate adenoma, polypectomy, and stopping bleeding by coagulating vessels in the bladder.

There are monopolar and bipolar methods of using high frequency current. In the monopolar technique, the working tool is the active electrode, passive - provides electrical contact with the patient's body. With the bipolar technique, it is envisaged that both outputs of the generator are connected to active electrodes, for example, with the branches of bipolar tweezers.

The company "Uni-Tech" proposes to consider EHHF model range “Efa”which are divided into three main types:

  1. High-frequency coagulators.
  2. EHU, devices operating at two frequencies: HF and radio frequency.
  3. Coagulator that combines the RF, radio frequency and the possibility of working with argon.

These devices have a number of distinctive advantages:

  • High efficiency of summing a given power to the tissues developed in a wide range of loads (100 - 2000 Ohm).
  • Built-in self-monitoring and control parameters of the output signals, increasing the safety of the device.
  • The optimal choice of the frequency and form of the output RF and RF signal, which reduces the level of RF interference induced on video systems, and allows you to use the device for endovideosurgical interventions.

High frequency Coagulators operate at a frequency of 375 kHz, are available with a capacity of 100, 200 and 300 W, have an optimal set of modes for the surgeon (mixture, cutting, cutting soft, coagulation, surface coagulation, bipolar coagulation), which are regulated from 2 W to maximum power. EHU apparatus of this type is universal and recommended for use in all areas of surgery, the power of the device is selected depending on the operations performed, for example, 100 W coagulators are recommended for use on an outpatient basis.

EHH, devices operating at two frequencies: RF and radio frequency работают как на частоте 375 кГц так и на 1500кГц, линейка также выпускается различной мощности -100, 200, 300 Вт, набор режимов в данных аппаратах отличается от обычных ВЧ коагуляторов – смесь, резание, радиочастотное резание, коагуляция, радиочастотная коагуляция и биполярная коагуляция. Данные аппараты заменяют в операционной 2 аппарата - ЭХВЧ и «Сургитрон» - в отличие от последнего, не требуют дорогостоящих расходных материалов.

Коагулятор, совмещающий в себе ВЧ, радиочастоту и возможность работы аргоном – It does not have a bipolar mode and is recommended mainly for use in flexible endoscopy.

Electrosurgery is really new opportunities that allow us to carry out operations today, which previously could not be done, EHU of a new generation allow bloodless effective operations to be performed. Modern electrosurgery has found the widest application in almost all areas of medicine.

What is a coagulator?

The device is based on high frequency current. It is passed through the fabric and heats them. As a result of this process, the protein in the tissues collapses, and the blood stops secreting. The main purpose of the coagulator is to stop the bleeding, but this is not the only situation in which it is used in medicine.

The coagulator can be called a point action device, but if it is moved, large areas of soft tissue can also be processed. This allows doctors to devitalize parts of the human body. Thus, the therapy of tumors of benign and malignant nature occurs.

Any medical equipment, including a coagulator, is of a stationary and mobile type, and can also work in several modes. With this, specialists have the opportunity to adjust the power for each problem individually - this contributes to the efficient processing of tissues that are damaged.

When developing new models, manufacturers have added new technologies to the medical device that allow the obliteration of vessels. This process is called a heat stapler, and with it, procedures such as argon plasma and electrosurgical coagulation have appeared in medicine.

To reorganize a large area of ​​tissue, it is necessary to adjust the coagulator to a non-contact mode, namely, spray-coagulation. In this case, the work is carried out using an electric arc that occurs between living tissues and electrodes.

The main advantage of this technique is that there is no contact with the patient’s body, much less time is spent on the operation, and there is no risk of the device parts sticking. The latest versions of coagulators differ from their predecessors in absolute safety and ease of use. On new models, you can see the touch panels, with which the specialist selects the desired mode.

The main functions of the coagulator

As mentioned above, this device is used in almost all branches of medicine. With it you can:

  • cut tissue for deeper surgical intervention,
  • to combine tissue after surgery
  • to epilate tissue.

During the procedure, the medical device begins to release high frequencies that pass through the local space of the skin. As soon as the tissue maximally warms up, the process of evaporation of excess fluid inside the cells will begin. Also at this time, the protein begins to collapse, precisely at the point where the tissues are in contact with the active electrodes.

As a rule, coagulators have a point effect, but if the doctor starts moving the electrode, the area of ​​impact will increase significantly. Due to this, this medical equipment is used to devitalize pathological foci.

The device is used by specialists in various industries, in the event that it is necessary to conduct an operative intervention. As a rule, these are dermatologists, surgeons, gynecologists, urologists, cosmetologists, ophthalmologists and others.

Varieties of coagulators

Today, there are two main types of such medicines - they are stationary and mobile. But they, in turn, are divided into subspecies. The separation takes place according to the mode of action of the biological tissue with the device electrodes.
The monopolar coagulator differs in an active electrode, which is installed separately from the others. This electrode is placed under the patient.

Bipolar coagulator is presented in the form of tweezers with two active electrodes.

Also in medical practice electrosurgical coagulator is used, but this happens quite rarely, since during the procedure the electrodes very slowly pass the necessary impulses, and sometimes there are situations when the patient's life depends on every second. It was observed that similar impulses had a negative impact on other electrical appliances.

When developing the latest models, all deficiencies were eliminated, and instead of them sound and light alarms appeared. In addition, they are easy to manage and preserve the set parameters.

Before proceeding with the operation, it is necessary to choose the right coagulator. The medical device is selected depending on the method of coagulation.

A non-contact coagulator is intended for radio wave surgery. In this case, the soft tissue incision will be carried out by high-frequency waves up to 4 MHz. The dissection of the tissue occurs as a result of heat exposure, which is formed in the process of tissue resistance.

When conducting infrared coagulation, contactless coagulators do not cause excessive evaporation at a temperature of 100 ° C. It should be noted that when used, electromagnetic interference is not dissipated, which can interfere with the operation of other devices.

During various surgical interventions, it is important that the blood coagulates operatively - this is the only way to achieve an effective result. Often, doctors insist that patients before surgery stop taking medicines, which thin the blood, and also ask them to follow a certain diet. But not always, following these simple recommendations, blood clots as needed by specialists. To this end, modern inventors have come up with a medical device called a coagulator, and now not a single surgical operation can do without it.

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