SURGICAL DIATHERMY

CLINICAL PRESENTATION
DEPARTMENT OF SURGERY
BMSH
DR BATUBO

OUTLINE
INTRODUCTION
TYPES OF SURGICAL DIATHERMY
OPERATIVE PRINCIPLE
PREOPERATIVE PREPARATION
INDICATIONS AND USES
RISKS, DANGERS AND COMPLICATIONS

INTRODUCTION

 Diathermy is one of the most commonly

used tool in the operating theatre.
It is the generation of heat in body tissues
by means of radiofrequency energy,
within the range of 300- 3000kHz.
used for
surgical cutting,
controlling bleeding by causing coagulation
hemostasis at the surgical site and
destruction of unwanted cells.

TYPES OF SURGICAL
DIATHERMY
monopolar generator, active
electrode (diathermy pen), patient,
return electrode (diathermy pad)
Bipolar active and return electrode
between two tines of forceps

 One advantage with this type is that

production of the cutting current is
virtually impossible.
The field of coagulation is limited to the
contact area;
the surrounding tissues are not damaged.
There is no patient plate attached.

Operative Principles
Surgical diathermy produces radio frequency( 300kHz3MHz), alternating current, and patients body forms
part of an electric circuit
The passage of current through the tissue produces a
heating effect beneath each electrodes
A high frequency current flows through active electrode
Cell ruptured-fumes or evaporates.
Return path through dispersive electrode
RF generation can be activated by a foot switch or
finger switch on the surgical handle.

Effect of RF on cell includes:

1. Thermal effect.
2. Electrolytic effect.
3. Faradic effect.
Operating frequency and typical value
Operating frequency
300 KHz to-3MHz
Monopolar :
CUT
0-to-350watts
COAG
0-to-100 watts
Bipolar : CUT
0-to-50 watts
COAG
0-to-10 watts

EFFECTS OF SURGICAL
DIATHERMY
The effects of diathermy depend
largely on the intensity of the current
passing through the tissues
Can be divided into 3 categories
1.Coagulation
2.Fulguration
3.Dissection or cutting

Degree of Tissue
Destruction
Superficial: Dissection and
fulguration
Deeper Tissue: Coagulation
Tissue Cutting: section

COAGULATION
One applies and slowly moves the
electrode across the lesion until slightly
pink to pale coagulation occurs.
uses low-voltage and high-amperage
current in a biterminal fashion to
cause deeper tissue destruction and
hemostasis with minimal carbonization
High amperage causes deep tissue
destruction and hemostasis.

 A curette may then be used to remove

the coagulum.
Haemostasis: by touching the electrode
directly to the bleeding vessel, or by
using biterminal forceps.
The heat generated seals the vessel by
fusion of its collagen and elastic fibers.
It is useful for vascular lesions

Fulguration and
Dissection

use high-voltage and low-amperage current

in a monoterminal fashion to produce
superficial tissue destruction
DISSECTION:
the electrode contacts the skin and
superficial skin dehydration occurs as a
result of Ohmic heating.
they are best suited for superficial and
relatively avascular lesions, such as
verrucae and seborrheic keratosis.
Are not suitable for very vascular lesions

FULGURATION
electrode is held 1-2 mm from the skin surface
causes tissue dehydration by sparks
cause superficial epidermal carbonization.
This carbon layer has an insulating effect and
minimizes further damage to the underlying
dermis.
lesions treated by fulguration usually heal
rapidly with minimal scarring

SECTION OR CUTTING
uses undamped or slightly damped, low
voltage, high-amperage current in a
biterminal fashion to vaporize tissue with
minimal peripheral heat damage.
Undamped current yields cutting without
coagulation
slightly damped current provides some
coagulation.

 Advantages of electrosection are

1.its speed
2.its ability to simultaneously cut and
3.seal bleeding vessels
in the excision of large, relatively
vascular lesions, such as acne keloidalis
nuchae and rhinophyma, Malignant
growth

PREOPERATIVE
PREPARATION
History and ph.exam
Notice risk factors of the procedure:
1.bleeding diathesis,
2.poor healing, such as vasculopathy,
3. poor general medical condition.
Identify : cardiac pacemakers or
implantable
cardiodefibrillators

 All Jewelry should be removed Risk of

burning
For Prep use: nonalcohol prep solution
(risk of ignite)
Use chlorhexidine or povidone-Iodine
work in the perianal Region:
Use moist packing over anus to
prevent ignition of methane

POINTS TO REMEMBER IN
PROPER PATIENT PLATE USE
Avoid placement near scars, implant sites
or ECG electrodes
A muscular well vascularised area is most
suitable
Site must be clean, dry & shaved
Protect skin integrity by ensuring pt is not
resting on dispersive plate clamp

 Do not allow fluid to pool at dispersive

site
Check pt contact & connection before
commencing
Only aqueous fluids should be used for
irrigation
On completion of procedure, remove the
plate carefully & inspect the skin
Document use of diathermy in pts record

SUGGESTED SITES FOR PLATE

PLACEMENT

CALF
UPPER ARM
ABDOMEN
MID BACK
BUTTOCKS
ANTERIOR & POSTERIOR THIGH

INDICATIONS AND USES

RISKS, DANGERS AND COMPLICATIONS

Explosion if flammable, volatile anaesthetic
agents are used, e.g ether or cyclopropane
Gas explosion in obstructed hollow viscera
Electrocution of the patient or surgeon
because of faulty cables
Superficial burns
Diathermy burns

CONCLUSION
Advances in medical technology have
produced better and safer diathermy
equipment
We may see in the future microchip
functioning diathermy units
Knowledge and adequate patient
preparation will prevent the risks, danger
and complications

THANKS