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Some types of electrical energy are very useful for laparoscopy and thoracoscopy. Many grasping and dissecting forceps, as well as scissors and biopsy forceps have connections for monopolar cautery.
For endoscopy, the bipolar mode is used for ovariohysterectomies, ovariectomies, cholecystectomies, and dissections such as obtaining lymph node biopsies, lobectomies, tumor resections, adrenalectomies, etc.
The primary procedure is to coagulate prior to cutting, thus reducing blood and visibility loss. If hemorrhage develops during dissection and is modest, hemostasis can frequently be obtained by pinpoint monopolar cautery, bipolar cautery, or with hemostatic clips. Excessive hemorrhage requires the use of a suction/irrigation device and perhaps cleaning of end of the laparoscope. Uncontrolled hemorrhage can require conversion to an open surgery. Requirement to convert due to bleeding is rare for the experienced endoscopic surgeon.
Many electrocautery devices can be used if they have a remote, usually foot controlled, method to start and stop energy application. Care should be taken to confirm that sufficient and appropriate power settings can be obtained. Appropriate energy settings can be tested before surgery by using steak or chicken to determine the approximate settings and gain experience with new devices. If the operator has any reservations about their technical application of a new energy source, training is indicated.
Above: Chicken breast being used to develop appropriate settings and proper use of a carbon dioxide laser. This laser is seldom, if ever, indicated for endoscopy.
An energy source (Ellman International) using high-frequency electrical current that can be used as either bipolar or monopolar mode (4.0 mHz). The zone of injury is comparable or less than a carbon dioxide laser when both are used in appropriate fashion for traditional surgery.
As such, radiofrequency is an excellent technique for such procedures as declaws and plastic/reconstructive surgery, and oncologic surgery in highly vascular areas. It can thus be used to replace traditional electrocautery with its lower frequency, higher current, and greater zone of injury or as an alternative to the carbon dioxide laser with its health concerns for the operators.
Above: Round steak being used to develop an appropriate technique for cutting and cut/coagulation (blended) with the radiofrequency monopolar tip. Similar use of these inanimate tissue models are used to develop appropriate techniques for bipolar cautery and sealing devices.
For endoscopy, the bipolar mode can be used for laparoscopic ovariohysterectomies and ovarioectomies, and for other hemostasis with a narrow zone of injury. A Patton Surgical HotBlade, a Storz bipolar forceps, or a LigaSure endoscopic sealer/divider can be used. For efficiency, a coagulation/division instrument is preferred as this avoids to need to alternately replace a dissecting scissors with the bipolar forceps as tissue is being sealed and then divided during hemostatic dissections. The monopolar mode can be used with any dissecting, biopsy, or scissors with a monopolar post for attachment of the cable. A grounding antenna is needed when used in the monopolar mode.
Left: An Ellman 4.0 radiofrequency device demonstrating connection to monopolar endoscopic forceps. A wide variety of standard endoscopy instruments can be connected to this device and many traditional electrocautery generators.
Right: Special connector to provide bipolar capability to bipolar forceps, HotBlade, or LigaSure sealer/divider forceps.
Examples of an Ethicon Endosurgery and Storz endoscopy instruments with monopolar connectors. Care must be taken to insure that the appropriate size connector between the endoscopic device and the generator is available.
Left: Bipolar forceps used with the Ellman radiofrequency generator for traditional surgery. It is important to use a generator that can alternately provide both bipolar power for cautery with minimal collateral injury with the use of a monopolar power for cutting, cutting/cautery, and cautery. This combined used of types of energy increases the efficiency of doing general surgery.
Right: Demonstration of using monopolar powered wire needle electrode for feline declaws.
Above: A Patton Surgical HotBlade is a laparoscopic sealing and cutting forceps that can be used for laparoscopic ovarioectomy or ovariohysterectomy.
Above: The hand grip of the Patton Surgical HotBlade is squeezed to compress tissue between the tips and then a remote controlled bipolar electrocautery is initiated. Adequacy of cautery is determined visually. Sometimes, greater compression on the tissue can be obtained by rotating the tips. Larger dogs and those with fat pedicles may required multiple firings at adjacent locations before transaction of the ovarian vessels.
Above: Once the surgeon has judged that the vessels are cauterized, the thumb trigger is advanced. This propels the blade forward between the tips. The blade becomes an active bipolar device and electrically severs the tissue. Some forward pressure on the blade may be required to insure that the tissue does not slide from between the bipolar tips.
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This page last updated February 4, 2008.