ELECTROSURGERY

From Big Medical Encyclopedia

ELECTROSURGERY — techniques of use of current of high frequency during the performing surgeries. The term is more than doubtful. However, considering that it got into literature, the essence of techniques of use of currents of high frequency is briefly stated at surgical grants below. In 1909 Mr. Doyen the first used a method of electrothermic coagulation of fabric. For the first time described a section of fabrics by means of electric current in 1910. V. Czerny. In Russia V. N. Shamov in 1910 — 1911 applied electric current at treatment of malignant tumors. Due to the development of radio electronics and improvement of technical means possibilities of use of currents of high frequency in surgery, oncology, gastroenterology, urology, stomatology, ophthalmology and other areas a wedge extended. medicine. So, in abdominal and thoracic surgery preliminary coagulation of commissures and unions provides their anemic section. By means of an electroknife it is possible to cut a serous and muscular coat of a stomach and intestines, to make coagulation of vessels of a submucosa in a zone of formation of an anastomosis. By means of the loopback electrodes entered via the endoscope with a fiber optics (see Endoscopy) went to various departments. - kish. a path, make a polypectomy and a stop of bleeding by coagulation of a vessel. In a wedge. to the practician the method of an endoscopic paipillotomiya is implemented. In neurosurgery currents of high frequency apply to a section (electrocision) of tissue of brain, removal of the tumors located in hardly accessible sites (electroscission), processings of a bed of a tumor method of electrothermic coagulation. In urology use a transurethral electroresection of adenoma of a prostate, patol. formation of a bladder and urethra (see Uretroskopiya, Zistosko Pius). Use of the specified methods in operational oncology provides destruction of tumor cells as a result of electrothermic coagulation (antiblastik), and coagulation lymphatic and blood vessels prevents distribution of tumor cells (see Tumours, operational treatment).

A major factor of impact on fabrics of currents of high frequency is heat created in them during the passing of current (see Diathermocoagulation). Giving of such current is provided by various generators. In clinical practice the universal devices EN-57M and ES-500 are used, to-rye are used in surgery at resections and coagulations, the device DKS-2M found application in stomatology, the device ES-30M — in microsurgery etc.

Depending on a route of administration of current of high frequency distinguish a monopolar and bipolar technique. At the most widespread monopolar technique the working tool of the surgeon is the active electrode, the passive electrode provides electric contact with a body of the patient outside a surgery field. Creation of heat in the limited site of fabric is caused by a difference in sizes of electrodes. The area of a working part of an active electrode is many times less than the area passive, as provides the greatest density of current at an active electrode, necessary for the corresponding thermal influence (see Conductivity of biological systems).

At a bipolar technique both exits of the generator are connected to active electrodes, e.g. to the branches of so-called bipolar tweezers isolated from each other. In this case thermal influence is carried out by two active electrodes (branches) on limited space between them. The corresponding choice of power of current, the sizes of a working part of active electrodes and duration of influence provide electrocutting, an electrosection, electrocision or coagulation and fulguration (carbonization) of fabrics.

Cutting of fabrics (acusection) is carried out by use of monopolar influence (an electro-knife, a needle electrode) at which due to explosive effect of steam which is formed instantly in an adjacent intercellular lymph at an active electrode the effect of a gap is reached. As a result of at the edges gap only the thin coat of koagulirovanny fabric is formed, the fabrics more deeply located do not suffer. The wound repair occurs in the same terms, as the wound given by a scalpel. Slow influence of an active electrode at its bigger area leads to deeper warming up of edges of dissect fabric with formation of the expressed koagulirovanny layer (koagulotomiya). Healing of such wound happens second intention after rejection of koagulirovanny fabrics (see Wounds, wounds).

Coagulation is applied also for the purpose of a stop of bleeding; it is carried out by means of bipolar tweezers. The bleeding vessel is taken such tweezers; at the time of inclusion of electric current temperature between its branches increases that leads to formation of blood clot. For a stop of bleeding also active monopolar electrode is used. For this purpose it is quickly put to the styptic clip imposed on a vessel that also leads to instant formation of blood clot. Use of coagulation of the bleeding vessels reduces time of operation and provides the best wound repair.

Fulguration of fabrics is carried out for the purpose of their destruction, e.g. in onkol. to practice for destruction of papillomatous growths (see Papilloma, a papillomatosis). This effect is reached due to more long coagulation or use of current of bigger force.

From possible complications during the use of currents of high frequency in surgery it is possible to note burns of fabrics out of an operational wound, in a zone of gapping of a passive electrode. If on the way of passing of electric current in fabrics there are foreign metal bodys, use monopolar E. can cause coagulation of nearby vessels and nerves due to local heat release.

Bibliography: Doletsky S. Ya., Drabkin R. L. and Lenyushki of A. I N. High-frequency electrosurgery, M., 1980, bibliogr.; Petrovsky B. V., etc. Studying of system of a hemostasis at recovery aorta and main arteries operations by means of electrowire prostheses. Cardiology, t. 11, No. 4, page 9, 1971; Shamrayevsky S. M. Modern problems of an electrosurgery, M., 1950, bibliogr.

V. G. Mazurov.

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