Valleylab SSE3B User manual

TN

Valleylab

Prior

(General)

1.

2.

3.

4.

5.

6.

To

Know
instruction

Have

designed

Check

operation
electrode

Replace

return

Do

not

Avoid
or

ether.

Use

which

all

the

the

E.S.U.

equipment

and

operation

of
on

all

electrodes.

cut,

use

will

manual.

approved

the

return

the

patient.

broken,

crease

of

flammable

ELECTROSURGICAL

be

used

and

and

accessories

for

the

unit.

of

the

alarm

bent,

or

sharply

cable

sentry

excessively

bend a disposable

prep

SAFETY

how

available

systems.

prior

scratched

solutions

to

TIPS

use

it.

and use

If

applicable,

to

placement

such

or

return

as

acetone,

Consult

only

accessories

check

of

otherwise

electrode.

the

the

the

return

damaged

alcohol

7.

Avoid
should

8.

Always

as

9.

Do

10.

Replace

11.

Check

not:

12.

Do
frayed

13.

Use a conductive

14.

Have

(Patient

Always

15.

electrosurgical
scarred

the

be

place

possible.

not

use

uninsulated

the

be

used.

not

use any
or

back-up

Returr

place

areas

use

of

evident

E.C.G.

needle

line

cord

power

taped.

equipment

tlectrode

the

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and

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the

electrodes

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instruments

and

plug

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accessory

gel

specifically

available.

Placement)

return

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electrode

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protuberances.

anesthetics.

E.S.U.

electrodes.

as

with

on

cover.)

the

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far

away

updated

E.S.U.

cord that

designed

on

the

patient

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fatty,

warning

from

equipment.

Extension

is

broken,

for

electrosurgery.

the

as

bony,

to

site

|

close

this

of

cords

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to

hairy,

effect

surgery

should

the

heavily

|

|

16.

17.

Avoid

Do

not

should

placing

slide

be

lifted

the

the

return

return

and

placed

electrode

electrode

on

the

where

under

return

fluids

the

patient.

electrode.

may

pool.

The

patient

18.

During

1.

2.

3.

4.

5.

If

the

patient

far

from

Use

Use

the

effect.

wrong.

Position

wheel

If

electrode

an
not

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field

all

Do
leakage

equipment

the

patient

adhesive

just

an

and

outputs

not

coil

it

as

lowest

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need

cords

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electrode,

the

adhesive

active

contact

are

up

active

currents

has a pacemaker,

possible.

possible

for

so

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is

moved

in

accessory

with

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and

power

abnormally

they

present

electrical

or

repositioned,

good

border.

when

or

present a potential

make

is

the

patient.

one

patient

contact

sure

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the

return

settings

high

cords.

the

in

is

activated.)

cables - this

settings

no

with

gelled

use,

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to

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electrode

achieve

check

the

patient.

area

remove

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danger

should

the

desired

indicates

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that

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is

in

it

from

of

today's

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to

increase

the

be

something

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not

return

using

good

contact,

the

surgical

generators,

R.F.

patient.

as

surgical

is

6.

7.

8.

9.

10.

11.

After

1.

2.

Do

not

the

unit.

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not

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the
(This

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Keep

reduce

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accessory

Turn

Turn

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forceps

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use

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not

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all

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activate

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the

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the

forceps

with

eliminate

endoscopes

electrodes

the

to

activate.

unit

off.

dials

to

active

the

0.

electrode

damage

electrosurgical

electrode
the

with

and

active

the

and

majority

insulated

clean.

require

accessory

to

ground

unit

or

introduce a patient

unit

for

creating a metal

and

then

"jolts"

eye

pieces.

build-up

power

in

activate

liquids.

of

Eschar

higher

to

confirm

long

lengths

to

metal

the

to

the

will

settings.

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operation

hazard.

of

arc.

generator.

surgeon.)

increase

may

cause

of

time.

Touch

resistance,

the

Disconnect
the

power

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electrical

Do

not

reuse

all

cords

supply

disposable

cord

cords

by

grasping

first.

when

storing:

accessories.

the

plug,

don't

not

bend

the

or

cord;

kink

disconnect

them.

Routinely
every

Wash

or

ETO

life.

3-4

all

soak.

sterilize

replace

months,

reusable

accessories

all

"permanent"

depending

accessories

if

cables

upon

usage

with a damp

at

rate.

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appropriate

cloth.

will

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not

prolong

intervals

immerse

their

-

SSE3B

INSTRUCTION

MANUAL

EFFECTIVITY:

VALLEYLAB

PART

PRINTED

NUMBER

AUGUST

IN

A

USA

1,

945

1984

110

016

A

~

ELECTROSURGICAL

VALLEYLAB

GENERATOR

SSE3B

PRODUCT

INFORMATION

INTENDED

The

Model
generator
monopolar
for

cutting

BLEND
degrees
respectively.

procedures

cutting
settings
for

details.
desiccation

independently

instruments,
instruments.

CONTRAINDICATIONS

There

The

patient's

use

use

with

and

#3

or

are

USES

SSE3B

intended

and

and

of

must

no

of

condition

Electrosurgical

bipolar

a

patient

fulguration.

COAG

hemostatis,

The

including

fulguration

be

used

The

bipolar

without

controlled.

it

is

known

external

for

output

return

are

intended

monopolar

transurethral

and

fulguration

also

absolute

or

may

require

Generator

use.

in
connections.

electrode

Its

voltage

and

output

using

output

possible

internal

the

the

surgeon

Although

contraindications

special

the

operating

for

smooth

fulguration

is

resections.

monopolar

is

is

an

isolated

or

cutting.

designed

to

use the

pacemakers,

precautions.

is a general

The

and

is

waveforms,

cutting,

with

powerful

output

referred

The

primarily

bipolar

to

monitoring

room.

monopolar

designed

CUT,

cutting

a

enough

Desiccation

to

output

bipolar

the use

purpose

The

output

for

BLEND.

minimum

is

practical,

the

which

for

output

equipment,

electrosurgical

SSE3B

is

electrosurgical

fl,

with

of

for

Instruction

output

use

of

all

with

is

intended

with

with

electrosurgery.

has

BLEND

increasing

power

monopolar

both

intended

cutting,

common

minimal

but

Manual

bipolar

and

#2,

low

for

is

the

WARNINGS

Never

both

Burns

monopolar

surgeon's
inherently

or

Electrosurgical

一

一
一

pacemaker

the
electrosurgical
mode

increase

the

to

objects.

heart

or

active

the

active

hands.

unsafe

because

which

inhibit

the

and

the

surgeon's

electrode

Electrosurgery
for

units

of

could

current

the

pacemaker

power

use

the

beyond

patient

hands

with

should

danger

cause

can

return

are

is

touched

involves

flammable

be

of

fibrillation.

cause

entirely.

the

normal

electrodes

possible

used

introducing

a

pacemaker

settings

in

to

a

electric

anesthetics

with

caution

without

and

their

most

metal

clinical

instrument

sparking

or

in

electrosurgical

Also,

to

interference

revert

connections.

situations

to

near

flammable

the

to

first

held

tissue

presence

currents

an

asynchronous

checking

in

and

fluids

from

if

of

into

a

the

is

a

the

PRECAUTIONS

The

surgeon
such
standby
a
cannot
higher
Low
return

pass

as

significant

frequency

directly

should
random
generator

detect

than

electrode

normal

component

and

risk

loose

current

should

through

be

aware

failure

accessories

to

the

connections

low

frequency

components

be

the

region

that

patient.

placed

the

or

defective

are

in

the

components

could

so

that

of

the

Model

recommended

The

SSE3B

SSE3B

active

cause

the

heart.

can

malfunction

active

electrode

in

electrosurgical

or

patient

if

generator

Return

the

electrosurgical

fibrillation,

Fault

which

for

electrodes.

malfunction

safety system

may

result

current.

so

the

current

will

reasons

A

is

in

patient

not

POTENTIAL

The

most

unintended

patient

combinations
complication
bipolar

PREVENTATIVE

To

insure

checked

Of

particular

lint

A

steps

Test

thorough

that

to

insure

and

taken

the

Procedure,"

COMPLICATIONS

common

burns

return

of

is

the

electrosurgery

MAINTENANCE

safe

and

for

wear

and

importance

dirt

build-up,

visual

to

correct

generator

outlined

continued

complications

to

the

patient

electrodes,

fault

dependable

inspection

be

efficacy

conditions,

explosion

are

tear.

are:

power

any

inspected

in

very

operation,

printed

cord

of

and

the

and

associated

and

insufficient

of

flammable

unusual.

wear,

the

all

of

at

least twice

service

safety.

surgeon

or

poor

this

circuit

and

generator

the

above

manual,

with

monopolar

caused

patient

surgical

bowel

generator

board

looseness

should

conditions.

a

year

be

by

gas.

should

contact

of

mechanical

be

made

and

performed

electrosurgery

defective

electrode
technique.

Complications

be

finger

and

It

is

that

the

at

active

contact,

À

rare
with

periodically

corrosion,

parts.

appropriate.

recommended

"Acceptance

these

times

are

or

ii

THE

SSE3B

SYSTEM

Congratulations.
generator
available
rivals
effect.
cutting
irrigated
directly
separate,
characteristic
applications.
bipolar

SSE3B

safety
grounded

Electrode

In

order
capabilities
information
facts
understanding
situations

For

the
Sections
and

limitations

should

must

be

ever
in

the

The

and

procedures.

in

isolated

instruments

is

equipped

system

electrosurgery.

Monitoring

to

and

surgeon

1

be

able

used

Your

built.

a

single

best

PURE

watts

spark

variable

CUT

with

bipolar

which

Hand-switch

with

which

instruct

and

must

specifications.

and

and

to

limitations

be

of

his

recognize

the

2.

These

of

the

to

decide

accomplish

new

It

generator.

gap

BLEND

is

exceptionally

For

a

large

is

ideal

as

well

the

combines

System

the

provided.

equipment

potential

most

sections

generator.

what

SSE3B

offers

generators

gives

your

lighted,

output

for

activation

as

conventional

"Balanced

the

The

SSE3B

(REM).

user

Ideally,

important

procedures

them.

is

the

features

The

a

convenience

which

neurosurgery,

may

significant

may

of

an

of

his

The

user

so

he

hazards

contain

After

most

and

SSE3B

and

wide

smooth

digital

has

Output"

also

electrosurgical

he

can

parts

reading
his

has

with

range

and

the

display.

a

non-sparking

be

used with

footswitch

patient

advantages

be

generator,

must

before

the

be

should

use the

of

basic

SSE3B

versatile

performance

COAG

a

minimum

of

starts

output

laparoscopy,

both

equipped

a

given

be

given

they

occur.

these

surgical

these

sections

can

electrosurgical

never

fulguration

of

hemostasis

promptly

is

The

SSE3B

(desiccation)

monopolar

activation.

return

of

isolated

with

generator

great

more

a

generator

instructions

capabilities

handle

and

before

which

cutting

while

even

calibrated

has

or

other

electrode

the

Return

of

deal

than

a

just

complete

in

surgeon

how

in

a

and

The

and

the

of

new

are

it

The

basic
their
Section

electrical

The

technical
increasingly
such

Sections

If

Valleylab

hesitate
Service
Department
problems.

generator

remainder

as

any

problem

is a lack

9

is

a

layman

of

topics

relevant

the

circulating

3

through

questions

representative.

to

call

Department,

are

always

most

short

and

the

which

8

as

arise

or

surgeons

of

primer

Section

Instruction

are

for

the

nurse

well

about using

If

write

Maintenance

our

happy

and

knowledge

on

10

is a glossary

of

less

hospital

and

as

Sections

there

factory.

Service

to

nurses

of

electricity.

electricity

Manual,

concern

engineer.

OR

supervisor

1

and

your

are

questions

The

help

you

have

Sections

new

Department,

in

and

of

terms.

to

will

2.

SSE3B,

he

personnel

with

trying

To

fill

electronics

3

through

the

surgeon

Other

be

call

can't

in

and

your

electrosurgical

to

understand
this

8,

OR

personnel

interested

your

answer,

our

Customer

Engineering

for

but

need,

cover

local

do

the

are

in

not

iii

SECTION

1.

Electrosurgical

Theory

Applied

CONTENTS

to

the

LOM,

SSE3B

Electrosurgery

-

Gastrointestinal

-

Laparoscopic

-

Urologic

-

Neurosurgery

-

Patients

-

General

Description

The

SSE3B

Patient

REM/CoHesive

Surgery

with

Electrosurgery

of

Patient

Return

in

the

Endoscopy

Sterilization

Pacemakers

Controls

Return

Electrode

System

Operating

and

Generator

Electrode

Recommendations

Room

Safety

Design

System

26

27

36

45

49

51

53

57

66

85

89

Interference

Technical

A

of

Glossary

10.

Warranty

il.

Specifications

Primer

Electrosurgery

on

to

Basic

Monitoring

Electricity

Equipment

for

iv

Better

92

96

Understanding

109

122

131

一
一

一

SECTION

1

ELECTROSURGICAL

Electrosurgery

to

sever

a

low

muscles

could

Although

to

4,000,000
become
confine

operates
extremes.

Medical

is

passed

used

is

never

diathermy"
difference
electric

tissue

frequency,

and

electrocute

a

quite

these

at

diathermy

so

that

high

current.

THEORY

can

or

nerves.

generator

Hz

prominent

radio

750,000

through

the

enough

for

electrosurgery.

between

be

achieve

say

Putting

the

patient.

could

(4

MHz),

frequency

Hz

is

similar

the

current

these

APPLIED

defined

below

at

(750

patient's

density

to

cause

two

TO

THE

as

the

hemostasis,

100,000

it

another

perform

reactive

such

high

currents

KHz)

to

electrosurgery

body.

is

necrosis.

This

techniques

SSE3B

use

of a radio

A

high

Hz

(cycles

way,

electrosurgery

phenomena,

frequencies

to

wires.

which

kept

is

Large

low

The

is

very

is

the

radio

per

a

low

quite
capacitance
and

For

a

compromise

in

that

entry

and

the

British

descriptive.

density

frequency

frequency

second)

frequency

well

it

becomes

these

radio

and

resulting

use

of

at

reasons

between

frequency

exit

the

the

electric

is

used

will

electric

frequencies

and

difficult

electrodes

tissue

term

since

radio

current

because

stimulate

current

inductance,

the

SSE3B

these

current

heating

"surgical

the

major

frequency

up

to

two

are

There

electrosurgery.

Electrosurgical

Electrosurgical

effect.

Electrosurgical

significant
char

The

1.

Electrosurgical

Of

waveform

passed

in
wire
through

are

tissue.

SSE3B

the

the

is

three,

(either

through
tissue.

in a toaster

it.

only

Desiccation

Cutting

Fulguration

cutting.

optimized

Desiccation

desiccation

the

This

three

They

CUT

or

electrical

is

or

surgical

are:

-

-

Electric

Fulguration

to

perform

COAG)

exactly

stove

which

Low

-

Electric

is

technically

can

resistance

the

effects

power

sparking

can

all

three

be

used.

same

becomes

which

coagulation

to

sparking

coagulate

of

these

the

In

of

the

phenomenon

hot

when

can

be

without

tissue

to

large

functions,

simplest

desiccation,

tissue

as

the

achieved

with

tissue

bleeders

because

and

the

current

sparking.

a

cutting

without

current

heat

arises

resistance

passes

with

and

ANY

is

When

tissue
the

the
active
imperative

A

the

tissue

water

dirty

tissue

and

hence

turns

is

electrode

that

or

charred

becomes

the

a

driven

in

the

electrode

light

electrode

name,

off.

good

hot,

the

desiccation.

‘brown

Since

electrical

be

desiccates

water

color,

desiccation

kept

DESICCATION

is

.

What

then

contact

clean

poorly.

slowly

one

it

steams

with

and

sees

takes

free

[1]

driven

and

place

the

of

out

is

that

bubbles

tissue,

dried

of

with

tissue.

the

first

as

the

it is

Electrode

contact

Deep
spreads
Relatively

brown

Desiccation
be

performed

to

desiccate

larger

produce

setting,

desiccation

in

good

with

the

coagulation

radially.

soft,

eschar.

TYPICAL

with

with

depends

the

electrode

the

same

the

more

will

tissue.

light

CURRENT

the

SSE3B

either

current

current

proceed.

CUT,

on

the

contact

density.

using

BLEND

area

area,

that

ELECTRODE

=

0.5

AMP

either

or

COAG.

of

the

the

Then

is

delivered

of

active

more

too,

RMS

the

The

current

monopolar

exact

electrode

the

higher

and

TISSUE

setting

is

the

outputs

since

required

the

control

faster

can

needed

the

to

the

The

bipolar

panel)

to

electrode

currents,

Shortly,

fulguration.

Desiccation
long

is

deliver

group

output

optimized

large

is in

the

maximum

the

bipolar

can

of

five

(the

for

currents

firm

also

contact

receptacles

four

desiccation.

voltage

output

be

done

receptacles

to

low

with

is

is

with

at

resistance,

the

very

poor

the

the

lower

at

This

tissue.

for

means

low,

electrosurgical

monopolar

left

the

and

that

moist

In

as

output

of

lower

spite

will

the

right

it

tissue

of
be

which

panel.

is

designed

when

the

explained

cutting

of

large

is

the

the

or

the

The

and

the

BLEND,

monopolar

thus

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One

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REFERENCES

Harris,
presented

Hoenig,

on

Morrison,
Structures

possible
patient
patient

The

farthest

electrode

banana

will

Biomedical

allow

ON

F.W.;

W.M.;

problem

jack,

electrode

way

will

the

ELECTROSURGICAL

to

AAMI

C.F.;

Incorporated

it

to

overcome

left

must

plug.

a

attenuator.

Desiccation

Convention,

The

Mechanism

Engineering,

with

will

receive

The

disposable

Electrosurgical

and

of

then

E0502-5

Therein;

attenuate

will

this

the

the

be

THEORY

as a Key

of

pp.

the

attenuator

current

make

pencil,

Washington,

58 — 62,

the

problem

three

attenuator

plugged

LectroActive

to

Cutting

Devices

U.S.

returning

RETURN

is

to

handswitching

without

into

such

Patent

as

Understanding

D.C.,

in

Electrosurgery;

January

3,970,088,

is

that,

FAULT

plug

the

Adapter

the

March

1975.

Having

if

to

circuit

it

into

jacks

any

attenuator

has

E2504

Electrosurgery;

18,

Sesquipolar

20

it

is

plugged

the

generator

more

the

active

(LectroSwitch

modification.

by

means

such

a

banana

LectroChuck

1978.

IEEE

July

Transactions

1976.

into
from

likely

side.

of

plug

to

Paper

Electrode

to

The

a

be

Dalziel,
Engineering

C.F.,

69:

Mansfield,

794 — 800,

T.H.;

1950.

Perception

25

of

Electric

Currents;

Electrical

SECTION

2

ELECTROSURGERY

This
often
endoscope
electrosurgery.

Laparoscopy

in

generators
SSE3B,
patient

chapter

open

about

electrosurgery

patients

return

IN

attempts

specific

produces

and

on

the

electrode.

THE

more

The

Urologic

same

with

OPERATING

to

answer

procedures

problems

following

surgery.

including

patient,

pacemakers,

ROOM

the

and

three

The

hemostasis

the

and

questions

techniques.

and

questions

sections

final

use

the

of

use

that

sections

in

neurosurgery,

two

active

of

we

at

Electrosurgery

than

deal

the

all

with

cover

electrodes

bipolar

Valleylab

other

G.I.

unusual

the

output

hear

through

uses
Endoscopy,
situations

use

of

with

with

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an

for

two

your

a

26

、

GASTROINTESTINAL

Polypectomy

1.

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is

uterus,

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and

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in

one

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as

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current

this

relative

3]

will

snare

very

will

if

art

POLYPECTOMY

DESICCATION

polyp

have

wire

the

loop.

polyp

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quantities

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tight

rise

stalk

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continue

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it

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art

HEMOSTASIS

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the

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density

AT

FOR

to

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|

DESICCATION

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HEMOSTASIS

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ARD.

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28

|

AM

IN

MA

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it

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tightening
will

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of
tissue

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hemostasis.

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29

Cutting

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polyp
wire,

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wire

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wire

#3

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mm.

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electrosurgical

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[4]

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30

about

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the
(.012"

mm

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polypectomy

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of

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the

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to

5).

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difficulty
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wire

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ELECTROSURGICAL

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snare

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(45mm
Relatively

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High

loosely

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-

.7mm).

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start

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30

Polypectomy

In

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Electrosurgical

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series

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wires.

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wire

to

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solid

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the

(5,

6]

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state

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hemostasis),

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tension

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prompt

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SSE2).

generator,

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to

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mm

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by

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to

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technique

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results.

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to

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to

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fine

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it

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polyp

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at

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to

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the

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the

better

31

used,

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thin

the

3

the

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is

desiccation

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to

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5,

any

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characteristic

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of

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creeping

the

mode,

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of

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BLEND

at

low

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tissue

get

but

is

#2.

in

tissue

|

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the

it

not

the
The

all

not

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to

cut

has

POLYPECTOMY

In

summary,

successfully,

is

already

exact

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snare

equipment,
one

and

HEMOSTASIS

Blended

Thick
thin

Let

successful.

instructor's

technique

wires

wires.

the

spark

all

but

cut

(.45mm - .7mm)

of

each

snare,

can

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or

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the

cutting,

these

polypectomy

is an

For

settings

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ELECTROSURGICAL

provides

provide

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art

and

the

beginner,

and

and

power

the

most

more

force

techniques

should

technique

setting

hemostasis.

hemostasis

the

wire

through.

can

be

learned

it

is

advisable

used

with

than

be

from

by

another

made

someone

to

his

instructor.

instructor's

to

use

work

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the

3.

Coagulation

Recently

bleeding.

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believe

Papillotomy

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bile

direct

done

Valleylab

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of

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duct

of

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and

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ulcer

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the

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vision

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has

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irrigation

at

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setting

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a

and

been

still

cases

probe.

COAG

new

fluoroscopy,

5

of

of

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endoscopic

Bleeding

increased

an

experimental

[7,

8]

to

7.

the

COAG

to

interest

are

using

One

of

He

applies

generator
5

to 7 watts

provide

electrosurgical

a

catheter

in

procedure,

desiccation

these

the

in

1/2

with

relief

is

introduced

coagulation

but

surgeons

electrode

to 2 second

the

from

stones

procedure.

the

with

[7]

SSE3B

into

of

surgeons

a

combination

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to

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bursts.

will

in

the

[9]

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upper

using

margin

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common

Under

Papilla

GI

who

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a

oo

一
一

A

wire
catheter
tip.
severed

linkage

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by

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in

wire

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length

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of

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electrode

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a

handle

wire

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flexes

along

CUT

and

one

the

the

side

tip

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sphincter

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the

is

Injury

procedure.

cutting
incision,
cutting

the

tissue.

Sparking

to

force

a

delay

not

more

and

when

and

perforate

Because

the

surgeon

with
equipment,
as

vitro

Leakage

Some

between

RETURN

active
especially
of
black
capacitance
greater
although

patient,

after

well

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the

before

of

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metal

plastic

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to

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To

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well

Technique

will

not

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will
sparks

in

starting

force.

the

procedure

settings,

any

snare

ground,

if

between

the

the

scope

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electrode

the

obtain

using

longer

circuit

the

wire

between

SSE3B

RETURN

papillotomy

as

Bypass

the

the

and

than

pancreas

prevent

controlled

occur

the

occur

to

jump

If

duodenum.

and

surgical

any

Cables

colonoscopes

wire

colonoscope
framework

covering

cannot

has

been

is

this,

is

important

until

electrode

until

across

to

cut,

one

applies

finally

is

potentially

first-hand

and

technique

procedure,

new

for

Colonoscopes

and

will

it

may

over

the

patient's

the

active

FAULT

inserted

a

potentially.

it

with

equipment

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not

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no

sparks

is

the

the

one

should

does

training

if

metal

permit

not

be

is

inside

the

and

activated

circuit

is

essential

starting

in

making

can

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pressed

tissue

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more

begin

hazardous,

possible,

as

it

have over

possible

grounded

the
flexible

body

the

half a meter

has

apply

force,

from

closely

is

or

methods

and

frame

more

colonoscope

and

colonoscope.

with

will

tissue.

severe

that

delay

the

output

freely

firmly

to

duplicate

very

Gastroscopes

150 pf

Of

than

through

portion.

colonoscope

frequently

been

LESS

it

spark,

we
someone

as

possible.

helpful

which

the

to

the

or

against

will

strongly

120
activate

colonoscope

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complication

the

or

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controllable.

from

sufficiently

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force

it

of

colonoscope.

the

is

the

the

on

increase

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to

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pf

coupling

light
just

As
is

frequently

The

result

permit

of

electrosurgical

during

electrode

tissue,

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if

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the

electrode,

the

delay

cut too

recommend

instructor's

In

papillotomy

experiment

familiar.

the

source.

underneath

&

result,

free
the

deeply

successful

coupling

Since

between

generator,

is

that,

of

surgery

this

the

The

to

the

is

that

in

the

Most

the
the

much

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However,

insertion,
used

Valleylab

it
make
permanent
drilling

eyelet

the

to

for

such

E7001

if

then

shunt

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attaching

patient

patient

a

small

on

the

plate.

the

RETURN

the

colonoscope-to-patient

the

leakage

not

make

a

cable

electrodes

plate

hole

colonoscope-to-patient

FAULT

to

a

can

in

the

patient
from

and

easily

the

plate

circuit

patient

electrode

the

these

33

continues

electrode

electrode

colonoscope.

may

be

be

modified

next

plate

to

cable

with

used.

the

to

bypass

as

well

a

second

Other

to

present

can

trigger

cable

as

connection

manufacturers

The

Valleylab

accept

connector.

then

be

following

ground.

a

cable

riveted

must

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be

on
do

by

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to

One

colonoscope
cable.
separating
defective,
bowel
leakage
density
centimeter

In

conclusion,

colonoscope.

about

Alternatively,
plate

120 pf

used,
voltage

be a threat

plastic

of

the

to

applies.

the

For

the

with

S-Cord

On

wall

would

could

keeping

cable

and

the

on

eyepiece

colonoscope

perform

active

Valleylab

Multiple

the

CoHesive

is

some

the

exposing

mucosa

be

for

10

there

First,

the

one

provided

trigger

surgeon

the

to

him

polypectomy

The

gastroscopes

and

scope,

electrosurgical

Return/S-Cord

needed.

manufacturer

of

their

bowel

easily

metal

mucosa

the

were

concentrated

seconds,

are

one can

patient

can

that

the

should

parts

and his

to

protect

insulation

so

Return

has

given

scopes

metal

to

be

in

a

two

plate

use a colonoscope

the

RETURN

be

patient.

through

usually

these

Adapter

Electrode

being

from

wire

touch

at

excess

burn

ways

use

the

in

active

FAULT

aware

of

the

the

surgeon's

before

precautions

generators

the

structure

one

this

is

possible.

to

good

colonoscope

a

have

(Model

in

another

used

colonoscope

of

these

contact

of

handle

"S-Cord“

contact

without

to

ground

circuit.

that

The

each

there

minimum

eye and

procedure.

gastroscope

only

may

equipped

GI

laboratory

in

of

100

the

and

capacitance

25

not

E0506)

reason

the

field,

has

the

colonoscope.

exposed

site.

milliamperes

leakage

be

with

a

colonoscope-to-patient

If

the

will

that

precautions

a

and

pf

be

with

is

for

the

become

wires,

Since

problem

scrupulously

the

patient's

doesn't

"S-Cord"

always

theoretically,

thorough

It

is

the

capacitance

necessary.

the

available

procedures

using

insulation

cracked

the

per

with

be

should

examination

also

possible

same

REM

for

where

this

If

all

current

square

careful

skin.

exceed

is

a

small
could

be

advice

between

system,

or

the

the

the

not

a

use

an

COLONOSCOPE

(EYEPIECE

BE

PLASTIC)

SHOULD

SNARE

PATIENT

CONNECTION

PLATE

(For

"S-CORD"

(LEAKAGE

OF

THE

generators

ACTIVE

—

"S-CORD"

not

WIRE)

equipped

34

OR

LEAKAGE

with

PATIENT

BYPASS

REM)

WIRE

-=

REFERENCES

Williams,

Endoscopy

Gaisford,
124:744-749,

COLONOSCOPE
(EYEPIECE

SHOULD

PLASTIC)

BE

ON

GASTROINTESTINAL

Christopher:

Seminar,

W.D.:

COHESIVE

Canary

Gastrointestinal

1972

RETURN

Presentation

ELECTRODE

ENDOSCOPY:

Islands,

"S"

CORD

to

Medical

Spain,

Fiberendoscopy.

February

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of

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Arch

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Curtis,

Makers,

Wolff,

À

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Wolff,

1974,

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Zimmon,

for

Choledocholithiasis,

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106:458-462,

L.E.:

Inc.,

W.I.;

of

288:329-332,

W.I.;

Seminar:

John

D.S.;

High

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Shinya,

Neoplasms

Shinya,

W.D.:

P.:

JAMA.

Gastrointestinal

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H.:

Beyond

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Falkenstein,

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the

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on

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Electrocoagulation

1172-1173,

D.B.;

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Control

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Kessler,

J.

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in

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of

the

of

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293:1181-1182,

Via

the

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Current

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Upper

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the

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American

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Gastrointestinal

1975.

Cystoscope

Colonoscope:

N.

Eng.

in

Surgery

Upper

Papillotomy

Jd.

35

LAPAROSCOPIC

STERILIZATION

There
can

here

to

are

be

is

help

1.

MONOPOLAR

many

divided

not

to

the

user

Laparoscopy

The

oldest
biopsy
Salpinx
cut

off
technique
terminal

clear
needed

but

different

into

pass

sleeve.

for

judgment

perform

-

technique

has

the

which

ileum.

they

fulguration.

basic

monopolar

his

Monopolar

The

been

fulgurated,

specimen

all

The

seem

techniques

techniques

on

which

technique

Fulguration

uses

tube

grapsed

too

exact

to

be

LAPAROSCOPY

a

is

often

reasons

related

for

and

exact

with

monopolar
grasped

the

rotary

in

resulted

performing
bipolar

technique

the

SSE3B.

With

forceps,

and

the

forceps.

for

to

the

is

or

Without

fulgurated.

biopsy

in

accidental

these

use

this

techniques.

the

best,

Biopsy

usually

sleeve

This

burns

of

are

high

procedure.

Our

but

with

When

is

is

burns

not

peak

sufficient

twisted

the

They

purpose

rather

a

rotary

basic

to

entirely

voltages

to

the

PATIENT

PLATE

DESIRED

CURRENT

PATH

CURRENT

MONOPOLAR

PATHS

LAPAROSCOPY

TERMINAL

IN

36

Another

resistance

most

burn

places.

coagulated
remainder
from
some

those

Consequently,

current

coagulation.

possibly

Loffer.

THE

factor

obvious

technigue".

the
distance

viscera

out

WRONG

of

situation

If

the

tissue

of

the

uterus.

away

fulgurating

through

coagulate

[1]

which

the

If

WAY

salpinx

That

first

will
salpinx

The

on

which

the

the

TO

may

be

where
is,

coagulation

acquire

will

current

the

skin

have

(or

the

fimbria

current

bowel.

|

COAGULATE

very

and

mesosalpinx

this

the

salpinx

a

higher

tend

is

trying

and

the

desiccating)

were

This

important

would

is

to

to

it

will

lowest

and

small bowel

concentrated

theory

TWICE

is

during

be

important

is

coagulated

close

electrical

become

return

travel

electrical

proximally

the

rising

coagulation.

to

the

resistance

electrically

to

the

there

during

enough,

was

first

is in

in

two

uterus,

patient

primarily

first

proposed

electrical

the

"two

separate

and

isolated

plate

resistance,

may

force

the

second

it

could

The

the

the

via

by

ーーーーー…

THEORETICALLY,

Cego

TAL

DESICCATION

PORTION

PATIENT

SHOULD

PLATE

FIRST

İİ

TT]

/

|

COULD

|

|

BE

COAGULATED

|

|

Ÿ

COAGULATION

+

e:

OCCUR

HERE

DISTAL
COAGULATED

A

CASA

SEAS

SALPINX

LAST

クン

ンジ

37

Similarly,
in

that

.

of

the
first
occurs

current

touching

whitening

forceps

on

the

on

could

the

a

single

proximal

the

flow

terminal

or

than

distal

desiccation

blanching

the

other.

side

side.

out

to

ileum.

of

the

Conceivably,

the

fimbria

(or

fulguration)

may

occur

Occasionally,

forceps

to

much

before

a

some

can

be

quite

more

large

rapidly

a

wide

area

significant blanching

proportion

small

point

on
will

where

erratic,
one

side

blanch

of

the

it is

MONOPOLAR
ELECTRICAL

DESICCATION

CURRENT
CONTACT

LAPAROSCOPY

ISOLATION

OCCURS

PROXIMALLY

DENSITY
AREA

IS

AND

CONTROLLED

NECROSIS

OF

IS

SALPINX

THE

FIRST

BY

UNLIKELY

FIMBRIA

TERMINAL

Another

forceps
after

cool

As

fulguration
an

mode.

discouraged

to

advantage

with

voltage

3.

the

to

explained

equal

keep

an

This

disadvantage

tips

ambient

Consequently,

the

SSE3B,

is

can

generator

is

magnitude

from
peak

of

fulgurating

so

high.

will

temperature.

in

considerably

we

be

heat

is

the

of

sparking

voltage

strongly

Instead,

roughly

of

fulgurating

them

shut

discussion

current

the

as

equivalent

to

the

to

temperatures

off,

[2]

more

current

bowel.

low

as

salpinx,

advise

use

38

is

the

on

efficient

applied

leaving

The

possible.

against

BLEND

to

SSE2

that

forceps

fulguration

in

to

way

but

if
using

#3

at a setting

COAG

sparking

as

high

may

producing

tissue

the

to

discourage

We

are

this

set

require

in

fimbria

technique

COAG

at

as

in

not

since

3.

to

500°C,

minutes

Section

necrosis

à

desiccating

sparking

aware

no

higher

the

must

the

is

metal

of

peak

Even

to

l,

than

be

is

any

done

than

ELECTRICAL

AND

THE

“COAG”

ISOLATION

USE

OF

HIGH

"

OF

THE

VOLTAGE

BOWEL

SPARKING
HIGH
ALMOST

Laparoscopy

The
altogether.
fulguration
highest
desiccate

TO

CURRENT

CERTAIN.

best

for

TISSUE

DENSITY.

-

Monopolar

way

to

Desiccation

and

can

a

given

the

salpinx

IS

ALWAYS

NECROSIS

Desiccation

avoid

be

done

peak

using

A

IS

fulgurating

will

whiten

with

voltage

CUT

at

With

a

minimum

in

the

settings

bowel

or

or

Without

blanch

of

CUT

of

is

peak

mode.

1

to

the

to

Biopsy

avoid
tissue

voltage.

It is

2.

SPARKING

TO

BOWEL

fulgurating

as

well

Power

possible

as

is
to

It

may

be

because

sufficient

the

peak

through
at
BLEND
a

good

The
small

than

without

When

realize

entering
fulguration.
will take
happening.
begin
because

taking

the

the

same

(#1

compromise,

contact

forceps

fatter

stalling

desiccating

to

it

place

found

the

length

voltage

dehydrated

power

or

area

that

the

place

After

blanch

means

and

that

desiccation

of

(100

level

#2)

set

of

jaws

forceps.

sparking

When

will

than

with

desiccation

low

SLOWLY.

a

and

that

he

can

pure

salpinx

to

coagulum

at

the

the

dry

Large

small

the

phase,

settings

few

seconds

steam.

the

stop

CUT

is

"stalls"

has

been

300

volts

around

is

needed

minimum

forceps

out

the

forceps

jaws.

SSE3B

requires

In

laparoscopist

that

fact,

This

the

desiccation

monopolar

are

however,

not

or

desiccated.

peak)

and

level

is

also

tissue

very

is,

used,

at

slow

very

ends

is

the

forceps.

the

(1

very

jaws

output

LOW

to

prevent

first
the

desiccation

has

practical

prematurely

too

low

higher

to

3)

important

they

the

good

any

can

contact
desiccate

SETTINGS

resulting

nothing

salpinx

control

time

for

This

to

More

crest

may

it is

either

is

he

desiccation

occurs

force

peak

factor

work

since

more

important

to

cutting

desiccation

seems

will

an

over

likes.

before

because

current

voltage

out

to

quickly

more

prevent

to
gradually
advantage

what

[3]

of

very

area

a

a

be

to

or

be

is

39

If

the

SSE3B
response,
control"
intended.

If

it is

self-limiting

to

use

the

"desiccation

the

or

"erratic".

necessary

bipolar

only"

monopolar

desiccation

to

characteristic

output

performance.

output

may

This

have

seem

may

for

as

is

result

the

monopolar

a

turned

to

"run

instant

monopolar

up

away"

in

far

starting

desiccation

output

to

more

and

obtain

will

damage

and

and

an

be

"automatic",

it

is

achieve

instant

"hard

than

possible

this

ーー

to

was

cen

Since
other
Valleylab
in
banana
forceps.

It
would

switching

monopolar

section.

Laparoscopy

Some
requires

#2)

The
after

to

size

desiccation.
90

the

isolated

one

is

even

surgeons

or

most

first

cut

of

watts.

of

plug

have

CUT

the

bipolar

generator

patient

the

bipolar

is

The

generator

possible

to

jacks

applications

-

Monopolar

prefer

more

common

the

power

waveform.

lightly

salpinx

electrode

A

typical

output

plate

placed

to

be

fashioned

on

the

than

technique

desiccating
after

is

isolated,

for

monopolar

connector

jacks

is

Electrosurgical

to

setting

for

in

the

would

use

hand

bipolar

discussed

sever

desiccation

is to

the

and

how

then

which

it.

desiccation

for

(large

the

patient

other

be

switching,

plug.

in

the

pull

The

dry

the

it

may
applications.
size

plate

banana

controlled

would

more

Cutting

tube

and

the

setting

the

desiccation

be

Using

detail

electrosurgically.

will

forceps through

will

tube

be

banana

jack

but

the

require

of

depend

has

used

plug)

and

a

for

with

compatible

a

special

bipolar

at

CUT

become

would

the

the

a

or

greatly

just

The

is

second

the

footswitch.

output

end

BLEND

the

BLEND

after

be

CUT

like

connector
with

any

standard

placed

large

active

for

of

this

|

This

(#1

salpinx

needed

on

the

the

30

the

or

to

To

cut

the
Cutting
desiccating
will

practical

first
achieved
electrode

Cutting

sparking
other
therefore
graph,
is a purely

under

not

desiccating.

hand,

page

this

tube

through

it,

be

to

by

using

(forceps)

electrosurgically

as

theoretically

22,

voltage

electrosurgically

the

may

lead

properly

cut

through

However,

as

as

fulguration,
cutting

try

to

arbitrary

to

tube

low a setting

requires

directly

to

desiccated

possible.

does

since

not
avoid
number,

avoid

bleeding

the

it

more

as

exceeding

we

inadvertent

40

will
with

(insufficient

salpinx

is

vital

as

not

the

safe.

believe

require
a

because

with

that

practical

carry

peak

voltage

Referring

1000

sparking.

CUT

the

a

sufficient

quite

voltage

than

volts

it

is

at

least

current

walls

hemostasis).

BLEND

and

as

the

is

desiccating

to

the

peak.

wise

without

of

the

current

hemostasis

large

same

lower.

peak

Although

to

try

120

incision

a

risk

watts.

first

It

without

cutting

from

On

and

voltage

this

to

stay

is

be

the

is

一

一 一
一
一

Monopolar

La

paroscope

Laparoscopic

Sterilization

With

the

Single

Puncture

Some
as

this

ground

plate.

taken

When such
severe

frequency
capacitance
power

Square
MHz

will

Because
practical

with
enter
leakage
will
current
100
there
bowel.

of

100

reason,

will

produce

the

be

ma

pf

to

available

of

the

per

would

the

single

of

capacitance

some

connector"

This

insure

as

the

current

at

density

This

solution

a

laparoscope

it is

of

the

is

the

current.

have

16

problem

to

take

single

abdominal

least

square

be

solution

puncture

manufacturers

which

that

four

no

the

with

SSE3B

directly

from such

times

times

is

another

puncture

wall

will

will

be

6

be

centimeter.

risk

between

is

patient

is

other

is

relatively

proportional

For

more

relatively

approach.

less

or

8

well

of

was

first

laparoscopes

the

formerly

connects

acceptable

plate

used

with

generators

a

leakage

example,

as

much

leakage

laparoscope,

at

the

than

square

below

Even

peritonitis,

proposed

forceps

the

laparoscope

but

is

touching

the

SSE3B,

low

and

to

current

a

generator

leakage

power.

less

site

roughly

severe

If a metal

then

of

centimeters

the

danger

if a burn

in

by

on

the

and

recommended

extra

on

the

leakage

frequency.

is

current

with

trochar

the

the

100

ma,

of

level

did

contrast

Soderstrom.

market

the

precautions

the

the

market

proportional

which

leakage

incision.

occur

have

laparoscope.

using

to

patient's

problem

current through

Moreover,

operates

as

the

the

sheath

and

because

contact

which

at

to a burn

[4]

a

the

is

because

SSE3B

SSE3B,

current

Since

area,

is

this

as

much

"common

patient

must

skin,

not

to

at

it

is

there

roughly

site,

to

For

be

as

the

a
the
the

3

and

is
used
will

the

the

the

MONOPOLAR

SINGLE

PUNCTURE

ELECTROSURGICAL
GENERATOR

PATIENT

LAPAROSCOPY

Е

———

PLATE

/

7

,”

PATIENT

ABDOMINAL

7.

7

CAPACITIVE

LEAKAGE

RETURNS

PLATE

41

TO

VIA

WALL

LOW

/N

FREQUENCY

(<1MHz)

MINIMIZES

GENERATOR

LEAKAGE

Laparoscopy

The

SSE3B

The

simplest

places.

operation,

more

scissor
desiccation,
severed

centimeters

mechanically.

—

bipolar

Because

the

type

Bipolar

output

technique

so

tube

of

cutting

the

jaws

Desiccation

is

is

little

must

salpinx.

surface

are

perfectly

to

tissue

be

regrasped
One

closed

desiccate

bipolar

built

until

suited

the

is

affected

repeatedly

into

for

salpinx

forceps

the

bipolar

on

the

salpinx

with

to

the

jaws,

laparoscopy.

in

one

true

necrose

market

is

or

more

bipolar

two

has

and

completely

after

or

a

BIPOLAR

CURRENT

LAPAROSCOPY

PATH

!S

LIMITED

TO

THE

TISSUE

DESICCATED.

THE

SALPINX

TO

DESICCATE

MUST

BE

2

OR 3 CENTIMETERS

GRASPED

42

REPEATEDLY

THE

PROPOSED

The
standard

of
suggests

impedances

the

monopolar

The

used
bipolar
this

If
guidelines,

The
recommended
Moreover,

the

monopolar
patient's

this

American

this

problems

SSE3B

for

output

section,

one

wishes

use

desiccation

is

AAGL

for

proposed
a

laparoscopy.

bipolar

desiccation

not

equipment

limit

of

200

discussed

page

to

the

of

the

forceps

body

LAPAROSCOPY

Association

with

following

bipolar

because

SSE3B

may

were

practical.

to

standard

of

600

to

500

output

with

monopolar

55.

restrict

forceps

the

monopolar

spread

and

patient

isolated

EQUIPMENT

of

be

used

that

volts

ohms.

previously

is

incapable

both

active

the

SSE3B

settings

RETURN

output

away from

from

STANDARD

Gynecologic

for

applies

peak

[5]

concerning

monopolar

monopolar

should

with

electrode

laparoscopic

These

of

electrodes

the

FAULT

is

ground,

and 100

exceeding

or

not

monopolar

circuit

not

isolated

the

forceps

were

it

might

Laparoscopists

sterilization,

to

electrosurgical

watts

limits

bipolar

output

be

are

the

use

these

is

discussed

exceeded:

may

being

work

maximum

intended

of

limits

forceps.

to

less

output

not

permit

from

ground

just

used.

correctly,

has

drafted

generators

to

fulguration

and can

Use

at

the

than

is

as

The

for

prevent

the

If

of

end

if

part

load

AAGL

not

it.

and

a

the

but

a

in

be

the

of

CUT

BLEND
BLEND

BLEND

COAG

#1

#2

#3

Dial

No.

5

3

2

1

3/4

l 5

Watts

100

30
15

10

43

REFERENCES

1.

Loffer,

Private

F.D.:

Communication,

Arizona

June

Family

1974.

Planning

Service;

Phoenix

Arizona,

Larbig,

Histologische

Gerburish.

Engle,
Sterilization

Soderstrom,

Avenue

T.;

Seattle,

Soderstrom,

of

Gynecologic

California

J.;

90241,

Goltener,

Tubenbefunde

V.

Frauenheilk.

Harris,

J.

of

Richard

Washington

Richard

Laparoscopists,

11

E.;

F.W.:

Reproductive

M.,

Personal

98101,

M.,

Letter

July

1977.

Bassler

Bei

35:190-193,

The

Electrical

Med.

Communication,

21

April

to

AAGL

11239

R.:

Laparoskoischer

1975.

Dynamics

15:33-42,

1975.

Members,

South

Lakewood

Temperaturmessungen

Sterilisation.

of

1975.

Mason

Clinic,

American

Boulevard,

Laparoscopic

1118

Association

Downey,

Und

9th

44

一

一
一

一

UROLOGIC

SURGERY

Transurethral

Transurethral
watts

to
have
If a hypo-osmolar

of
hemolysis

patient,

If a good
Saline

power

salt

made

that
irrigation
conductive.

concern.

It

generator
power
patient

is

risk

using

or

provide

the

water

fluid

would

left

in

it to be

up

in

salt

is

possible

would

plate

difficult

to

the

conductive

more.

visibility

proper

would

of

conductor

be a short

over

the
is
solution

has

to

patient

Resections

resections

The

osmolarity

solution

pass

red

blood

overload

to

hospital

released

With

to

600

or

require

area

achieve

solutions,

bladder

and

into

of

do

the

quite

should

the

new

perform

more

almost

in

good

of

are

usually

and

irrigation.

and
like
the

cells

might

electricity

circuit

pharmacy,

with

using

and
also

surgery.

conductive.

from

cells

be

continuous

TUR's

watts

390

electrical

conventional

such

urethra

are

relatively

pure

patient's

on

replaced

distilled

result

precipitate

like

the

Even

only

when they

with

of

power.

square

high

a

high

are

insufflated

Glycine

body

in

kidney

normal

generator

tap

So if

distilled

frequently

irrigation

tap

water

For

centimeters

contact

patient

power

power

solutions

poor

water

by

congestive

saline

and

water

glycine

water

are cut.

technigues,

conductive

complete

with

plates.

is

not

procedure

conductors

were

osmosis.

failure.

solution

there

in

many

irrigating

should

to

keep

(60

the

patient's

worth

with
are

glycine

used

used,

This

In

heart

would

places

Consequently,

it

this

solutions,

safety,

square

We

believe

the

requiring

because

of

electricity.

large

could

a

susceptible

failure.

were

be

convenience

used,

not

be

has

solutions

used.

from

is

600

inches)

skin.

becoming

watts

that

150

solution

they

amounts

cause

the
enough
enough

are

Note

the

never

if

the

This

the

a

of
of

of

One

problem

the

complaint

COAG

could

crest
We
state

The
frequency
and

Typical

1/2.

and

hemostasis

the
resection
wire
require
cutting.

waveform.

believe

SSE3B

nerve

many

effect

loop

which

have been

factor,

that

always

As

cuts

is
currents
stimulation

settings

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urologists

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of

loop wire

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[1]

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That

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10.0,
the

also

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SSE3B's

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prefer

factor)

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early solid state

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TUR are

Section

#1.

Valleylab

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the

to

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the

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the

of

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patient.

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insulated
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currents

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measures

sensitive

found
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active
impregnated

conductor.

or

patient,

be

checked

the

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of

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the all

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ground

to

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try

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urethra.

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currents

endoscope

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eyepieces

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penis.

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by

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sufficient

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conduct

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to

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petroleum

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well

up

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mineral

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hands,

eye.

when

between

on

rest

this

a

shaft

The

Return

not

prevent

but

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wet

the

of

reason,

oil

the

pile

conductive

could

mode.

if

this

thin

and

the

hands

the

are

up

46

CURRENT

ON A METAL

RESECTOSCOPE

DIVISION

SHAFT

Current
plus

RF

from

scope.

|

Division

leakage

LEAKAGE

RESECTOSCOPE

«drawing

G.

FLACHENECKER

F.

FASTENMEIER

AN

INSULATED

after

CURRENT

&

WITH

SHAFT

/

Patient

AL

47

Current

In

the

a

pathway

and

the
shaft
from

the

shaft

authors
as

the

film

all

patient

are

the

recommend

urethra

of

lubricant.

metal

for a percentage

much

coupling

and

design,

plate.

higher

the

so

between

outer

that

that

[3]

the

metal

of

Consequently,

during

the

metal

the

lubricating

the

current

the

normal

active

shell.

shaft

current

the

operation

electrode

will

during

traveling

Because

jelly

not

normal

current

than

cutting

of

have

concentrate

about

operation
between
densities

would

this

the

be

loop

current

the

at

thin

can

resection

along

expected

conductor

density,

same

conductivity

places

serve

the

loop

metal
solely
inside

some

in

the

as

Suppose

comes
generator
stand
before

No

resectoscope
resectoscopes.
inspected

LectroCord

with

the

in

this’

harm

existing

each

contact

resection

output

for

occurs.

resectoscope
without

regularly

is

a

use

and

with

will

several

potential

To

summarize,

sterile,

thus

loop

the all

be

on

seconds

for

insure

breaks

metal

the

design

electrical

any

signs

disposable

the

with

resectoscope.

urethra.

and

the

is

perfect

the

resectoscope

of

electrical

the

metal

Fortunately,

surgeon

and

problems

deterioration.

resectoscope

integrity

design
If

can

there

until

and

cord

this

the

shut

active

which

of

and

occurs,

urethra

off

probably

there

The

the

active

the

broken

the

can

the

won't

are

metal

cable

Valleylab

can

be

cord.

end

entire

probably

generator

be

free

must

E0503

replaced

a

be

REFERENCES

1.

2.

3.

Glenn,
Harper

Goodman,
Urology.

Flachenecker,
Prostataresektion

Sicht.

J.F.

and

G.R.:

116:218-220,

Urologe

(Editor);

Row,

Goddard,

Hagerstown,

Electrosurgery

1976.

Go;

mit

A.

15:167=172,

D.W.;

Maryland,

Burns

Fastenmeier,
Hochfrequenzstromen

1976.

48

Thompson,

2nd

and

Edition

the

K.:

I.M.:

pp.

Urologist.

Die

aus

Urologic

456-527,

Transurethrale

Elektrotechnischer

Surgery,

1975.

Journal

of

=.

NEUROSURGERY

Hemostasis

Hemostasis

fulguration

desiccation.

plaque

water
away

this,

When
does

desiccation

the

be

tissue.
requires
the

sticking

The

Neurosurgery
intracranial
generally
bleeding

monopolar

would

of

is

from

only

neural tissue

not

forceps

kept

scrupulously

bleeding

Use

of

be

in

Neural

in

neural

does

If

coagulum

driven

the

normal

desiccation

shrink

is

are

Irrigation

contact

site

by

keeping

Monopolar

can

and

done

in

the

set-up

ideal

for

Tissue

tissue

not

one

attempts

is

off

and

is

enough

that

the

withdrawn.

clean

can

with

will

the

Accessories

be

extra-cranial.

monopolar

scalp

such

this

is

work

formed.

the

plaque

tissue

should

desiccated,

to

coagulum

To

so

also

moist

insure

electrode

divided

as

application.

tissue

and

incision

a

LectroSwitch

an

well

to

While

at

the

be

used.*

provoke

prevent

that

prevent

a

in

into.

primarily

unusual

and

fulgurate

the

shrinks.

margin

the

new

may

stick

only

in

order
uniform
cool.

Neurosurgery

two

For

or

other

problem

the

plaque

coagulum

this,

bright,

tissue

extra-cranial

(E2502B)

best

neural

is

As

the

and

cause

bleeding.

to

the

the

polished
sticking.

to

desiccation

separate

for

the

superficial

because

mode

tissue,

forming,

plaque

remains

forceps

electrode

pass

purpose

and

new

The

metal

the

and

sets

work,

locations.

a

CoHesive

unlike

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coagulation

a

hard,

virtually

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bleeding.

relatively

only
and

pull

(or

contacts

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current,

will

of

of

prevent

the

stopping

most

problem

forceps)

requirements;

tissues,

superficial

all the

it

may

To

avoid

soft

away

fresh

desiccation

irrigating

tissue

surgery

minor

А

simple

pad

(E7505)

is

pull

and
with
when

must

is

A

few

neurosurgeons

use

fine-tipped,

LectroHesive

purpose.

If

desiccation

very low

up

the

spark

can
waveform

CUT

*

and

be

waveform

Petty,

Australia,

and

power

cut

avoided

for

(E7503)

is

the

to

or

most

desiccation.

will

Peter;

1974.

prefer

monopolar

with

performed

desiccation

make

the

fulgurate,

easily

have

the

Unpublished

monopolar

forceps

the

Lectrode

with

will

desiccation

depending

when

This

least peak

is

study,

intracranially

or a pencil

needle

the

monopolar

proceed

proceed

on

using

the

because

voltage.

Prince

slowly.

faster

the

monopolar
for

as

with

(E1552)

output,

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waveform

a

given

Henry's

well.

a

needle

can

is

because

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output

level

Hospital,

the

not

Typically,
electrode.

be

used

setting

possible

it

will

used.

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using

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for

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begin

Sparking

current,

Melbourne,

to

the

they

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be

turn

to

CUT

the

49

To

use

CUT

at

generator

light

Key

the

the

CUT

knob

skirt

the

the

until

generator
light

monopolar

lowest

has

been

significant

just

marking

output

practical

activated,

voltage

in

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comes

or

about

for

setting.

and
on.

5

desiccation

is

useful

is

present

slowly

This

watts

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increase

usually

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with a fine

CUT

light,

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this purpose

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the

occurs

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power

needle

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output.

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setting

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calibration.

indicates

because

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of

forceps,

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zero
"1"

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on

use
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The use

monopolar

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difficult

Neurosurgical

If

neurosurgical

FAULT

is

connected
closer
current

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surgery

isolate

Desiccating

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SSE3B

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will

CUT

the
will

circuit

to

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it

than

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desiccate

or

FULGURATE).

current

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of

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output

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achieve

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the

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flow

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head

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E0015

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head

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to

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frames

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rapidly

Because

flow

as

possible.

self

sparking.

and

surgery

through

move

ground.

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is

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defeating.
output

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than

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head

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MONOPOLAR

Each
personnel

the
The
together

the

accessory

(£2400),

drapes

cases

not

recommend

FAULT

electrode

isolated

bipolar

probably

into

AND

or

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may

must

when

circuit

as

if

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equipment.

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output

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used

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event

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be

large

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disable

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was

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be

carefully

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the

interpret

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and

forceps

designed,

output

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one

is

substitute

enough

are

placed

monopolar

generator.

the

tissue

were

the

same

at

the

ACTIVE

guarded

recommend

not

available,

so

into

the

it

that

50

output

forceps

destruction

being.

was

case.

same

("HOT")

to

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holster

the

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addition,

used.

assumed

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time,

AT

prevent

use

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forceps

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as

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accidental

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syringe

autoclaved

tips

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radiate

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monopolar

mind

TIME.

Valleylab

are

forceps.

monopolar

accessory

that

contact

cases

repeatedly.

not

patient

away

BOTH

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taped

shorted

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output

from

output

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———

with

to

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typical
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be
bipolar
of-

having

recommended

setting

output.

necessary

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to

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widest

with

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correct

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readjust

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all

power

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use

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setting

way,

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range

output

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monopolar

3.
for

if

COAG

generator.

waveforms

and

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was

fine

were

just

is

because

planned

bipolar

used

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the

they

pencil

neuro-forceps

for

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linear.

do

for

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so

that

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also

CUT

not

change

be

has

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used

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BLENDS

linearly

3

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bleeders

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with

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advantage

are

as

be

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When
affects
increase
settings
required

PATIENTS

It

The
pacemaker
pacemakers

interference.

ventricular

several
use.
but
This

the

during

There

myocardium

the
electrosurgery

connection

Substitute
the

will

to
triggered

the

bipolar

the

the

to

WITH

is

frequently

radio

years

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they

means

interference

the

is

one

myocardium

RETURN

be

current

ground

speed

quantity

used

frequency

and

are

if

with

desiccate

PACEMAKERS

is

were

tachycardia

since

pacemakers

designed

that

few

seconds

report

at

the

was

plate.

FAULT

through

this

output

at

necessary

current

therefore

prone

This

such

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patient

continues.

in

tip

burned,

unit

broken

This

circuit

division

the

current

is

being

which

of

tissue

bipolar forceps

with

the

to

can

a

to

increase

could

and

pacemakers

are

still

to

be

will

the

electrosurgery

the

literature

of

an

but

was

a

so

that

situation

will

at

such

catheter.

flow

used,

the

which

monopolar

use

interfere

threat

result

fibrillation.

inhibited

return

That

external

the

simple

the

should

detect

a

becomes

increasing

desiccation

is

desiccated.

are

not

output.

electrosurgery

with

to

the

their

were

subject

is,

heart

RF

grounded

Again,

firing

in

rapid

built

rather

to

the

is

of

electrosurgery

pacemaker

grounded

grounded

be

the

excessive.

to

his

fibrillated.

broken

catheter,

the

the

occurs.

nearly

on

the

electronic

patient.

rate when

pacing

As

far

and

interference

than

heart

pacemaker

activated.

catheter.

type

pacemaker

impossible

patient

RETURN

power

patients

as

there

to

block

will

and

so

FAULT

It

For

as

critical

The

subjected
which
we

know,

should

from

produce

rate

[1]

causing

In

the

with

connection.

some

setting

does

this

with

circuitry

early,

might

be

electrosurgery

rapid

for

be

inhibited

a

[2]

catheter

this

patient

the

curent

circuit

Not

SSE3B

primarily

not

greatly

reason,

as

pacemakers.

in

fixed

to

lead

it

has

no

more

firing.

as

long

burn

to

only

case,

became

because

will

will

the

those

the

rate

radio

to

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in

as

only

the
was
the

plate

a

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flow

be

To

avoid

not

pass

bipolar

patient

and

the

far

removed

interference

through

instruments

plate

current

should

from

the

path

the

with

vicinity

as

much

be

located

between

heart

the

as

pacemaker,

of

the

as

possible.

as

the

surgery

possible.

heart.

close

51

the

as
and

[3,4,5]

electrosurgical

The

best
When
possible

the

this

patient

way

to

to

isn't

the

plate

current

do

this

practical,

site

is

of

should

should
to

use
the

surgery

be

as

Checklist

For

Operating

On

Patients

With

Pacemakers

1)

2)

3)

4)

5)

Before
and

metal-to-metal

Use

If
close
current
pass

ALWAYS

ALWAYS

with

starting

patient

bipolar

monopolar

as

path

through

MONITOR

KEEP

pacemakers.

plate

sparking

instruments,

instruments

possible

from

the

PACEMAKER

A

DEFIBRILLATOR

surgery,

cable

to

the

vicinity

double

to

in

the

if

must

the

site

of

PATIENTS

check

be

sure

connectors.

possible.

be

site

of

surgery

the

READY

of

heart.

there

used,

surgery

during

during

all

connections

will

place

and

to

the

surgery.

electrosurgery

be

no

the

make

patient

on

intermittent

patient

sure

plate

on

the

plate

that

does

patients

active

or

as

the

not

REFERENCES

i.

ON

ELECTROSURGERY

Wajszczuk,

Pacemaker

280:34-35,

Geddes,

Electrocautery.

Fein,
Cardiac

Fein,

Internal

Titel,

Electrodes

29:845-846,

L.A.;

R.:

Pacemakers.

R.L.:

Cardiac

J.H.;

W.J.;
by
1969,

Transurethral

and

1968.

Mowry,

Transurethral

etal:

Med

Transurethral

Pacemaker.

El

Etr,

WITH

Electrocautery

PACEMAKER

F.;

Instrum

JAMA

A.A.:

New

Electrocautery

202:7-9,

Resection

PATIENTS

Dugan,

Electrocautery.

Electrical

9:112-113,

J.

Fibrillation

of

N.L.:

1967.

of

Urology

During

1975.

Procedures

the

97:137-139,

Resulting

Surgery.

Deactivation

New

Hazard

Prostrate

of

England

Associated

in

Patients

with

An

1967.

from

Anesthesiology

a

Demand

J.

Med.

with

with

In

Situ

Pacemaker

一

一

52

GENERAL

ELECTROSURGERY

Simultaneous

The

SSE3B
jack
switching
conceivably
desirable

Whenever
clearly
GENERATOR
left

However,

is

use.

What

electrodes
remarkably

fulgurating

almost

if

electrode

power

sparking

The

continuous

There

electrode

then

750,000

each

voltage
the

occur.
and
will

tissue

sparking
electrode
in

and

unguarded.

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one

at

reason

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goes

second.

sparking

it

jump

is

electrosurgical

Use

is

equipped

the

three

accessories.

be

plugged

during

more

understood

50cc

independent

electrode

first,

cycles

developed

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can

than

IS

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to

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the

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only

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operation,

of

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holes

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suggest

cases

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to

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generator

procedures.

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process

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being

ALL

ELECTRODES

is

imperative

Valleylab

as

is

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power

from

the two

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two

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setting

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are

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the

LectroSwitch

two

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mentioned

at

the

electrosurgical

electrodes

no

noticable

if

in

power

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1.5

depends

many

voltage

the

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distance

operate

the

voltage

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million

tissue.

of

be

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"unused

terminals;

active

at

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to

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of

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cycle.

on

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one

and

accessories

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electrodes

(£2400)

page

drop

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to

electrodes

sparks"

50.

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53

Desiccation

at

one

resistance.

if

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to

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Valleylab's
monopolar
handswitching

when

electrodes
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or
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RETURN
electrodes

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CUT

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sparking

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ground.

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capacitance

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surgeons

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accessories.

forceps

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single

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system

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at 6 or

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adapter

dual

any

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up

to

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above.

immediately

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and

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adapter

switch

be

its

holster

dual

to

electrode

ground.

produce

usually

settings

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careful

allows

on

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adapter,

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RETURN

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pf

twice

and

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simultaneous

adapter

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after

of

with

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touch

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current

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meter

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flows

activated.

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plate

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ALL

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frequent
voltage

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plates

cause

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to
of
be

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patient's

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periods,

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current

harm

plates

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of

may

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removing

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moment

the

if

occurs,

provided

body.

site

the

Two

Generators

be

desirable

example,

the

the two

other

one

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touching.

flow

that

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avoid

of

buttocks

in a coronary

saphenous

to

moment,

acquires

or

both
will

from

it

problems,

surgery

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and

to

use two

generators

when

an

of

the

be

a

one

produces

and

example,

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54

bypass

vein

while

are not

one

patient

opposite

generators

large

plate

no

sparks

place

make

sure

in a coronary

under

generators

procedure

the

negative

potential

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the

each

plate

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synchronized,

plate

has

an

difference

other,

high

shoulders.

current

as

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bypass

it

is

desirable

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has a high

voltage.

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is

isolated

close

no

one

performs

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current

densities

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possibility

on

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output.

possible

plate

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to

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are

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electrodes

to

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observed.

are

bipolar,

there

are

no

special

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discussed
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not

practical
with
the

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outputs

plugging

can

connectors.
monopolar
desiccation.

setting

"hot"

holster

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Occasionally
refuse
generators
circuit

the

leakage

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when

use

one

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at

(E2400)

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in

the

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of

above,

if

to

operate

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be

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bipolar

applications

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believe

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we

supply

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used with

time

while

receive

long

to

the

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separate

two

monopolar

bipolar

interference

outputs

other

work

which

the

cables

increased

the

there

both

outputs

are

and

without
output
will

that

with

other

requests

SSE3B.

and

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is

no

generators

monopolar

are

and

output

in

supplying

bipolar

changing

is

correspond

the

both

means

is

being

for

because

leakage

problem

are

used

and

sufficiently

bipolar

only

electrosurgical

current

instruments simultaneously,

the

designed

to

surgeon

outputs.

that

each

used.

extra

they

current

using
for

bipolar

circuit

desiccates

to

generator

so

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typical
will
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electrode

long

compromise

be

active

and

each

electrically

paths

tissue

typical

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monopolar

tool.

electrodes

is

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can not

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simultaneously.

controls

power

settings

able

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cables.

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safety

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find

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guarded

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or
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for

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RETURN

bipolar

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probably

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fulgurate,

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the

surgeon

accessory

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for

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a

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patient

SurgiStat
obtain
neurosurgical
also
sparking,
desiccation
scrupulously
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to

stop
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use

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plugged

are

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the

return

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the

so

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SSE3B

electrode

models

forceps,

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dry
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far

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are

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for

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promptly

output

the

the

radio

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is

as

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sparking

monopolar

and

the

monopolar

are

his

begins.

and end

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a

left

frequency

Instruments

isolated

the

isolated

with

laparoscopy

output,

electrosurgical

needed

will

or

happen

foot off

patient

right

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from

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monopolar

the

regular

output,

to

prevent

the

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in

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output

setup

forceps.

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footswitch)

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of

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jacks,

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allow

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low

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surgeon

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with

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can
for

and

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tissue

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or

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to

if

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55

E7503

Patient
Electrode

Prep

II

Return

.

E2504

with

Electrode

LectroChuck

E0502-1

or

Lectro
£1552

Disposable

Adapter

Needle

Electrode.

Chuckhandle

and

£1551

Blade

THE

SSE3B

BIPOLAR

OUTPUT

WIRED

56

FOR

MONOPOLAR

OPERATION.

SECTION

3

DESCRIPTION

CONTROLS

OF

AND

GENERATOR

DESIGN

FRONT

VIEW

57

FRONT

VIEW

POWER

Rock
on.

internal

COAG

This

the
level
300 ohm

(See

CUT

This
generator
average
resistive

COAG

This dial
graduated

ON/OFF

switch

The

POWER

digital

generator

of

note

POWER

digital

LEVEL

SWITCH

to
combination
failure

READOUT

LED

is

average

resistive

1.)

READOUT

LED

is

switched

monopolar

load

when

CONTROL

rotates

from

0

turn

or

display

switched

monopolar

display

power

to

AND

SSE3B

power

momentary

load

"ON".

the

to

select

10.

CIRCUIT

on.

swith

overload.

is

visible
to
power

when

is

visible

The

in

watts

generator

coagulation

BREAKER

Power

"ON".

the

switch

and

circuit

in

generator

above

number

which

is

keyed

Rock

above

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watts

illuminates

breaker

switch

the

number

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CUT

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current

in

be

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to

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level

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intensity.

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reset.

level

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in

control

mode.

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off

in

control

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delivered
the

COAG

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to

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(See

The

SSE3B

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to

mode.

level

300 ohm

note

dial

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of

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the

of

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CUT

©

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CUT

The

minimum

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buttons

"CUT"

RETURN

Indicator
plate
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must

6

on.

of

LEVEL

dial

MODE

four

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FAULT

plate

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Service

CONTROL

rotates

from

SELECTOR

push

hemostasis

have

After

reset

buttons

BLEND

completely

been

result

INDICATOR

illuminates

connection.

correcting
by

Manual

0

to

BUTTONS

current

pressed,

in

pushing

to

select

10.

select

or

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intensity

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if

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The

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for

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1,

BLEND

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SSE3B

SSE3B

patient

RETURN

cutting

type

2

of

explanation.

#1

or

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is

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current

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3

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level

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disabled

indicator

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current,

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selected,

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as

long

the

RETURN

button.

The

either

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the

If

none

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FAULT

See

dial

PURE

CUT

of

and

keying

patient

indicator

circuit
Section

for
while
level

the

is

一

-一

一

一

^

58

Note

l:

If

either

power

blank.

supply

a

return

disabled,

fault

the

.

condition

digital

exists

display

or

of

the

power

high

output

voltage

will

MONOPOLAR

These

strip

two-prong

may

MONOPOLAR

This
which
or

PATIENT

This

of

Monitor

L.E.D.

BIPOLAR

These

output

power

standard

allow

hand-switching

three

accept

be

keyed

is a rectangular

will

adapter

RECEPTACLE

rectangular

dual-pad

system

within

RECEPTACLES

four

which

is

accessed

keying

SWITCHING

position-coded

the

three-prong

plug

ACTIVE

banana

of a switching

via

these

RECEPTACLE

accept

plugs

(REM)

position=-coded

is

of

most

for

receptacle

and

is

the

receptacle

electrically

plug

generator

bipolar

ACTIVE

receptacles.

receptacle

standard

accessories

single-pad

activated

via

the

connectors.

accessories.

RECEPTACLES

receptacles

plug

forceps

active

which

accepts

by

housing

receptacles

separate

horizontally

power

via

of

located

the

return

the

flashes

The

the

located

Valleylab

cord.

on

accessories

do

not

twin-lead

electrodes.

center

provide

from

aligned

vertically

four~prong

CUT

the

fit

pin

in

the

on

the

LectroSwitch

mode

white

of

directly.

plugs

The

оп

dual-pad

the

event

an

isolated

monopolar

receptacles

aligned

connector

white

or

plastic

other

used

Return

outputs.

plastic

Pencil

COAG

of a REM

mode

manufacturers

on

plugs.

bipolar

which

receptacles

of

Jack-

or

power

jackstrip

the

cords

Electrode

alert.

power
Output
accept

Valleylab

the

An

COAG

when
available
illuminated
indicator

may

CUT

The

when
available
illuminated

indicator

may

The

backlighted

indicate

POWER

backlighted

indicate

POWER

the

the

INDICATOR

generator

at

the

at

the

upon

INDICATOR

generator

upon

a

at

at

a

keying

generator

the

keying

generator

word

word

the

“COAG"
is
output

zero

of

"CUT"

is

output

zero

of

will

keyed

level

malfunction.

in

connectors.

the

COAG

will

keyed

malfunction.

in

connectors.

setting.

the

CUT

be

the

setting.

mode

be

the

mode

59

visible

COAG

Absence

at

visible

CUT

Absence

at

above

mode

This

level

above

Mode

This

level

the

and

indicator

of

illumination

settings

the

and

indicator.

of

illumination

settings

COAG

usable

CUT

usable

power

RF

will

greater

power

RF

will

greater

readout

power

not
of

than

readout

power

not

of

than

is
be

this

1

is
be

this

1

REAR

VIEW

AUDIO

This

FOOTSWITCH

This

footswitch

POWER

The

of

Properly

power.

explosion=proof

cords,
should

Valleylab

EKG

This

cardioscope
monitoring
whenever
Manual

VOLUME

dial

low

the

BLANKING

banana

controls

four

CORD

leakage

unit.

grounded

The

three-prong

NOT

representative

the

for a complete

CONTROL

CONNECTION

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demonstration.

than

small

out

purpose

the

patient

touching

conventional

demonstration

and

hospital

provided

is

remove

infinite,

but

painful

with

at

from

from

the

that

of

active

the

less

the

of

the

both

the

a

LT

^,

za

80

The

purpose
points
problem

electrode.
and

the

very
generator
flow

large

is

are

in

the

patient

is

limited

is

to

touching

patient

If

the

is

currents

well

to a low

prevent

the

circuit

SSE2

isolated.

patient

coupled

can

level

desiccation

patient's

by

to

flow

from

With

which

skin,

not

electrode

ground,

the

the

is a function

burns

allowing

is

(as

active

RETURN

where

The

isolated

electrosurgery

contacting

he

almost

to

FAULT

of

small,

invariably

ground

system,

the

grounded

system

the

even

power

signals

at

the

patient's

is)

though

ground

settings.

contact

a

active

body
then

the

current

TROUBLE

If

the

in

the

Look

1)

likely
electrode.
stick-on

If

2)

firmly

border
out

replace

electrode.

Look

3)

a)

b)

SHOOTING

RETURN
patient

for

at

patient

a

stick-on

applied

is

gel

pad

the

for

excessive

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more

RETURN

If

the

the

SSE3B
interpreted
surgeon.
coil

In

short,

possible.

A

RETURN

FAULT

circuit,

intermittent

in

FAULT

of

the

This

patient

to

good

may

stick-on

than

active

handle,

If

wire

keep

light

junction

electrodes

have

will

by

it

FAULT

check

is

especially

electrode

the

contact

eléctrode.

coupling

two

trigger.

cable

the

is

with

the

INDICATION

trips

connections

skin

been

active

RETURN

necessary

a

during

the

between

now

and

with skin.

applied

between

is

wrapped

this

extra

rubber

active

surgery

following

on

the

troublesome

on

the

is

used,

not

to

Never

the

electrodes

around

capacitive

FAULT

to

band

cable

circuit

coil

items:

the

patient

market.

"tented"

It

is

the

try

active

are

up

and

allow

as

and

there

patient

with

check

to

a

to

so

also

skin,

re-apply

electrode

plugged

grounded

coupling

as a threat

extra

the

far

from

is

no

cable.

cable

some

see

that

conceivable

If

active

coil

and

of

that

only

this

an

and

into

metal

to

to

cable,

to

grounded

obvious

This

the

the

all

the
that

is

adhesive

ground.

the

object

ground

the

hang

failure

is

patient

disposable

of

it

adhesive

a

dried

suspected,

patient

SSE3B,

such

will

patient

secure

in

space.

objects

most

is

the

as
be
or

the

as

с)

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the

active

the

scope

resectoscope.

hands

the
The

~
一

一
一
一

а)

repaired.

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light

not

inserted

and

RETURN

solution,

the

active

source,

allow

in

could

body.

FAULT

the

the

accessory

divert

This

This

circuit

of

course,

accessory

it

is

generator

patient.

is a resectoscope,

active

current

current

is a colonoscope

quite

to

is

is

likely

be

may

has

not

to

activated

81

current

go

been

just

have

that

to

the

then

into

ground

known
for

protection

resectosocope

which

the

RETURN

until

to

a

the

through

burn

is

the

short

metal

grounded

colonoscope

the

of

FAULT

circuit

frame

the

urologist,

inspected

surgeon's

the

patient.

through

circuit

has

inside

of

will
been

the

so

and

the

4)

b)

After

the

colonoscope

the

RETURN

"S-Cord"

Look

for

tripping

a)

Check

with
patient
electrode
back

ground

the

A

NEUROSURGICAL

the

is
electrode.
headframe
cable

insertion

FAULT

discussed

current

the

for

the

or

as

patient

common

patient

to

modify

and

into

and

circuit

in

division

RETURN

current

patient

electrode.

were

shoulder,

the

electrode

example

HEAD

electrode

the

If

can

be

clamp.

the

the

patient's

will

Section

as

FAULT

on

patient

necessary,

circuit.

division

at

For

the

the

of

FRAMES.

headframe

wired

colon,

allow

2

another

points

example,

upper

ECG

electrode.

closer

current

closer

directly

is

by

pad

In

so

and

there

body

the

the

source

looking

closer

arm

could

to

the

division

this

to

the

that

if

to

is

usually

to

lower

operation

only

and

solution.

to

if

during

a

be

This

site

case

surgery.

it is

everyone

the

the

of

ground

for

grounded

the

grounded

carrying

could

of

occurs

it

understands

patient

enough

ground

to

proceed.

currents

site

a

laparotomy

be

surgery.

in

is

not

The

not

serving

electrode

coupling

currents

objects

of

surgery

ECG

pad

as

much

corrected

the use

practical

only

the

between

so

that

If

not,

which

the

were

of

good

as

by a shunting

may

in

contact

than

patient

on

current

by

moving

grounded

to

solution

a

patient

risks,

the

the

move

the

the

be

to

5)

If

the

should

ELIMINATING

Another

grounded
pads
as

a

can

good
electrodes,

All
possible.

well
few

ohms

Rectal

but

in
convert

frequency

the

can

the

few

be

patient

isolated

hundred

is

should

series

range

Ferris

seconds

agreement

cause

be

checked

THE

approach

points
be

used

Red-Dot

without

tolerated

should

monitoring

Unfortunately

only

ohms.

better

or

the

of

than

esophageal

be

encapsulated

with

leads

characteristics

22

of

SMALL,

to

which

to

for

with

the

to

the

out

GROUNDED

the

problem

are

disperse

with

causing

about

our

never

at

60

[7]

zero

thermometers

ECG,

to

a

100

mH.

RETURN

by

findings.

be

equipment

most

Hz.

As

ohms,

plethysmograph

high

FAULT

the

the

focus

the

an

area

a

10

seconds

used.

"isolated"

At

Finlay,

in

plastic.

impedance

unaltered.

[4]

procedure

CONTACT

of

patient

of

current.

of

burn.

Very

should

RF

and

[4]

should

triggering

outlined

POINTS

burns

the

problem.

A

.3

cm2

Becker,

before

small

be

ECG

frequencies

others,

not

It

is

and

telethermometer

at

RF

Finlay,

cannot

in

is

good,

can

disperse

et

a

burn

electrodes,

isolated

instruments

the

point

have

also

frequencies

et

practical

al,

the

to

eliminate

Large,

gelled

al,

occurs.

impedence
out,

bare,

recommend

be

found,

Service

ECG

100

state

from

presently

even

grounded

but

the

Manual.

all

well

electrode,

ma

for

that

[3]

especially

ground

may

a

few

to

put

leads.

leave

RF

the

gelled

at

100

This

whenever

sold

be

hundred

metal

RF

This
their

chokes

circuit

small

ECG

such

least

ma/cm2

is

needle

are

only

tips

chokes

will

low

in

a

in

pe

62

Hall,

is

clear
current
affect
before

et

al,

that

and

prevent

the

performance

attempting

say

any

that

extra

these

3.3

impedance

burns.

of

modifications.

mH

Finlay

an

inductance

in

ECG

and

the

warns

the

is

adequate

grounded
that

ECG

to

leads

using

manufacturer

inductors

prevent

will

help

in

should

burns.

decrease

the

be

[9]

leads
contacted

may

It

the

Although

doesn't

patient
A

small,

and

the

will

SUMMARY

There
Balanced

with
current
eliminated.

of

procedures.

Isolated
completely

plate cannot

virtues

generator,

through

conventional
which

leaving

Rather
amount,
returning

use

of
power
points.

current

hurt

electrode

grounded

patient

if

located

is

Output:

a

well

doesn't

electrosurgical

of

small,

can

travel

via

than

the

through

large

settings

to

electrode

distal

no

perfect

comes

isolated

Unfortunately,

isolated.

be

isolated

there

is a possibility

grounded

grounded

to

the

simply

Balanced

ECG

will

division
take
should

skin

pass

truly

active

ground.

electrodes,

precautions

contact

to

solution

closer

generator

through

Grounded

grounded.

and

generator,

ground

limiting

Output

prevent

is

limited

be

as

close

point
will
the

generators

contact

lead than

take a larger

main

to

than

the

bipolar

generators

grounded

the

by

current

the

is

Regardless

proper

patient

to

current

patient

any

are

patient

instruments

are

the

systems.

of

current

points

Balanced

is

ground

sensitive

patient

by

prevent

to

the

which

path.

other

the

best

not

are

SSE3B

on

division

returning

path

of

what

burns

the

Balanced

its

site

is

percentage

electrode

system.

perfect

electrode

of

the

located

existing

and

not

system

division

the

Output system limits

current

to

the

at

are

With

by

sensing

generator

small

the

only

because

perfect

attempts

a

patient's

via

the

Output

occurrence.

surgery

in

between

of

the

safety,

Bipolar

solution,

patient

usable

because

conventional

causing

when

the

patient

to

some

proportion

design

positioning,

grounded

circuit,

as

the

current

but

instruments

electrode

in a minority

they

can

to

combine

current

body.

more

arbitrary

skin

the

the

of

may

and

First,

possible.

surgery
than

the

SSE3B

since

never

patient

grounded

to

Unlike

current

current

electrode.

total

current
be,
minimum
contact

it

the

it

used

the

is

be

the

pass

a

is

the

The

best

the

most

electrode

properly

disturbed.

safety

primitive

cable

and

rechecked

system

is

checked

is

grounded

every

of

course

generator

religiously

time

the

a

well

can

and

patient

83

trained,

be

the

is

used

patient

moved

vigilant

safely

electrode
or

the

OR

if

the

is

patient

team.

patient

positioned

cable

Even

is

REFERENCES

Mitchell,
Limitations

Battig,

204:91-95,

Becker,

Frequency

Finlay,

Leeming,
Burns.

Wald,

With

Health

Finlay,
the

Hall,
Anesthesiology

C.G.:

C.M.;

B.;

JAMA

A.S.;

Electrocautery.

Devices:

B.;

Use

of

Se?

J.P.;

1968

Current

et

M.N.;

214:1681-1684,

Mazzio,

Couchie,

Miniature

Malhotra,

Lumb,

Brit

Electrosurgical

Malhotra,

al:

Cole,

Electrosurgery

42:641,

G.N.:

J.

Surgery

and

Burns.

Electrosurgery

R.

V.D.B.;

JAMA

D.;

ECG

1975.

The

i

I.V.;

Anesthesiology

Jr.;

Electrodes.

I;

Howland,

1970.

Spencer,

217:916-921,

Boyer,

Hedley-White

Principles

50:314-320,

Burn

Heley-White,

Injuries

burns.

2:183-226,

L.:

of

Surgical

1962,

and

J.:

38:106-122,

Anesthesiology

W.S.:

F.C.:

1971.

Electrosurgery

Anesthesiology

Low

Accidental

1973.

J.:

Their

The

Distribution

Voltage,

Burns

41:263-269,

Electrosurgery

Diathermy

Prevention.

1973,

42:641-644,

Direct-Current

Burns

Associated

Resulting

and

of

1974,

Burns.

Its

JAMA

Radio

1975.

From

84

SECTION

5

PATIENT

When

using

patient

body

safely

considerably
kept
not
not
having
ground

The

somewhat

watts

low
grounded
as

a
people
for

skin

of
admittedly
inconvenient

followed,

return

electrode,

current

a

factor

patient

patient

The

main

the

highest

lasts

though

for

it
desirable
improperly

RETURN

monopolar

electrode

and

larger

and

no

at

“ground

make

ECG's

contact

controversial.

generator

quite

size

one

need

is

applied.

of

two

electrode

regardless

factor

peak

a

second

is

rational

to

have

applied

ELECTRODE

serves

return

than

significant

low

plate".

the

or

other

area

power
conservative,
for

never

the

and

will

of

which

current

or

the

or

RECOMMENDATIONS

electrodes,

as

to

the

heating

frequencies,

By

assumption

purposes.

reguired

The

per

a

patient

worry

blood

It

high

flow

seems

currents

begin

how

well

is

the

which

two

at

to

expect

extra

safety

defective

a

means

the

active

not

old

square

to

be

to

behave

it

saving

can

the

these

in

a

patient

for

generator.

electrode

occurs.

we

refer

calling

that

for

(1970)

centimeter

but

it

electrode.

about

through

true

are

was

applied,

grace

be

obtained

beginning

currents

of a large

some

electrode

the

to

it a ground

the

patient

safe

patient

NFPA

is

the

conditions

the

tissue,

that

prolonged

like

of

if

an

small

way.

current

The

patient

so

that

Because

it

as

a

electrode

Manual

of

not

an

Moreover,

this

indefinitely,

active

blood

patient

at a given

of

a

cut

to

drop

patient

is

ALWAYS

to

the

the

"patient

plate,

electrode

76

skin

inordinate

if

of

or

the

guideline

electrode

flow,

or

to a safe

electrode

required.

leave

electrode

current

return

electrode"

we

is

CM

recommended

contact.

this

the

skin

length

is

eventually

or

other

electrodes

power

fulguration.

the

patient's

density

electrode

hope

a

convenient

operation

or

guideline

under

of

exceeded

and

burn

setting

level,

in

case

must

to

avoid

This

totally

time

factors.

is

that

only

Even

it
it

The

be

is
is

and

is

1.5

is

is

the

the

by

the

the

is

is

Valleylab

can

be

THE

E7001-1®

This

with

plug

on

is a permanent,

a

at

the

pulled

defects

fastens
contact
becomes

patient

cable.

makes

used

with

PERMANENT

screw-on

the

SSE3B

connector

generator

is

inadvertently.

and has

the

cable

with
free
plate

the

during

because

three

the

SSE3B.

stainless

recessed

two

to

the

patient

a

single

PATIENT

mounted

end

and

to

The

wire

conductors

patient

circuit

procedure,

it

has

section

They

PLATE

steel

plugs

provide

insulation

no

electrical

are:

at

for

plate

when

the

patient

plate

the

into

good

extra

has

the

metal

85

which

corner

the

strain

is

a

plate

sleeve

connection

return

connects

of

patient

relief

clear

security.

threaded

is

cannot

electrode

the

jack.

so

it

sleeve

secure.

plate.

in

may

The

serve

with

systems

to

the

patient

The

The

patient

case

be

inspected

connector

which

If the

as a substitute

the

wiring

cord

the

only

connector

which

has

cord

which

makes

in

cord

a

jack

is

for

the

The

E7001-1

that

patient

We

that

skin.

THE

The
application
covered
is
cable
square

(80

gravity

square

recommend

the

Conductive

E7501-1

E7501-1

the

E0501-1

to

hole

is

can

inches)

if

it

is

the use

skin

is

LECTROPLATER

LectroPlate

to

with

non-anodized

the

patient

at

designed

insure

applied

wet
gels

the

which

one

of

and

are

E7001

is

plate

end

to

an

surface

properly.

of

LectroGel®

that

discussed

is

discussed

aluminum

similar

of the

go

under

adequate

area

the

a

disposable

by

means

disposable

of

plate

above.

to

the

contact

which

or

in

more

foil.

the

of

buttocks,

some

is

in

patient

The

E0009

large

plate.

area.

at

other

good

detail

It

is

cable

but

plastic

least

at

plate,

made

has

thigh,

It

has

half

conductive

electrical

the

end

from

for

this

a

clamp

teeth

shoulder

over

can

contact

of

similar

cardboard

disposable

which

516

be

Paste

this

which

or

square

touching

to

section.

in

size

locks

go

through

anywhere

insure

with

which

plate

cm

the

the

and

is

the

a

Like

conductive

it
gel,
the

The

any
guideline

Sharp,

THE

For

where

LectroHesive

electrode
centimeters)
Sheet
surrounds
for

The

the

insufficient

LectroHesive

direction
lose

from

LectroHesive

connect

the

is

possible

this

possibility

LectroPlate

size

ragged

E7502-1

those

it is

of

all

routine

LectroHesive

patient's

much

the

the

permanent

gel

such

to

scheme

or
of

LECTROHESIVE®

procedures

with

foam

the

of

of

package,

semi-disposable

is

of

can

shape

1.5

watts

foil

not

practical

patient

an

of

contact

covered

gelled

procedures.

system

skin.

area

were

the

LectroHesive,

its

contact

and

placed

the

patient

as

LectroGel,

wrap

acceptable

thromboembolism

be

cut

desired.

per

edges

in

Return

effective

electrode.

relies
If

actually

connect

generator.

plate,

it

around

with

square

be

carefully

PATIENT

which

to

Electrode

area.

with

the

on

the

area with

cord

the

E5501.

a

electrically,

due

scissors

This

the

area

adhesive

touching

centimeter

RETURN

patient

place

of

The

The

on

its

pad

flank,

the gel

the

A

to

is

patient

LectroHesive

the

semi-disposable

the

E7501-1

leg

and

to

restriction

to

all

removed.

ELECTRODE

a

patient

is

at

least

so

adhesive

is

applied

the

and

pad

skin.

permanent

generator.

Because

tape

but

provide

right,

is

likely

the

electrode

that

patient.

later

may

is

the

the

of

skin

plate

solution.

20

the

is

to

hold

the

fold away

After

adapter

designed

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user

of

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torso

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(E0504-1)

place.

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Patient

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but

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reference

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m

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the

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ground

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88

SECTION

THE

SSE3B

AND

TWO-SECTION

6

PATIENT

ELECTRODE

ELECTRODES

AREA

MONITOR

SYSTEM

Valleylab

(REMTM)
catalog
sections
impedance

paths

fault
surface
occurs.
both

The

cm.

preparation

discussed
cord
The
of
clean

The

as

1.

for

monitor

audibly

REM

by

and

application

adipose

and

specific

follows:

Remove

the

electrode.

has

System.

number

of

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with

RF

area

Either

and

patient

9

cm.,

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in

connector

tissue.

free

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E7505,

plate

the

patient.

currents.

system

electrode

system

visually.

electrode

with

application

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preceding

to

site

of

installation

electrode

should

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monitor

REM

circuitry

and

the

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to

ensure

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is a pregelled

58.5

plug

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cm2

are
section.
into

be

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epidermis.

instructions

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employs

patient's
Both

REM

system

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surface

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measures

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right
to

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section

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currents.

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2.

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operation

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With

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b.

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cord

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in

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REM
conductivity

Gently

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the

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power

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body.

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insure

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electrical

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The

6.

Installation

7.

Use

caution

movement.

The

SSE3B

appropriate

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the
is
cable.

electrodes.

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resistance

on

resistance

updates
increase
and
connector
ohm

The

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capable

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the

disable

value

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surface

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Fig.

hysterisis

System

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only.

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in

7.

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Valleylab

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4.

5,

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Patient

Broken

Patient

Reduction

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Excessive

REM/CoHesivelM

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of