Electrosurgical unit (Diathermy)

50 hz
 Contents
• Introduction to electrosurgical unit
• Differences of electrocautery and ESU
• Modes of electro surgery and principles
• Components of ESU
• Safety and preventive maintenance ESU
• Troubleshooting
Introduction to electrosurgical unit

Activity 1.1: Individual reflection

Explain what is electrosurgical unit? Discuss function
and purpose of electrosurgical unit?

Time : 5 min.
 Purpose of ESU
• ESU is a simple method of making surgical cuts,
controlling bleeding and destroying unwanted tissue
cells by the use of a high frequency “electrosurgical
current”.
• An electrosurgical unit (ESU) passes high frequency
electric currents through biologic tissues to achieve
specific surgical effects such as cutting, coagulation,
or desiccation.
• Its benefits include the ability to make precise cuts
with limited blood loss by causing coagulation
(hemostasis) at the surgical site
 Conti…
• An ESU is an AC source that operated at a
radio frequency (RF) in the range between 300
kHzand3 MHz
• It depends on the heating effect of a high
frequency electrical current which flows
through the sharp edge of a wire loop or band
loop or a point of a needle into the tissue.
• It is a dedicated medical therapeutic equipment
used by surgical departmental doctors for the
purpose of cut, coagulate, desiccate, or
fulgurate tissue.
 Principle of Electro surgery in OR
• The electrosurgical generator is the source of
the electron flow and voltage.
• The circuit is composed of the generator,
active electrode, patient and patient return
electrode.
• The patient’s tissue provides the impedance,
producing heat as the electrons overcome the
impedance
 Conti…
• Standard electrical current alternates at a
frequency of 50 cycles per second (Hz).
• At 50 cycles, excessive neuromuscular
stimulation and perhaps electrocution would
result.
• Nerve and muscle stimulation stop at 100,000
cycles/second (100 kHz).
 Conti…
• Electro surgery performed safely at “radio”
frequencies above 100 kHz.

• At this frequency electrosurgical energy pass

through the patient with minimal
neuromuscular stimulation and no risk of
electrocution
 Effects of high current to the human body

• Electric currents directed through your heart can

trigger fibrillation, which is a type of fast
heartbeat which does not pump blood.
• Large electric currents can cause heating which
cooks tissue.
• The large abnormal electric current cause nerves
to fire, which causes muscles to contract.
• Suddenly‐tensed muscles can throw the body
across a room hard enough to break bones or
cause concussions.
Why HF current not giving shock?
• Very high frequencies (like above 20khz), the
current will show tendency to flow the skin
surface . It will not show the tendency to flow
deep
• The High frequency , the nerves muscles will
not contract, instead they sit still.
• This doesn't fire nerves, so the no pain and
muscle contractions, Since its flowing on small
area of surface the heat energy will produce high
than normal current flow
Why HF current not giving shock?
 Activity 1.2: Group discussion
Explain what the difference between electrocautery and
electrosurgical unit?
Time: 5min

12
 Electrocautery Unit Vs Electrosurgical Unit
• Electrocautery refers to direct current (electrons
flowing in one direction) whereas electro surgery uses
alternating current.
• During electro cautery, current does not enter the
patient’s body. Only the heated wire comes in contact
with tissue.
• In electro surgery, the patient is included in the circuit
and current enters the patient’s body.
• A high amount of current is passed through the
electrode and burning or coagulate the tissue.
• Electrocautery is used in surgery to burn unwanted or
harmful tissue. Also used to stop hemorrhage.
Cont’d
 Mode of Electro surgery
• Two modes are used as desired by Doctors-
(i) Monopolar
(ii) Bipolar
 Activity 1.3: Group discussion
Explain what are modes of electrosurgical unit and its
principle ?
Time: 10min

16
 1.Monopolar Electro surgery

• RF current flows through ESU and Active

Electrode
• Returns to ESU through Return
Electrode(Dispersive electrode)
• Patient is main parts of the circuit
• Used for cut and coagulation
• Mono-polar technique: the current flows from
the generator to the active electrode through the
patient to the neutral electrode (return electrode)
from which it returns to the generator
Block diagram of monopolar ESU mode
 Conti…
• There are two types of Electrodes used In
Electro surgery.
1. Active Electrode
2.Dispersive Electrode (patient return/
neutral/indifferent/ passive electrode)
 Active electrode
• It is one that carry the HF current to the
surgical site. it has variety of shape and size
• It has higher current density than dispersive
electrode
 Dispersive Electrode(patient Return electrode)

• It has lower current density due to it bigger

surface area than active electrode
• The function of the patient return electrode is
to remove current from the patient safely.
• There are no intended thermal tissue effects at
the plate electrode, since the current is less
concentrated.
 Conti…
Current Concentration/Density
• The more concentrated the energy the greater
the thermodynamic effect
Conti…
 Conti…
• A return electrode burn occurs when the heat
produced, over time, is not safely dissipated by the
size or conductivity of the patient return electrode.
• BURN = (CURRENT x TIME)/AREA
• I can be Lead (Metal) plate wrapped in wet cloth
bag.
• Disposable Type Electrode.
• Area should be larger than active electrode about
more than 100cm²
• it can be single contact surface or double contact
surface type
Conti…
 Placement and area of affect of dispersive
electrode
• The patient becomes the part of electronic circuit
• As the current seeks for shortest and less resistive
path to ground, user should be aware that position of
patient return electrode should be as shorter as
possible.
• If a return electrode is placed far from the operating
task, the current has to travel a long distance,
resulting increase in the power setting.
• Accidentally, if any part of the patient body touches
to ground, a burn effect will occur at that site.
• Ideally the arms or muscular abdomen can be a
suitable site for placement of patient return electrode.
 Conti…
• Two points are of practical importance:
(i) Sufficiently large contact area.
(ii) High electrical conductivity between the
body and electrode.
Conti…
Operation mode of monopolar electro surgery
• Monopolar electro surgery has the means of
delivering energy to the tissue through several
modalities like pure cut, blended cut, desiccation
(pinpoint), and spray (fulguration)
 Cont’d
Cut
• The first clinical mode of a modern ESU is
cutting. The unit offers the surgeon two types
of cutting:
• pure cut and blended cut.
• In pure cut the current flow is continuous so
there no current flow interruption. The duty
cycle is 100% ON.
• electric current divides tissue without
coagulation.
• In a pure cut the heat energy is so great that
cells vaporize
 Conti…
Blended cut
• Adds some hemostatic effect (The blended cut
permits the surgeon to cut and coagulate at the
same time)
• The term “blended” does not refer to a blend
of currents, but rather a blend of surgical
effects.(cut and coag)
• By adjusting the blend the surgeon can get
varying degrees of homeostasis.
 Conti…
Blend can be different type:
• BLEND 1(pure blend): Duty cycle is 50% ON
and 50% OFF.it is cut with minimum
hemostasis.
• BLEEND 2: Duty cycle is 40% ON and 60%
OFF. It is cut with moderate hemostasis
• BLEND 3: Duty cycle is 25% ON and 75%
OFF. It is cut with maximum hemostasis.
 Conti…
Coagulation
• Clotting of blood by burning the ends of
vessels to control bleeding.
• The surrounding tissue is heated when the
waveform spikes and then cools down
(between spikes), producing coagulation of the
cells.
 Conti…
Desiccation(Coagulation)
• Electrosurgical desiccation occurs when the electrode is in
direct contact with the tissue.
• Desiccation is achieved most efficiently with the “cutting”
current.
• By touching the tissue with the electrode, the current
concentration is reduced. Less heat is generated and no cutting
action occurs.
• The cells dry out and form a coagulum rather than vaporize
and explode
• Coagulation By Needle Electrode or Ball Electrode can be
achieved
 Conti…
Fulguration (Spray)
• Fulguration is another type of coagulation.
• Fulguration can be defined as non-contact coagulation in
which current sparks or jumps from the active electrode to
the tissue
• Many surgeons use spray coagulation to destroy the surface
layers of cells in the bed from which a suspicious lesion has
been removed, to prevent possible migration of malignant
cells.
• In general during coagulation ball type electrode is preferred.
 2.Bipolar electro surgery
• Active output and patient return functions are both
accomplished at the site of surgery.
• Current path is confined to tissue grasped between
forceps tips.
• no patient return electrode is needed.
• It is much safer than Monopolar surgery
 Advantages of Bipolar

• It is much safer than Monopolar

• RF current flows only through well defined area,
while in monopolar current flows back through large
section of patient body
• Risk of patient touch is low
• Less Interference for other instruments
• No ‘patient plate’ or ‘Return electrode’ is required
• It has lower power setting
• Its possible for patient with artificial implant, which
forbidden in monopolar mode
 Power Settings

• The power settings for various procedures varies

from one user to another, as different surgical
techniques are used with different electrodes
Monopolar power setting
Low Power
• Oral surgery
• Dermatology
• Plastic surgery
• Neurosurgery
• Hand surgery
Medium power
• Orthopedic surgery
• Normal thoracic
• Head/neck/ENT surgery
 Conti…
High power
• Thoracotomies for heavy coagulation
Bipolar power setting
• MICRO‐BIPOLAR (up to 15 watts output)
Low Power
• Eye surgery
• Fine neurosurgery
Medium Power
• Neurosurgery
• Fine plastic surgery
High Power
• Hand surgery
• Plastic surgery
 Conti…
• MACRO‐BIPOLAR (up to 50 watts output)
Low Power
• Hand surgery
• Plastic surgery
Medium Power
• General surgery
High Power
• Orthopedic surgery
 Types of electro surgical system
1. grounded electrosurgical system
2. Isolated electrosurgical system
1.Grounded Electrosurgical Systems
 Conti…
• Originally, generators used grounded current from a wall
outlet.
• It was assumed that, once the current entered the patient’s
body, it would return to ground through the patient return
electrode.
• But electricity will always seek the path of least
resistance.
• When there are many conductive objects touching the
patient and leading to ground, the current will select as its
pathway to ground the most conductive object.
• which may not be the patient return electrode.
• Current concentration at this point may lead to an alternate
site burn.
 Conti…
Patients are exposed to risk of alternate site
burns:
(1) current follows the easiest, most conductive path;
(2) any grounded object, not just the generator, can
complete the circuit;
(3) the surgical environment offers many alternative
routes to ground;
(4) if the resistance of the alternate path is low
enough and the current flowing to ground in that path
is sufficiently concentrated, an unintended burn
may result at the alternate grounding site.
Cont’d
Isolated Electrosurgical Systems
 Conti…
• The isolated generator isolates the therapeutic current from
ground by referencing it within the generator circuitry.
• The circuit is completed not by the ground but by the
generator.
• Even though grounded objects remain in the operating room,
electrosurgical current from isolated generators will not
recognize grounded objects as pathways to complete the
circuit.
• Isolated electrosurgical energy recognizes the patient return
electrode as the preferred pathway back to the generator.
• By removing ground as a reference for the current, the
isolated generator eliminates the hazards inherent in
grounded systems, most importantly current division and
alternate site burns.
 Conti…
• If the circuit to the patient return electrode is broken,
an isolated generator will deactivate the system as
current cannot return to its source.
• with isolated circuits mitigate the hazard of alternate
site burns but do not protect the patient from return
electrode burns.
• The only difference between the “active” electrode and
the patient return electrode is their size and relative
conductivity.
• The quality of the conductivity and contact area at the
pad/patient interface must be maintained to prevent a
return electrode site injury.
 Components of ESU

Activity 1.4: Group discussion

Being in group of 4 and discuss major components of
electrosurgical unit and its function

Time: 10min

48
General Block Diagram of ESU

Electrosurgical machine
 Conti…
Power Supply
• The power supply generates the supply of
5VDC, 15VDC, 12 VDC, 24VDC etc.. which
is supplied to all units.
• It is basically like a low voltage power supply.
• The 5VDC are used for the front panel control
and Display.
• It also monitors the generated voltage for
diagnostic purpose to measure the current
drawn from power supply.
 Cont’d
Front Panel :
• It consists of membrane keyboard, Patient Return
Electrode, Monopolar, Bipolar connector, power
adjustment key in each setting.
• Front panel also interfaces with Display Board and
Power Supply Board.
• The Power Supply Switch supplies the AC mains
current to the Electrosurgical Unit.
Rear panel: consists of power switch, power setting
parameter, foot switch receptacle etc..
 Cont’d
Display Board : It is located in the Front Panel Assembly.
• It contains RF indicator lamp, Monopolar / Bipolar mode of
surgery.
• The RF indicator lamps are used for visual indication of presence
of RF power during activation.
• The improper attachment of Patient Return Electrode is visually
indicated by Patient Return LED.
• It also contains LED driver circuit, which indicates the Bipolar,
Monopolar, Cut, blend, forced coagulation, soft coagulation power
settings
Audio Tone Generator: Audio circuitry gets ON at time of activation
of high frequency, any malfunction or Fault of ESU, improper or
loose attachment of patient Return Electrode and Power up.
• It activates with signals provided by micro ‐controller and gives
high and low tone
 RF output and generator board
RF output Board : It has a power amplifier assembly,
which comprises with Bipolar, Monopolar, CUT/ COAG
and BLEND waveform.
• The output circuit is fully isolated. It generates the out put
as per front panel instruction given to Main Board and
Logic Control Board.
RF generator: It generates the Switch mode pulse pattern
generator, Drive circuit for output switching power
MOSFETS and High Frequency filtering components.
• In enhanced type generator, the output power is managed
and controlled according to patient’s tissue impedance
• Common RF generator currently was solid state
oscillator
 Cont’d
Memory Board :The function of this board is to accept
operating mode control signal from front panel, rear panel and
foot switch.
• It checks and identifies that which connector is in use and
monitors its continuity.
• Interfaced Front Panel switch signals decode and passes
information to Display.
• It has a microprocessor, the analog to digital conversion of
signal to convert the commands received from front panel
and fed to logic board.
• It also generates the audible command whenever any fault
occurs during self‐test and operation.
• It detects all front panel operation and acts as per instruction
 Cont’d
Logic Board / Relay Board :
• This board is mainly interfaced with Main Board or
sometimes all functions of Main Board are
incorporated.
• It is a liaison between front panel and output
required.
• All signals are inter‐related to this board.
• It gives the power output command to RF or Power
output board and monitors the output.
• It has relay board too, which activates according to
finger switch or foot switch control
 Cont’d
Isolation board:
• The patient interface board is interfaced with the Main
Board. It has several different functions, which is
concerned with patient connected parts and provides the
patient isolation voltage.
• It monitors the high frequency leakage current. This board
passes the Active electrode signals to main board and
continuously monitors the patient plate continuity.
• If any break occurs in plate lead or not plugged IN, the
related signal activates and passes to main board to
generate audible signal.
Safety and Preventive maintenance of ESU

Activity 1.5: Group discussion

Being in a group of 3-4 and Discuss safety and preventive maintenance
procedure of electrosurgical unit
Time: 10min.
 Safety in using ESU
• Electrodes and cables are to fasten carefully
• Electrosurgical unit is recommended to use only by
qualified medical personnel.
• To avoid burns, do not touch active electrodes.
• To avoid explosion, do not operate unit in an
explosive atmosphere.
• Prevent Electrosurgery use in the presence of
flammable gases, flammable liquids, or flammable
objects
 Electrical safety
• Electrosurgical units may cause interference with improperly
shielded medical equipment.
• Use only a power cord in a good condition with properly
grounded receptacle.
• To avoid fire hazard, use only fuses of correct type, voltage
rating and current rating as specified.
• Remove the power cord during replacement of fuse.
• Do not touch the active electrode to grounded metal parts or to
the patient plate for function proving.
• The cables to HF‐electrodes should be as short as possible and
must be arranged without loops so that they touch neither the
patient nor other cables.
• Only cables recommended by the manufacturer should be used.
 Patient safety
• Ensure that there is no air gap between patient’s body and
patient return electrode.
• Ensure that no small‐surface area contact is made between the
patient and any of the metal parts of the treatment chair, table,
saline water stand, which conduct ground potential.
• Heat may be generated at such points leading to undesired
burns.
• The patient plate shall be reliable in good contact with the
patient‘s skin for the whole operation;
• If patient plate is fastened at limbs, Be careful that it doesn’t
affect the supply of blood.
• The patient with pacemaker should be treated and consulted
through cardiology department as the high frequency may
affect or damage to the pacemaker.
Patient return Electrode safety precautions
• Discard the disposable packages that have expired.
• Use ‘Patient Return Electrode’ according to the
manufacturer’s documented instruction.
• Inspect patient return electrode before each use for wire
breakage or fraying.
• Select appropriate size patient return electrode for patient (i.e,
neonate/infant, pediatric, adult).
• Do not cut patient return electrode to accommodate patient
size.
• Place patient return electrode on positioned patient on a clean,
dry skin, convex area in close proximity to operative site.
• Apply finger pressure to adhesive border of the electrode and
massages entire pad area to ensure adequate contact with the
patient's skin.
 Active Electrode safety precautions
• Avoid coiling, bundling, or clamping of active and
patient return electrodes.
• Avoid wrapping the active electrode cord around a
metal instrument.
• Remove all metal patient jewelry to prevent current
diversion and to avoid contact with other metals.
• Place active electrodes in a non‐conductive holster
designed to hold electrosurgical pencils and similar
accessories, when they are not in use.
• Inspect insulation on reusable and disposable
electrodes before and after use
 Preventative Maintenance
• Chassis / Housing ‐ Check Exterior of unit for cleanliness and
general physical condition. Be sure that plastic housings are
intact, that all hardware is present and fitting are firm and tight,
and that there are no signs of spilled liquids.
• Mount / Fasteners ‐ If the device is mounted on a stand or cart,
examine the condition of the mount. If it is attached to a wall or
rests on a shelf, check the security of this attachment..
• Line Cord ‐ Inspect the cord for damage & excessive bending.
If damaged, replace the entire cord. Verify the minimum power
cord length before cutting the defective position.
• Circuit Breaker / Fuse ‐ If the device has an external circuit
breaker, check that it operates freely.
• If the device is protected by an external fuse, check its value
and type against that marked on the chassis and ensure that a
spare is provided.
 Cont’d
Connectors : Examine all cables of the ESU for proper fittings and firm
contact of connectors.
Probes :Confirm that probes for their physical condition. For disposable
probes check expiry date.
Controls / Switches :Examine all controls and switches for physical condition,
secure mounting, and correct motion. Look for loose connections.
• Check for proper alignment, as well as positive stopping.
• Confirm the functioning of each switch and controls proper functioning.
• Indicators / Displays ‐ Confirm the operation of all indicators on the unit
that all segments of a digital display function and functioning of Alarms.
• Audible Signal ‐ Operate the device to activate any audible signals.
• Dispersive Electrode cable continuity – Check the patient return electrode
continuity and any alarm functioning on removal.
• Accessories (Footswitch) – To check the physical integrity, connection and
proper operation of all accessories related to ESU
• Check active electrode end was clean, sharp and not damaged.
 Troubleshooting of ESU

Activity 1.6: Group discussion

Being in a group of 3-4 and explain different methods of troubleshooting
Time: 10min.
 Troubleshooting

• Servicing Techniques
• Service Manual
• Guess or Judge
• Step by step procedure to
troubleshoot.
 Troubleshooting

N Symptom Possible Cause Remedy

o
1. ∙ The ESU cannot turned on ∙ Blown fuse ∙ Replace fuse with the some
∙ No voltage reaching the ∙ Power cord may be rating.
machine. defective ∙ Check point by point all switch
∙ Circuit breaker has and line connections
blocked

2. Monopolar Mode use ∙ Electrode holder ∙ Replace with new one

Cutting or coagulation /finger switch may be ∙ Repair the defective unit.
output only not available defective
∙ Monopolar foot switch
may be defective
 3. Both outputs
∙ Electrode holder ∙ Replace with new one
/cutting/coagulation are not
available /finger switch may be defective
∙ Repair the defective unit.
∙ Monopolar foot switch may be defective
4. Bipolar Mode use
∙ Bipolar foot switch may be defective ∙ Replace with new one
Bipolar output is not
available ∙ Repair the defective unit
∙ Accessories may be defective
5. Patient electrode alarm
∙ Patient electrode cord is not connected ∙ Check connection
activated
∙ Patient electrode ∙ Replace with new one
defective
6. Over load alarm
∙ Load exceeds the pre set value ∙ Decrease the output pre setting
7. Grounding alarm activates
∙ Protection ground ∙ Check connection
cable not connected
∙ Repair
∙ Protection ground
cable defective
/disconnected
8. Generator is on, but could
∙ An alarm condition exists ∙ Check the display for an alarm number
not complete self-test
∙ Software malfunction ∙ Loose or disconnected ∙ Turn off, then turn on the generator
internal cables
∙ Check and correct all
∙ Faulty low voltage power supply internal connections
∙ Damaged control board connectors and /or ∙ Check the low voltage power supply
malfunctioning control board
∙ Remove the control board and inspect the
∙ Shorts or disconnects on power supply/RF connector to the power supply /RF board and to
board the display board for damage, poor seating, etc. if
the problem persists, replace the control board.
∙ Faulty power switch ∙ Malfunctioning front
panel ∙ Check the power supply board for shorts or
 Footswitch connected to monopolar 1 to malfunction.
footswitch receptacle is being used for ∙ Use only a covidien footswitch
instrument connected to monopolar 2 ∙ Connect the footswitch to the monopolar 2 footswitch
instrument receptacle receptacle
∙ Power set too low ∙ Increase the power setting ∙ Check the cut display for an alarm
∙ An alarm condition exists number
∙ Blown fuse on power supply/RF boar ∙ Check the high voltage power fuse and replace if necessary
∙ Control board malfunction ∙ If the indicator bar does not illuminate and the tone does not
∙ High voltage power supply malfunction sound, replace the control board.
∙ If high voltage is not present on the power supply/ RF
board, troubleshoot the high voltage power supply.

10. Activation and/or ∙ Poor connection or damaged footswitch ∙ Check connection. If indicated, replace the footswitch board
alarm tones do not board ∙ Replace the footswitch board
sound, speaker is ∙ Faulty connections or speaker on footswitch ∙ Replace the control board
malfunctioning board
∙ Audio signal malfunction on control board

11. Black orconfusing ∙ Faulty ribbon cable between control board ∙ Check/connect ribbon cable that connects the display board to
LED display and display board the control board
∙ Incorrect display modes communicated ∙ Replace the control board ∙ Replace the display board
through the control board
∙ Display board malfunction

12. Modes buttons do not ∙ Faulty ribbon cable between control board ∙ Check/ connect ribbon cable that connects the display
function correctly and display board. board to the control board. ∙ Replace the control board ∙
when pressed ∙ Incorrect modes communicated through the Check/correct the ribbon that connects the display
control board board to the front panel.
∙ Faulty ribbon cable between the front panel
 and the display board

13. Continuous ∙ Faulty chassis-to – ground connection ∙ Check and correct the chassis ground
monitor ∙ Electrical equipment is grounded to different objects connections for the monitor and, if
interference rather than a common ground. The generator may applicable, for the generator.
respond to the resulting voltage differences between Check other electrical equipment in the
grounded objects. room for defective grounds.
∙ Malfunctioning monitor ∙ Plug all electrical equipment into line power
at the same location
∙ Replace the monitor

14 Interference ∙ Metal-to metal sparking ∙ Check all connection to the generator,

with other ∙ High setting used for fulguration patient return electrode, and accessories. ∙
devics only ∙ Electrically inconsistent ground wire in the operating Use lower power setting for fulguration or
when room select the desiccate mode
generator is ∙ If interference continues when the generator is ∙ Verify that all ground wires are as short as
activated activated, the monitor is responding to radiated possible and go to the same grounded
frequencies. metal.
∙ Check with the manufacturer of the monitor

15. Pacemaker ∙ Intermittent connections or metal to-metal sparking ∙ Check all connections to the generator.
interference ∙ Current traveling from active to return electrode during It may be necessary to reprogram the
monopolar electro surgery is passing too close to pacemaker
pacemaker ∙ Use bipolar instruments, if possible. If you
must use a monopolar instrument, place the
patient return electrode as close as possible
to the surgical site.