How to Use Monopolar, Bipolar, Harmonic Scalpel and Ligasure Part I

This video demonstrate How to Use safely Monopolar, Bipolar, Harmonic Scalpel and Ligasure Part I.

An electrosurgical device applies high-frequency alternating current to cells, with the polarity alternating from positive to negative approximately 500,000 times per second. Cellular cytoplasm contains electrically charged particles such as electrolytes and proteins. The alternating polarity causes those ions to rapidly oscillate back and forth, resulting in frictional forces that increase the cellular temperature. This is used to create a cellular and tissue effect or a combination of cellular and tissue effects including vaporization (manifested as cutting), desiccation or coagulation. Instead, coagulation and cutting is effected by ultrasonic vibrations at frequencies from 23-55 kHz, creating thermal energy from tissue friction. Completion of tissue sealing is subjective for most ultrasonic devices and relies on visual and tactile cues and tissue tension. Ultrasonic devices have United States FDA approval to seal vessels up to 5 mm in diameter. The main advantage of ultrasonic devices is the speed of dissection that can be accomplished.
With every surgical energy device, the thermal spread profile must be monitored carefully. Ultrasonic devices typically have a 1-3 mm thermal spread pattern. A clear disadvantage is that the ultrasonic vibrating tip gets very hot. Temperatures can reach as high as 300 degree C during activation. Tissue death usually occurs at 60 degree C, so extreme caution should be undertaken while these devices are used. The surgeon should allow time for the ultrasonic tip to cool down before handling any tissue.