Medical Instrumentation I ‫كلية االسراء الجامعة‬

Lec asst. Noor Talib

Lec. 11 ‫قسم هندسة تقنيات االجهزة الطبية‬

An electrosurgical unit (ESU) passes high-frequency electric currents through biologic

tissues to achieve specific surgical effects such as cutting, coagulation, or desiccation. It
has been used since the 1920s to cut tissue effectively while at the same time controlling
the amount of A: deeding.
Cutting is achieved primarily with a continuous sinusoidal waveform, whereas
coagulation is achieved primarily with a series of sinusoidal wave fat packets. An
electrosurgical unit can be operated in two modes, the monopolar mode and the bipolar
mode. The most difference between these two modes is the method in which the electric
current enters and leaves the tissue.

In principle, electrosurgery is based on the rapid heating of tissue. To better understand

the thermodynamic events during electrosurgery, it helps to know the general effects of
heat on biologic tissue. Consider a tissue volume that experiences a temperature
increase from normal body temperature to 45°C within a few seconds.

The cytochemical changes do in fact occur. However, these changes are reversible, and
the cells return to their normal function when the temperature returns to normal values.
Above 45°C,-irreversible changes take place that inhibit normal cell functions and lead
to cell death. First, between 45°C and 60°C, the proteins in the cell lose their

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Medical Instrumentation I ‫كلية االسراء الجامعة‬
Lec asst. Noor Talib
Lec. 11 ‫قسم هندسة تقنيات االجهزة الطبية‬

quaternary oat, configuration and solidify into a glutinous substance, this process,
termed coagulation, are accompanied by tissue blanching. Further increasing the
temperature up to 100°C leads to tissue drying this process is called desiccation. If the
temperature is increased beyond 100°C, the solid contents of the tissue reduce to
carbon, a process referred to as carbonization. Tissue damage depends not only on
temperature, however, but also on the length of exposure to heat.
In the monopolar mode, the active electrode either touches the tissue directly or is
held a few millimeters above the tissue. When the electrode is held above the tissue, the
electric current bridges the air gap by creating an electric discharge arc. A visible arc
forms when the electric field strength exceeds 1 kV/mm in the gap and disappears when
the field strength drops below a certain threshold level.

Monopolar Electrosurgery

In monopolar electrosurgery, tissue is cut and coagulated by completing an electrical

circuit that includes a high-frequency oscillator and amplifiers within the ESU, the
patient plate, the connecting cables, and the electrodes. In most applications, electric
current from the ESU is conducted through the surgical site with an active cable and
electrode. The electrosurgical current is then dispersed through the patient to a return
electrode returning the energy to the generator to complete the path. Monopolar
electrosurgery has the means of delivering energy to the tissue through several
Modalities (modes of operation): pure cut, blended cut desiccation (or pinpoint), and
spray (or fulguration). The delivery system of the monopolar electrosurgical generator
can be a hand controlled pencil (reusable or disposable) or a foot controlled pencil. A
number of accessories can be adapted to the foot control output jack to deliver energy
through a number of instruments.

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Medical Instrumentation I ‫كلية االسراء الجامعة‬
Lec asst. Noor Talib
Lec. 11 ‫قسم هندسة تقنيات االجهزة الطبية‬

Bipolar Electrosurgery

In bipolar electrosurgery, two electrodes (generally the tips of a pair forceps or scissors)
serve as the equivalent of the active and dispersive leads in the monopolar mode.
Bipolar electrosurgery does not require a patient plate. Electrosurgical current in the
patient is restricted-to a small volume of tissue in the immediate region of application of
the forceps. This affords greater control over the area to be coagulated. Damage to
sensitive tissues in close proximity to the instrument can be avoided. There is less
chance of current capacitive or directly arcing to surrounding structures such as the
bowel. Patient burns are virtually eliminated.

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Medical Instrumentation I ‫كلية االسراء الجامعة‬
Lec asst. Noor Talib
Lec. 11 ‫قسم هندسة تقنيات االجهزة الطبية‬

Dispersive electrodes

A dispersive electrode is an electrode with a relatively large surface area which is

positioned on the patient in order to allow the high frequency current to flow back with
a low current intensity in order to prevent any physical effects, such as undesired burns.

Over the years electrosurgery has advanced, so too have the types and styles of
dispersive electrodes. Early on in electrosurgery the only choice was a solid pad (at first
a stainless steel plate) that was placed on the patient to disperse the heat of the RF
energy. If the solid plate was not applied correctly or began to move off the patient
during the case, the ESU would continue to deliver energy to the tissue, causing a
potentially dangerous situation.

Current Density

Electrosurgery makes use of an intensely concentrated current to induce a heat energy

that is capable of a range of effects: from the drying out of cells with consequent
coagulation of blood, to the vaporization of cells Permitting an electrode to physically
separate a path through living tissue. The degree of current concentration is called
"currenrcensity."

Current density is one of the most important concepts in electrosurgery. Simply stated,
current density is the amount of current concentration at a given point. In electrosurgery
all of the RF current is force flow through the tiny area where the active electrode
makes contact with the skin. At this point, the current flow is concentrated intensely.

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Medical Instrumentation I ‫كلية االسراء الجامعة‬
Lec asst. Noor Talib
Lec. 11 ‫قسم هندسة تقنيات االجهزة الطبية‬

The heat at the site is great enough to achieve cutting and coagulation. Current leaves
the body via a dispersive electrode (grounding pad).

The pad has a large surface area thus the current density is quite low. As long as this
large, so-called "dispersive" electrode makes good contact with the skin it should offer
a passage of least resistance for safe exit of the RF current from the patient. The large
surface area generates little heat. A generator supplies RF to the active electrode.
Current passes through the patient, exiting by way of the return electrode. It returns to
the generator to complete the circuit. Without complete circular path, from generator to
patient, back to the generator, the current should not flow.

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Medical Instrumentation I ‫كلية االسراء الجامعة‬
Lec asst. Noor Talib
Lec. 11 ‫قسم هندسة تقنيات االجهزة الطبية‬

ESU waveform:

ESU generators are able to produce a variety of electrical waveforms. As a waveform

change, so will the corresponding tissue effect. Using a constant waveform, like "cut",
the surgeon is able to vaporize or cut tissue. This waveform produces heat very rapidly.
Using an intermittent waveform like "coagulation", cause the generator to modify the
waveform so that the duty cycle "ON time" is reduced. This interrupted waveform will
produce less heat, instead of tissue vaporization, a coagulum produced.

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Medical Instrumentation I ‫كلية االسراء الجامعة‬
Lec asst. Noor Talib
Lec. 11 ‫قسم هندسة تقنيات االجهزة الطبية‬

The first electrosurgical instrument used spark gap technique and figure below shows
the principle of work of spark gap instrument. Consist of high voltage transformer and
electric spark gap and C 1/L1 circuit. The transformer will increase the voltage from
220 v to 3000-4000v which is able to ionize the air in the gap between the two points of
tungsten. When the gap-start to spark during production of electric arc by alternating
pattern, it will produce currents which radio frequencies which start to oscillate in the
circuit (Cl/L1). This circuit is coupled "connect" with output circuit (Ll/L2) by
induction. The output energy which gone to the patient can be control its intensity
through taken different level of energy from L2 through switch S2 which is connect
with the active electrode. Depending on the type and design of the instrument the power
is between 25 watt and few hundred watts. The coils RF1 and RF2 are used for
protection and prevent the effect or return back of radio frequencies to the input power.

In some instrument the capacitor is used parallel with the secondary coil of the
transformer T1.

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Medical Instrumentation I ‫كلية االسراء الجامعة‬
Lec asst. Noor Talib
Lec. 11 ‫قسم هندسة تقنيات االجهزة الطبية‬

These generators are used in cauterization and coagulation to stop the bleeding from
blood vessels. Most of these instruments exist in two mode cut and coagulate. The
rough foot selector switch. The wave for cutting is pure sinusoidal wave while the
coagulation wave is damped oscillation wave according to the type and technique of the
instrument.

2) Electronics circuits for electro surgery "solid-state circuit":

The electronics circuits are used now in electrosurgical instruments so its small in size
and weight, the circuit in (figure below) is one of the types of amplifier of the power of
radio frequency.

The circuit is push-pull/parallel circuit. There are two raw or sides of 3 transistors
from Q1 -Q3 "the first", and from Q4_Q6 "the second". Each three transistors are
connected parallel, and the two raw are connected by push-pull circuit. The
transformers used in the circuit in a form of "toroid-shaped" to determine the magnetic
field in the circuit.

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Medical Instrumentation I ‫كلية االسراء الجامعة‬
Lec asst. Noor Talib
Lec. 11 ‫قسم هندسة تقنيات االجهزة الطبية‬

The radio frequency signal can be produced by Oscillator as shown in figure below.
When the transistor (QI) in forward deviation state, the circuit will be oscillate with
radio frequency according the value of circuit's element. The transistor (Q2) works as
control switch to control (Q1). When the (Q2) works, it caused to (Q1) works also
"forward deviation". In the cutting mode the (Q2) continue working and the output
signal is continuous sinusoid / wave (figure below), but during coagulation mode
rectangular wave is given to the base of transistor (Q2) which is going to cut it to
produce chopped sinusoid wave (figure below). There are another circuits used another
technique according to the manufacture company.