Principle of surgical diathermy

High frequency currents are used for two purposes in medicine, one is for the therapeutic application in
physiotherapy and other is for surgical purposes. The frequency of the current used in surgical
diathermy units range is in the range of 1-3MHz where as the frequency used for therapeutic application
is in much higher range.

Figure Principle of surgical diathermy machine

Standard electricity current alternates at a frequency of 50/60 Hz. The surgical diathermy machine also
known as electrosurgical unit can operate at this frequency as well but at this frequency excessive
neuromuscular simulation and perhaps electrocution would result. Because nerve and muscle
stimulation ceases at 100kHz, surgical diathermy can be performed safely at frequency above 100kHz.
For their intended function surgical diathermy uses the heating effect of the current. When the high
frequency current flows through the sharp edge of wire loop or the point of the needle into the tissue
there is high concentration of the current at that point and the tissue is heated to such extent that cells
which are immediately under the electrode are torn apart by boiling of the cell fluid. There is an
indifferent electrode with large aerea placed in contact with the patient to disperse the RF current so
that very little heat is developed at this site. The indifferent electrode acts as the return path for the RF
current.

The different purpose of the surgical diathermy (ESU) is achieved by varying the frequency if the current.
Electrosurgical cutting is achieved by passing high frequency current to the surgical site. Electrosurgical
coagulation of tissue is caused by the relatively lower frequency as compared to cut and heating is
locally so that it coagulates from inside (as boiled egg). The coagulation process is accompanied by
grayish-white discoloration of the tissue at the edge of the electrode.

Fulguration refers to a superficial tissue destruction without affecting deep seated tissue. This is
achieved by passing spark from the needle or bsll electrode of small diameter to the tissue. When the
electrode is placed the tissue without touching it, an electric arc is produced whose heat dries out the
tissue. Fulguration allows cauterization of fistula and redidual cysts and stoppage of minor
haemorrhages.

Electrosurgical desiccation occurs when the electrode touches the tissue and the amount of generated
heat is lower than that required for cutting. The tissue surface and some of the tissue more deep to the
probe dries out and forms a coagulum (a dry patch of dead tissue). This technique may be used for
treating nodules under the skin where `minimal damage to the skin surface is desired.

Electro-Surgery Technique

The electric current can only flow in any circuit if the circuit is complete or closed. Interms of the current
flow, there are basically two type of electro-surgical techniques. The monopolar and bipolar technique.

Monopolar technique: The monopolar technique uses monopolar electrode and the current
flows from the monopolar active electrode through the patient to the neutral electrode (Patient
plate) from which it returns to the generator. The cutting or coagulation effect depends upon
the contact area between the monopolar active electrode and the tissue which is very small
compared to the contact area between the patient plate and patient’s skin.

Figure Monopolar technique

Figure Bipolar Technique

Electrodes used with surgical diathermy

Varity of electrodes are used in the surgical diathermy. The high potential terminal of the
diathermy is connected to the cutting electrode which is mounted in insulated handle. The
cutting electrodes are available in different shapes depending upon the nature of application.
For example lancet electrodes are used for cutting application, needle electrodes for epilation
and desiccations and loop electrode for opening channels and remove extra growth. The active
electrode for the coagulation purpose is of ball or pate type.

In electro surgery, since the surgeons must be able to switch the frequency current on and off
themselves a figure tip switch in the electrodes or a foot switch or both is available in the
system.

Surgical Diathermy Machine

The surgical diathermy machine consist of the following parts as shown is the block diagram
given below:
• Power Supply

The power supply generates the supply of +5VDC, -5VDC, +15VDC, -15VDC, +24VDC, 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.

• RF output board

It has a power amplifier assembly, which comprises with Bipolar Monopolar, CUT/COAG and
BLEND waveform. The out circuit is fully isolated. It generates the output as per front panel
instruction given to Main Board and Logic Control Board. It generates the Switch mode pulse
pattern from generator, Drive circuit for output switching power MOSFETS and High Frequency
filtering components.

• Memory Board

The function of his board is to accept operating mode control signal from front and rear panel
and foot switch. It checks and identifies that which connectors are in use and monitors its
continuity. Interfaced Front Panel switch signal from front panel, passes information to Display.
It has a microprocessor, used together with EPROM as program memory and RAM. The analog
to digital conversion of the signal to covert the commands received from the 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 per instruction.

• Logic Board/ Relay Board

The board is mainly interfaced with the 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 the finger switch or
foot switch control.

• Front Panel

It consists of membrane keyboard Power switch, Patient Return Electrode, Monopolar, Bipolar
connector. Front panel also interfaces with Display Board and Power Supply Board. The Power
Supply Switch supplies the AC mains current to the Electrosurgical unit.

• Display Board

It is located in the Front Panel Assembly. It contains RF indicator lamp, Seven segment LED,
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 and Seven Segment
Display, which indicates the Bipolar, Monopolar, Cut, Coagulation power settings.

 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 patient plate continuity, plate voltage, BIPOLAR forceps switch, CUT / BLEND, and
COAG finger switches and patient earth monitor. 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.
 Audio Tone generator
It receives the command from main board, which activates the audio oscillator circuit. Audio
circuitry get ON at the time of activation of high frequency, any malfunction of fault of ESU,
improper or loose attachment of patient return electrode and power up. It activates with signals
provided by microcontroller and gives high and low tone.