ASGE Advanced Endoscopic Lesion Resection Course | November 2022-8 Amin

8 Amin_Know your electrosurgical unit

Pdf Summary

In this document, Dr. Sunil Amin provides an overview of electrosurgical units (ESUs) used in endoscopic surgery. He explains the concepts of current density, voltage, and power and how they apply to ESUs. The document discusses different types of ESU generators, including constant voltage, hybrid, and constant power models.<br /><br />Constant voltage generators, such as the ERBE VIO Series, calculate circuit impedance and adjust power accordingly. They allow you to set a maximum wattage level. On the other hand, constant power generators, like those from ValleyLab and Conmed, increase voltage as tissue impedance rises to maintain constant power. Hybrid generators, including the ERBE ICC Series and Olympus ESG, provide constant voltage in cutting and constant power in coagulation.<br /><br />The document also explains the cutting and coagulation waveforms. Cutting waveforms use microelectric "arcing" to create a cleave plane, while coagulation waveforms use spikes of high voltage followed by rest periods. The "blended cut" mode, such as Endocut I/Q, combines cut and coagulation currents to produce precise cuts based on tissue impedance.<br /><br />Various settings for different procedures are discussed, including standard settings for polypectomy, lift and cut EMR, underwater EMR, hot avulsion, and snare tip soft coagulation. The document emphasizes the importance of using high current density and provides suggested EMR settings for different scenarios.<br /><br />In conclusion, Dr. Amin advises familiarizing oneself with the ESU generator, understanding the different modes, and using high current density techniques when appropriate. Ultimately, it is important to choose a technique that you are most comfortable with.

Keywords

electrosurgical units

ESUs

endoscopic surgery

current density

voltage

power

constant voltage generators

hybrid generators

cutting waveforms

coagulation waveforms