So, when you think about the, this is my exposure again, when you think about the electrosurgical generator, you may feel uncomfortable. It seems like the black box. I also didn't, I don't know, I don't know detail about the technology, but if you can use it, very effective, but not so much knowledge is needed. Just ohms law and Joule's law should be no. It means the voltage equal resistance times current, and the power is voltage times current. And heat quantity is power times time. Times can be controlled by yourself. The other one you can select. So the machine can be much nicer in these days. The most important point is current, maximum current is double or under double. So it works because current is very important to output the power, especially when the resistance is very low, such as the bleeding and the water situation. If the current is very small, you can't put so much energy. That's why current availability is mostly important in such a situation. And also we are using now voltage controlled model, and now all modes can be controlled voltage. In the past, the power controlled generator was popular, but now we are using the voltage controlled model. Because if you can control the voltage, a unique quality can be done. But if the power is fixed, according to the difference of the resistance, the voltage is changing during the procedure. This is very important, voltage control, because the coagulation depth of the cut area depends on the voltage and the length of the spark. So the outcome mainly depends on the voltage. To do this, the machine is measuring, getting the feedback and controlling the voltage. In the VIA3, 25 million per second is measured, very, very precise voltage control can be done. For cut mode, it is very helpful when you use the end cut mode. Because as if you put the pedal longer time, automatically the current can stop, and the interval coagulation can come, and the next cut is come, and the interval. So stepwise incision can be done automatically, very, very helpful for us. But in VIA3, power peak system was omitted, because current is very high. That's why we don't need to use the power peak system anymore. So especially for ESD, we are conducting step motion, cut, stop, cut, stop. If you use the VIA300D, every time power peak system is coming, it is sudden cut is come, and according to the resistance, the cutting effect can be different. That's why VIA3 can cut very, very controlled cut. And also, I strongly recommend you to follow the three-step stroke, especially in this afternoon. Beginner want to cut very longer lengths, creating such curve, but it is very important to fix the knife onto the starting point, then control the knife tension, then conduct very short second, then knife can be proceeded automatically. So please don't move during the conduction, because if you conduct, if you move during the conduction, knife will slip out. So after small cut, please control again, and by connecting short and straight line, please create curve. This is the greatest point for the procedure. And if cut effect is not enough, you feel, please increase the duration. Duration means the cut duration. If you want to dissect much more precise, the shorter duration is available. This is the case of the fibrotic one. By using the end cut mode, duration to very short cut can be done. Then by just touching onto the fibrotic target, in a small spark, can dissect very, very precisely. So this can be done because no perfect system associated. You can see here the very nice approach. And also in the column, very precise dissection will be needed because muscle is very thin. But to do this, you need to carefully observe the target in a selected mode and conduct very short second. In end cut Q, this is recommended for using the snare, but it will be starting from the 600 volt, lower than end cut I. End cut I starting from the 700. And every step, it can be reached to the 800 volt. But if you conduct step motion, you can only use lowest voltage in end cut Q. That's why step conduction is not recommended for snaring because very, very low cut is coming. That's why at least you need to conduct longer. At least three cuts will come to do EMR or polypectomy. So for coagulation mode, there are so many, so many different modes. This mode is just something like the nickname. So when you start the conduction in every mode, the heat is coming up. And after the steam has come, the resistance of this is coming up. And there is some gap has created. In this moment, if the voltage is controlled less than 200 volt, so current immediately come to zero because the low voltage doesn't penetrate the current to such higher impedance stage. If your set mode was more than 200, next time the spark is coming. Spark will jump the gap. Then spark will create the coagulation and cut. But in spark emitting mode, there are so many different modes. So please recall the voltage and the spark length is the main point for the coagulation depth. That's why to modify the effect, many different voltage will be selected. But in general, if you want to coagulate or stop bleeding, higher voltage is needed, such as a spray coag. But if you conduct continuously with the highest voltage, you will just damage the tissue. That's why very, very short time conduction is come with the higher voltage, and just a little bit lower voltage and longer conduction, and much more, and much more, and much more, coming up to the cut mode. So in the ESD, we are mainly using the fourth coag or Swiss coag. For fourth coag, in BIOS 300D, what is fixed? That's why to arrange the effect, what control makes sense? Up to 60 watt, voltage gradually coming up. And if you select the effect, peak voltage is changing according to the effect. That's why if you want to stop more effectively, you need to select the higher effect. And also, just a little bit more, just a little bit less, every single 5 watt makes sense because the voltage is coming different. But as I mentioned, fourth coag was what's fixed. Then according to the impedance difference, voltage coming different. That's why sometimes very rare and sometimes very much well done. However, in the Swiss coag, the voltage is totally controlled in 300D too. So this coagulation mode is more incisive than fourth coag, but less coagulation ability because of the voltage lower. To arrange the Swiss coag, just you need to select the effect. But sometimes you want to arrange a bit more or a bit more or less. So in this moment, only effect selection doesn't fill the gap of your intents. So arrangement should be done, dramatic change of the watt set because voltage doesn't change according to the watt set. That's why at least 20% watt should be changed. Sorry, in the Japanese character. Here you can see the electric oven in the convenience store, 1500 watt. It can be cooked very quickly. But in home use, we don't have such larger electric oven. That's why heated up time is much different, much longer time is needed for small one. So if you want to make some difference, it is needed to change at least 20%. That's why 55 and 50 watt in Swiss coag doesn't make sense. So you need to up at least 6 to 17. I'm changing to double usually, but this is a little bit difficult. So in BIO3, even in the false coag, the voltage is controlled because of the 25 million feed workers calculating. And you can see here, wet tea condition, and it can be dissected very, very smoothly like the swift coag. And if you bleed a lot, you can stop it immediately. And also you can see yellow tissue, that will be the adipose tissue. Adipose tissue has a very high resistance impedance, that's why difficult to cut. So by using the BIO3 coag, false coag, the voltage is controlled. Then just in BIO3, you need to select the effect, no power setting or no voltage setting. Just you can change the effect after select the mode. But it can be started from 0.1 up to 9.9, 100 different effects exist. That's why it's very difficult to start from what effect and how interval is needed to change the mode. So this is the voltage and what's set in the BIO3. According to the effect is coming up, voltage is stepping up, and what's set is also coming up gradually, gradually. And all modes is following this concept. So if you are by 300 user, you already get your preferred setting. So please compare the voltage of both generator. If you are using the FX3, 50 watt in false coag in 300E, it will consist with the 1250 watts. So here will be the candidate for selection. Actually, you can see here the gap. However, just 0.1 doesn't make sense. So I recommend you to select every 0.5 interval. And also if you're coming down, it makes sense. So because the false coag, the problem in the false coag is the width of the step is different. Here you can see the wider step and very narrow, narrow, narrow. So that's why as if you change a bit, doesn't make sense, doesn't make change around here. But if you change 0.5 in BIO3, you can make some difference. But if you don't know which mode is better and which effect is better, you have the great opportunity to use the precise sect. This mode can provide you the different mode during the procedure. So something like automatic car, you don't need to change the shift. So by measuring the impedance of the tissue, machine is changing the mode automatically. But please remember, this mode is much more dissection or cut because it's starting from swift coag up to dry cut. So no stop bleeding is not so much effective stop bleeding is coming. But if you don't know which mode is better, please select this precise sect. So if you use BIO3, this is very similar with the air condition. Just select your mode and just up and down your effect. That's all. But in end cut, it is a bit complicated because end cut effect, cutting effect depends on the duration. But on the interface, you can only see the effect. This effect means the voltage between the cuts. That's why you cannot estimate the effectiveness of the cut mode. That's why all the time, you need to confirm by opening a window which duration you have set or changed. So please remember, in end cut, effect means the voltage between the cut. And the cut effect should be arranged by changing the duration. So anyway, you can select device. It means the current density. And also you can select the mode, as I mentioned. But after select or after arranged mode, you need to control your device speed. If you cut very fast, bleeding is easily come. And if you move very, very slowly, too much well done is coming. And also, please remember, you need to control the time for the conduction. So heat quantity is power times your time. That's why this is not knowledge. You can select something. But you need to control your conduction duration and the speed of the device. So thank you very much for your kind attention. Please enjoy your hands-on in the afternoon. Thank you very much. Thank you.

electrosurgical generator

medical procedures

voltage-controlled models

coagulation depth

BIO3 generator

tissue impedance