I think we'll move on to the basic thermal therapies video. And again, this will be Dr. Opstein demonstrating to us some of the electrocoagulation devices that we have at our disposal. What we're going to do now is look at what's called bipolar cautery or thermal coagulation. What this is is essentially a probe or a catheter that at its tip can coagulate an object. Usually when we use this, we'll use this to coagulate a blood vessel that's in an ulcer bed to achieve hemostasis or stoppage of bleeding. In this scenario, it's bipolar because we don't need a grounding pad because essentially the probe tip, it says both the input and the output or the return. So you can think of it as being both the device as well as the grounding pad all in a single tip. So what we'll do is we'll remove the grounding pad so that you can see it will work without that from our patient. We'll hook this up to our electrosurgical generator and then we'll demonstrate the technique. With this, different from APC, argon plasma coagulation, which you can see in that lecture series, this is a contact-induced hemostasis, meaning you do have to touch the tissue with some pressure for a certain duration of time, usually approximately three seconds, to achieve your hemostasis. And we'll see that when we demonstrate it in our stomach phantom. So what I'm going to do now with our assistant is hook this up and then we'll go and place this down our endoscope and demonstrate the technique. A few things to note during this are when you do coagulate using bipolar, essentially what happens is you're going to cook that tissue. And so in order to leave that escher behind and not rip that off of the vessel that you just coagulated, causing repeat of bleeding, you need to inject a little bit of fluid to help loosen that so that you can remove the object from the tip of the catheter without causing repeat of bleeding. And so what you can see here is we inject a little bit of fluid and you'll watch it come out. I'll ask my assistant to inject, please. And you can see the liquid come out the tip. Some caps also have needles that can come out the end or other objects. It just depends on the manufacturer. We'll just demonstrate basic by cap technique. What I'm going to do is hold the endoscope in typical endoscopic fashion. And again it goes down the therapeutic channel. So let's put the endoscope down. I'll ask my assistant to hold. Again, there's no need for a grounding pad in this scenario. We're going to come all the way down into our stomach. And again, if we pretend that there is an ulcer in here and a bed, we'll put the application of this catheter right on that vessel. We'll press down gently. We'll count to three and then we'll take it off. And so I'm going to make sure that our bipolar is all set to go and we'll get ready. So we're in our stomach here. We'll get good visualization. We're going to advance the catheter down the therapeutic channel of our endoscope. and we can see our catheter tip there and so what I'm going to have my assistant do is get ready with the irrigation and if we pretended that there was let's say a vessel in here let's say on this piece of tissue here we're going to apply some gentle pressure on that area as we coagulate so we're going to put our catheter in we're going to apply one two three we're going to inject a little bit and we're going to pull off that tissue and as you can see we have our burn there if there was a vessel that would be coagulated so we'll demonstrate this technique one more time we'll put the catheter out we'll get our area of tissue that we want to coagulate again we depress our foot pedal with gentle pressure one two three inject and pull away from that and you can see our thermal burn thank you for your attention okay again that was Dr. Opstein demonstrating electrosurgical probes which in this case is a bipolar probe meaning that the current as I back up electrical current always has to go somewhere and return to a grounded state and in this particular device the current is actually flowing from one of those metal bands on the tip to the other through the tissue and it's that little small circuit where the tissue is accepting the electrical charge where the heat is created creating a coagulation effect or cautery effect and it's called a bipolar probe because both poles of the electrical circuit are right low are localized right on the tip of the device other devices most devices in fact that we do use in gastrointestinal endoscopy are considered monopolar and we'll see some examples of that later on where the current is delivered to the tip of the device the current then travels through the tissue through the rest of the of the patient's body to a grounding pad that is applied to the patient's skin and that grounding pad is where the current returns to all the same concepts there's electrical currents traveling but the grounding pad essentially removes the current from the body in a safe location as opposed to traveling elsewhere in the body where it could be causing harm you may have noticed a couple of blue bands in the esophagus and stomach and that is the remnants of a banding device that we'll see later in a separate video but in case you were wondering what that was that dr opstein passed that's what we were dealing with the electric surgical generators that we use that you saw demonstrated there for the bipolar probe are very complicated devices uh there's a lot of physics that goes into understanding how electrosurgical units work and how those electrosurgical units deliver energy to the patient's tissue and understanding them is really important in order to avoid adverse events and to keep it as safe as possible in performing gastrointestinal endoscopy and it reminds us all as physicians as to why we took physics we never really understand why we needed physics to go into medicine but understanding electric electrosurgical generators is really quite critical

electrocoagulation devices

bipolar cautery

thermal coagulation device

hemostasis

gastrointestinal endoscopy