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Number 5

High Frequency Surgery: Mechanism of
Action, Risks and Risk Minimization
T

he hands are man’s most important tools. Gloves pro­
tect them from cold, dirt, contamination and injury.
In the medical field, special gloves are used to protect
the patients and the staff. When used properly, medical
gloves should prevent the transfer of pathogens from
the medical staff to the patient and vice versa.
The best possible sense of touch, high elasticity and
comfort are further product specifications that must be
met. With a thickness of only 0.2 mm, these re­quire­
ments are generally met. However, this raises the ques­
tion of whether and how a surgical glove can offer pro­
tection from voltages of approx. 1,300 volts, such as
they are applied in high frequency surgery.

ism: the Faraday effect, the electrolytic effect and the
thermal effect.
1.1.1.The Faraday Effect
Nerve and muscle cells can be stimulated electrically. In
human tissue, the stimulation effect is greatest with an
alternating current of approx. 100 Hz, and it de­creases
constantly with increasing frequency, thus losing its
damaging or life-threatening effect (Fig. 1).

1. General Aspects of High
Frequency Surgery
Biological tissue can be cut and
bleeding stopped with the help
of electric energy that is trans­
formed into heat.
Since this technology works with
high voltages, there are certain
risks involved. In order to mini­
mize these risks, it is important
to be aware of the method of
oper­ation.

1.1.2. The Electrolytic Effect
Electric current induces an ion flow in biological tissue.
Ions are small electrically charged particles.
When direct current is applied, positively charged ions
migrate to the negative pole and negatively charged
ions migrate to the positive pole,
where they cause damage to
Neuromuscular stimulation
the bio­lo­gi­cal tissue. Therefore,
direct current is not suitable for
use in surgery.
If, on the other hand, alternating
current with a very high fre­quen­
cy is used, the charged particles
constantly change their direction
of movement, i. e. they are made
to oscillate and thus they do not
have any damaging effect.

1.1. Interaction Between Elec­
tricity and Biological Tissue
Three effects are important when
electricity is applied to the organ­

1.1.3. The Thermal Effect
Due to the effect of electric
cur­rent, the tissue is heated,
where­by the degree of heating

Fig. 1:
Relation between the frequency of alternating current
and its stimulating effect on cells

1

Monopolar Technique In the monopolar technique. at de­pends on the following factors: • the current density • the specific resistance of the tissue • the duration of action of the electric energy The higher the current density. Principle of HF Surgery rent density. on the other hand. Tissue located at this site can be cut or coagulated. 2: Process within the cell when cutting 3. the greater the increase in tempera­ ture and thus the thermal effect is. Thereby. the current density is and bleeding is stopped with the markedly reduced. resulting in the formation of an electric arc and thus a very high local tempera­ ture.2. Fig. HF surgery can • prevention of pathogen transfer Method of operation in monopolar technique be used in two ways: for cutting and • protection of the tissue for cauteri­zing. the Current with a high density heats up depth of coagulation depends on the fluid in the body cells so quickly the intensity of the HF current. The tissue shrinks and the parts capable of coa­gu­lation are cauterized thermally. This makes it possible to cut and coagulate The principle of HF surgery is based on the processes in the adjoining tissue of the surgical field. the cur­rent density and temperature curve are so slight that there is no effect. Bipolar Technique (Fig.He at 2. the fluid inside and outside the cells evapo­ rates without destroying the cell walls (Fig. a Fig. In the more described above.2. Basically. 3). 4: are used. This results in hemostasis. The degree of coagulation at the cut surface depends on the shape of the 2. tion of nerve and muscle cells by the Compared with the scalpel. 4). Coagulation If the tissue is heated slowly. This principle is applied for The bipolar technique is used cutting tissue and – to a lesser de­ mainly in micro. Techniques in High Frequency Surgery Two methods are used in high fre­ quency surgery. On the large surface of the neutral elec­trode. A bipolar active electrode (for­ which results in hemostasis. gree – for coagulation. In order discharged from the body as electric to prevent damage to the tissue due energy via the large neutral electrode to the electrolytic effect or stimula­ without a thermal effect (Fig. He 3. that the resulting vapor pressure causes the cell membrane to burst 3. 2). lation.and neurosurgery. 3: strong thermal effect is produced Process within the cell when coagulating at the narrow active electrode (tip of the electrosurgical knife) due to an increase in cur­ 2. Fig. the and it can only be used for coa­gu­ adjacent small vessels are steno­sed. which differ de­ pend­ing on the path taken by the elec­tric current: the mono­polar and bipolar technique. The cur­rent density at the tip of the mono­polar electrosurgical knife (ac­ tive electrode) is increased. high frequency alter­ the following advantages: nating currents of at least 100 kHz • prevention of bleeding Fig. even in larger vessels. 5: ceps) is used. this has Fara­day effect. and the current is help of the thermal effect. The tissue is cut remote tissue.1. Cutting Tissue electrode and the type of cut. whereby both poles Method of operation in bipolar technique 2 .1.

If the surface of contact between the forceps the risk of burns is. Surgical gloves are not ment and the surgeon’s hand causes heat to develop necessary for protection. If the forceps are ble) between the surgical field and the neutral electrode not in contact with the tissue yet or if the electrode is can result in undesired dis­charges. Risk for the Patient “Thermal blowouts” occur mainly when coagulating with Contact with a grounded object (e. 5). The following points should be strong heat development will be observed for the patient’s safety: caused. Risks for the User Due to the effects described 4. The smaller it is (high through the forceps into the hand instead of through the current density). high-frequency surgery High safety standards and tech­ is a safe operating method for nical innovations have made high Fig. g. undesired dis­ of surgery when applied cor­ charges of electricity are possi­ rectly. Safety in HF Surgery above.2. the greater the thermal effect and thus patient. Current sparks) • Proper placement of the elec ­trode handle • Use of the lowest possible voltage • Proper placement of the neu­ tral electrodes 4. Electric energy is con­ ducted into the forceps. The thermal energy is so • No contact with grounded objects great that blowouts occur – the latex film melts. • No looping of cables. leaving a hole in • No isolated skin-to-skin con­ tact (between doctor/assist­the glove and causing burns to ant and patient. but naturally they have to be for a short time. the current flows charged via this contact surface. and the surgeon’s hand is very small (if the forceps are 4. The high temperature released will de­ used for hygienic reasons.1. no fixation with metal brackets 4. Safety for the Patient held very lightly) and the current density high as a result.have contact with the surgical field. we speak of risks can help to avoid adverse effects such as an elec­ a blowout. The effect is the same as the effect desired in HF sur­ • Proper storage (dry and Blowout insulated) gery. no points of contact latex. Instead of flowing activated too soon. individual parts of the patient’s The strong development of local body) heat can destroy surgical gloves of both natural and synthetic • Short wiring. 4. 6: both the surgeon and the pa­ frequency surgery a safe method Desired “flow of current” in monopolar HF surgery tient. If this happens at the surgeon’s hand. Tips for the User Like for the patient. Simply being aware of the ble. there are • Cautious handling of disinfec­ tants (the alcohol contained measures that the user can take Fig. As a result.4. and the thermal ef­fect at the tips re­ sults in coagu­lation of the tissue (Fig. A neutral electrode is not required. An elec­tric arc between the surgical instru­ tric discharge at unde­sired sites. but it occurs in the wrong place. stroy the film of the surgical glove and can also cause painful burns to the hand. the current cannot flow to the neutral through the neutral electrode. the electric energy is dis­ electrode via the patient. However. between the user’s hand. 7: can be ignited by electric to avoid undesirable incidents: Coagulation against air 3 .3. the operating ta­ a monopolar electrode and forceps.

e.22. tween the rubber surfaces provides an additional insu­ lating effect. sensitivity and comfort of the check for proper connec­gloves. elec­ wearing of two pairs of surgical gloves can be helpful trician’s gloves of safety class II with a wall thickness of and can minimize the risk of blowouts. two pairs of gloves is recommended.b. Modecenterstrasse 22.7.0. measures to ensure safety and ad­ In HF surgery. 8: during the operation: due to ne­ces­sary for protection. Therefore. Electrician’s glove. outs. longer surgery.3 mm are necessary to protect against such high volt­ 3 -5 3 -5 3 -5 3 3 3 13 Print Information Media Owner and Producer: Semperit Technische Produkte Gesellschaft m.cm] However. 8).10 Silver 0. average voltages of 1. A Liver.2. and that they can therefore Muscles. i. Does a Surgical Glove Offer Efficient Protection Fresh and dry surgical gloves can reduce the probability when used in HF Surgery? of blowouts.16.10 not be regarded as protective gloves for this purpose. therefore. 0. should there be any “misrouted” currents and blowouts as a result.3. The thicker the rubber film. Specific resistance of different materials in [Ω.10 for protection in HF surgery. but by no means 100 • Apply the active electrode to the tissue or. g. Summary from 0. The insulating effect de­ In order to increase the safety even further. it can be said that gloves are not necessary Biological Tissue Metal Blood 0. Surgical glove of natural latex: 10 – 10 [Ω. special forceps or the of up to 4.H. to the forceps first should be pointed out again and then activate it. E-Mail: sempermed@semperit. the use of pends on the physical composition of the rubber film.com. rubber is an insulator. span during which the glove is properly functional.10 likely.10 Brain 0. the ber depends not only on its latex film will slowly swell and thus reduce the timethickness.at.10 errors. A-1031 Vienna. spleen 0. it gu­lating. surgical glove grease from the skin and The insulating effect of rub­ contact with liquids. 5. if the HF generator is applied properly and without Fatty tissue 3.2 mm (1/10 of the thickness of an electri­cian’s glove).16. the glove material tends to swell.cm] with alternating current in the range 6. www. In longer surgery. Basically. thus reducing the insulating effect of rubber even more.10 Copper 0. the wall thick­ness of tion of the elec­trodes and surgical gloves is only about switches.3 to 1 megahertz [MHz] Basically.Fax: +43-1-79 777-630. Editor: Martina Büchele 4 10/2009 DM1500852 10 . kidney 0. when coa­% protection.000 V are used. In his own interest. According to EN 60903. Tel. it absorbs sweat and fluids from the surgical wound. However.10 Gold 0. but also on its physical properties.10 discharge of electric current through the surgeon is un­ Lung 1. Division Sempermed.• Check the equipment be­ages (Fig. the thickness of the rubber layer.. that if HF surgery is carried out ­properly.17.3. +43-1-79 777-621. gloves are not • Change gloves regularly Fig. the surgeon A surgical glove is expected to protect from injuries re­ should change his gloves at regular intervals during sulting from HF currents. • Always use the right acces­ sories for the equipment. such as e. etc. To optimize the fore use: avoid cable loops.sempermed. and the layer of air be­ greater the insulating effect is. 2. This doubles the and on its thickness.200 V with peaks ditional insulation. they can offer some protection from blow­ • Use insulated forceps.