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[Victor Yang] 14:32:32
So the Bovi device has changed a lot. You can saw that yellow, bipolar or yellow
electrode device during the video.

And the, the device is perfected by a surgeon by the name, Dr. And the special can
be considered the more than day, Dr.

And that device. Uses. Special metallic coating on the tip of the, electoral cadre
to decrease amount of carbonization.

So the question asked early about why it becomes black is very important. There are
other ways to decrease.

The carbonization to make the cutting better. And I'm gonna show you. So here is a
more recent paper, you know.

You're 2,008 so not nearly a hundred years ago, but above 1015 years ago.

Okay. And that this is down. Through a company called a peak surgical in
collaboration with Stanford University.

Okay. And what they are trying to do is to they're trying to uncover.

They're trying to uncover. Hold on second, sorry about that.

Let me resume the share.

They're trying to uncover. The fundamental mechanism of how electro surgery is
done. So what you are seeing here.

Is actually high speed camera pictures. Of tip of the electron. Think of this as
the tip of the electron during the electro surgical device from Dr.

Bowie. And then here are the RF pulses that's being passed through to the dip.

And this tip is in sailing or in conducting water. And the pictures are taken at
time sequence shown in the bottom here.

A few microseconds to tens of microseconds. And what's happening is that We are
seeing Plasma generation.

Through these bubbles. Of gas that's formed at the tip. Of the Electronic.

And the plasma can actually be detected. Using photosensitive dials. So here what
you're seeing is the plasma.

Light intensity. Horizontal access is time. And then we can see the voltage in
blue.

And we can see the current that's passing through. In green.

And we can see if we apply animal or castle different polarities. Of the current
onto the electrode, we see different behaviors in terms of plasma light intensity.

So what they are proving is that Bovie? Dr. Bolvey without knowing the underlying
physics.

Well, he didn't have the equipment because we have high speed camera systems now.
That he was actually forming.

Plasma. Using RF current.

And ask the RF current is applied to.

The ELECTRIC HARDY device. We actually see initial water heating. Vaporization
causing that bubble.

And then within the bubble, we see plasma generation. You can see the light
intensity increases during that plasma.

Generation. And this is the plasma that is cutting.

So now, people can design. With that knowledge, a far better electrode. This is a
very thin electoral.

That will decrease the vaporization threshold. And that you can lower. Energy
deposition into the tissue, which is the collateral damage.

So now this electrode is only 25 microns thick. So this gives you more precise cut.

And then when we Use it now this entire rim here. Of the electrode. As plasma.

So now, in comparison to the picture I showed you earlier, the heating and
vaporization.

Is occupying very small part. Of the entire operation now and the majority of the
time when we are passing the current through we're generating plasma.

So this is a far more efficient electrical coterie device. Then this one. Because
this has only about a third of the time we're generating plasma.

We're here over 90% of the time we're generating plasma. So armed with.

You technology like the high speed camera systems. Now we can understand the
fundamental physics that Dr. Bovi at Harvard University was unable to discover.

98 years ago. And with this new device now, we are able to actually cut into the
tissue.

So now you can see this is actually cutting through the cartilage. Of a pig. And
you can see the black area now.

It's only about 20 micron.

So much, much smaller collateral damage. Then what you were seeing in the videos
that I was doing.

So. I want to stop here for a second and then see if you guys have questions. Oh, I
actually I do see questions here.

Okay. Any questions about what I've covered so far?

If not, I'm gonna try to ask you guys a few questions.

Let me. Stop the share so you can see everyone's faces.

Okay, so.

Based on the story I've told you guys. What have you learned about? Electoral
coterie upon a hundred years ago.

And now. What is the real reason that electrical current can actually cut tissue.
Biological tissue.

If I phrase it in a different way. What are biological tissue primarily made of?
What are we primarily made of?

So I have some answers here, water. Carbon. Yeah, so water is actually the key here
because 70% of us.
A water. So electoral colony systems. Basically just have to cut through water.

And. What? Does the electrical current do the RF current? These are pulses of Hi,
frequency current that's running through water.

What does it do?

If you guys want to speak, you open your mic.

So who's gonna answer this question? It's not, if no one volunteers, I'm gonna pick
people.
[Rushil Rehman] 14:41:12

Hello. I think the current with the water, I think it probably has to do with like
the frequency in it.

Okay.

Like if you can make it vibrate at a really high rate. Hey, I think it's something
to do with the frequency, I guess, my guess.

Okay, I mean that's a good guess. So first of all, we I said remember in the
lecture notes, I said sailing, right?

Yeah

So sailing is basically water plus salt, which is ionic solution. So pure water
itself. What's the conductance?

Is it conductive?
[Adhavaa Chakravarthi] 14:41:50

You know.

No, right? This is not conductor. Okay. By adding sailing.

To make the sodium and chloride concentration. Similar to blood, that's sailing.

When we add the ionic solution to it, now the sailing is conductive. So now you can
actually pass current.

From the cathol and the can pass between them. Right? So. Now, you guys can look it
up after class to see what is the resistance.
For sailing. Now you can look up the conductivity of that and then we can figure
out assuming a cylinder of sailing and we can figure out what the equivalent
resistance of that is.

And now we've all learned in high school physics and then now the physics you guys
are learning now.

Is that when you pass current through resistance, what happens?

Anybody?
[Anthony Pham] 14:42:52

May I try? I'm pretty sure heat it generates heat.

Yep.

Okay, yeah, so some of the chat in the Chechnya people answer that early as well
will produce heat.

Okay, so now we're producing heat. Because the current is passing through the
Liquid solution, right?

Now the look at heats up. What happens next?

Sailing or water in our body currently is at body temperature, 37 Celsius. Now
you're passing current to it.

What's going to happen to the temperature?
[Mostafa Al-Tobeh] 14:43:34

Is it gonna rise and with the water evaporate?

Will stop uprising. Exactly. So then we're gonna heat water and the water will
reach boiling point.

And then it will vaporize. So now we have gas. So now in the gas mode.

What is the conductance in comparison to ionic? Water, liquid. Solution with sodium
chloride in it.

Okay, so we have some guesses here. So there's some of those thinking that the
conductance is low some people say the conduction blows up.

So. How many people think the conductance of Vaporized.

Water, Vip price saving has high conductance. Hands up. Let me see.

Okay, how many people? Will think that vaporized sailing. Has low conductance.

A lot more hands. Okay, good. Alright, so we almost go by democracy here. So that's
true.

So in gas form. You conductance is much lower. But the electrical voltage is still
there. So, and these are.

30 small. Bubbles. So the distance is small. So if you apply a large RF voltage
across A small air gap.

What happens?

Does it jump the gap and create like an hurt or something like that?

That's correct because When you have conducting material, sandwiching, non
conducting material in between, you basically have a capacitor.

And you put high voltage across the capacitor. You guys, I'm sure you're studying.

Or your physics problem telling there are breakdown voltages of capacitors. So when
you exceed the breakdown voltages between the capacitors.

Then you will arc through. And when you are through You are going to, it's like
lightning, strikes, right?

In a small scale. And now you are generating. Plasma and he will see light. Just
like the lightning.

So I went through the lecture there. To see if you guys did understand all of that.
And we do have to go step by step.

So now you understand. When we use electoral artery. We are actually making. Tiny
little lightnings.

In each of the cells. So each one of our cells contains water. And the we will say
that you know by weight 70% It's actually water.

So the water molecules are being heated up generating these small air bubbles
within the cell.

They're actually within the cell. And the voltages get applied to them. The our
voltage generates a small lightning or arcing through those small capacitors when
they break down.

With they're broken down and now we generate light. But the light is active
byproduct.

Because what happens is that and these small explosions of generating the vapor
bubble and arcing through it will actually rupture the cell.

And actually split it open. Which is what you see. On the pictures. So now let me
go back to lecture notes, then you can understand what that what that means.

So when we are making a cut through the tissue here. Using a knife that looks like
this, meaning that the entire rim of the knife is actually heated up and the we are
lighting through them with plasma.

And this 25 micron thick blade.

Has over 90%. Efficiency in terms of time generating plasma. And it can slip.
Through the tissue because these individual cells, you know, by the way, this is a
zoom in picture of this region here and then this arrow bar here is this bar here
scale bar is 500 microns.

So each so 100 microns this distance here and each cell is about, let's say 5 to 10
microns.

So one, over 10 or 1 20 third is a cell. So you can see the darkness of the
carbonization is just about one cell thickness.

So we are literally cutting through. Single cells in the line. Splitting them open.
Because we put the water in that cell.

To a temperature such that it will vaporize and we arc through it to produce plasma
and explode it open.

And then go on to the next cell and go on to the next cell. And so that's why when
we use the electrocard device on the tissue.

I'm actually not using as a knife, but when I hold it there, it will actually cut.

Right through it.
Is that clear?

Okay. All right. So now we can, venture a bit more and then we will of course
finish the rest of the, part of that slides during the, during the next lecture.

And I just want to give you a few examples. So what we show here is carting
cartilage, which is like semi card.

This is soft tissue. Which is like a soft tissue covering of the cartilage.

It's like a thin layer of of soft tissue cutting, you know, covering the coverage
and then they grow the cartilage.

And that something harder than coverage is bombed. And in surgery we have to cut
all kinds of tissues.

We will cut soft tissue like Dura, which is a covering of the Bering or covering of
the spinal cord, the bring prank em up, which is the the white matter or the great
matter of the bring a self.

And sometimes we have to cut heart issue like bomb.

So one example here. Is so-called the trance. You know, trans means going through.

And Sphino is one particular bomb at the center of our head. And at the center of
our head, There is a gland called the Patuity Gland, which is like the Master
clock, the master clock of your hormonal system.

In order to get there. We have to cut through the bone. Of the seller and the
seller is a term in anatomy referring to The Seat is like a cushion, a seat, a sofa
of the petuitary gland.

So the particular glance sits in the cellar. And we currently use a mechanical
drill. A high speed mechanical drill that rotates very fast to cut through the
bone.

And then to cut into the capsule of the tumor we use a telescoping knife.

And there are a lot of critical structures nearby. For example, we have carrot
arteries.

These are 2 main arteries going through the human brain. The optic nerves where the
optical information coming from our eyes are being communicated to the brain and
the predatory stock.
Is like the output from the master clock. Of the bring of of the human body. Okay,
so where is that?

That location is over here. So this is a corona, meaning a MRI that's going through
my head this way.

And then we are looking at essentially the center of the head. You can see the eyes
over here and then here is the pituitary gland or in fact we have a tumor in the
pituitary glam and this picture is going through my head this way.

So now if you look at both pictures, you know, this picture is going. This way and
this picture is going this way.

So where they intersect is where we see these this tumor. Now this is a third
picture, this so-called a sagittal cut, which is a picture going through that head
this way and again we see the tumor here.

So you can get a sense that this tumor is at the center of the head. In front of
the bring stam and behind the nose so to speak.

So in fact, it's very important to recognize behind the nose because we actually go
through the nose to get to this tumor at the center of the head.

And here is how the setup looks like in the operating room. So the patients over
here and we have our camera systems or our GPS systems in the operating room and
let us visualize the center of the head.

And we can actually put a camera through it. So now this is after the bone have
been drilled away.

And the crowded artery is right here. And the right here, if we nick it with a very
small hole.

The blood will come out from that at speed. Equivalent to a meter per second. So
this entire camera will immediately become red and we will not be able to see
anything.

So we have to know exactly where we are cutting. And here we are using a
telescoping knife to cut into the tumor capsule.

And that we will remove the tumor from that capsule.

Okay. And You may ask. You know, where do we, I mean, how do we get there?
How do we make sure we don't? Can we distinguish? This is the Carotta Audrey, and
but that's not a priority.

How do we know where we are? We will be covering that in our later sections. Those
are questions about surgical navigation, like having GPS coordinate.

And this location here is very important because You can see the Carrot Audrey on
Anatomy textbooks looks like that.

And the here is the pituitary gland. And you can see the pituitary gland sits
within a cushion and this is what's called the cellar.

So within that area, the protuberry glance sits and the immediate to it. We have 2
carrot otters running through that.

And then in addition, you can see this 2 white stumps and those are the optic
nerve.

No, the enemy textbook, we cut it. So this is optic nerve that has been cut in
cross section and optic never actually runs from here to there.

And goes into from here to there goes into the patient's eye, both sides. Any
questions about that?

Let me stop the share for a second. If you know, let me just keep the share on and
see if you guys have any questions.

So we are swimming. Back to modern surgery, right? And the, Procedures we do now, I
just showed you that we need to address the cutting requirements for not only the
soft tissue but also hard tissue and in between for example the cartilage.

Now one key issue here is in is to understand that in order to make this cut, we
are actually the patients going through the patient's nose.

So we're actually making cuts right over here and the instrument it's going through
the patient's nose and the surgeons holding the instrument outside and nose.

So a very important question that comes is how deep are we cutting? From left to
right, we can see our camera views.

For example, like this, we can see our camera views. We can we can have a sense
from left and right how accurate we are.

But in the depth direction, you in and out the depth direction. We don't know
because the surgeon's hand will have a tremor.

And the My Trimmer is on the order of a hundred, 200 microns. And, so I can only
move.

Emplitude larger than that if I want to move amplitude smaller than that I will
need robotic devices

And we know the lateral direction, the cutting knife that I just showed you earlier
can actually have accuracy about 20 microns.

So in this scenario, the latter direction.

Cutting accuracy of the instrument is already better than my trauma. So therefore,
if I make He wobbly cut that's not into the knife that's due to my hand tremor.

In the depth direction. We also need to Consider that camera system is looking. In
the forward backward direction is not so easy to judge depth.

As you guys preceding your, undergraduate curriculum, especially a fourth year. And
hopefully you guys will encounter me again.

And the capstone projects will be doing camera based, imaging to figure out that.
And we know that it's not easy to control.

Death.

We will be talking about other techniques to control death. In the next lecture.
And I don't think we have sufficient time today to cover those and that we can pick
this up from next lecture.

Alright, now let me stop the share. I just want to know, so next week we are all in
a reading week, right?

So there's no lecture on reading week and we will, pick up the, lecture, the week
after that.

And that week, right now I don't know my schedule very well yet. And due to

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[Victor Yang] 14:32:32

[Victor Yang] 14:32:32

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[Victor Yang] 14:41:05

[Rushil Rehman] 14:41:12

[Victor Yang] 14:41:14

[Rushil Rehman] 14:41:23

[Victor Yang] 14:41:32

[Rushil Rehman] 14:41:32

[Victor Yang] 14:41:38

[Victor Yang] 14:41:47

[Adhavaa Chakravarthi] 14:41:50

[Victor Yang] 14:41:52

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