Diathermy, Cryosurgery

and LASER

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***DIATHERMY*
*

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 HISTORY OF DIATHERMY:

• Diathermy, which literally means

"through Heat" is a technique using
high frequency energy to directly
heat deep seated tissues and produce
a therapeutic response.
• Diathermy was first used in 1907 by
Nagelschmidt, a Berlin Physician.
 HISTORY OF DIATHERMY:
• by the late 1950's, with the advent of
pharmacological agents to treat many of these
conditions, the use of Diathermy began to decline.
• Recently, it has been realized that modalities such
as the deep therapeutic heat of diathermy are
desirable and don't have side effects. This coupled
with the advent of modern, more efficacious,
safer to use equipment has led to a
resurgence in Diathermy use.
 Properties of Electricity

• CURRENT =Flow of electrons during a period of time,

measured in amperes
• CIRCUIT =Pathway for the uninterrupted flow of electrons
• VOLTAGE =Force pushing current through the resistance,
measured in volts
• RESISTANCE = Obstacle to the flow of current, measured in
ohms (impedance = resistance)
 Properties of Electricity
• Current flow occurs when electrons flow from
one atom to the orbit of an adjacent atom.
• Voltage is the "force" or "push" that provides
electrons with the ability to travel from atom
to atom.
• If electrons encounter
resistance, heat will be
produced. The resistance to
electron flow is called impedance.
• A completed circuit must be present in order
for electrons to flow. A completed circuit is an
intact pathway through which electrons can
travel.
 DIATHERMY Contd..
• Electrosurgery:
• use of electricity to cause thermal tissue
destruction, most commonly in the form of
tissue
Dehydration
coagulation
vaporization.
 DIATHERMY Contd..
• High-frequency electrosurgery: in which tissue
resistance to the passage of high-frequency
alternating current converts electrical energy
to heat, resulting in thermal tissue damage.
 DIATHERMY Contd..
• High Frequency ElectoSurgery :
Heat generation occurs within the tissue, while
the treatment electrode remains 'cold'.
This method includes :
electrodesiccation,
Electrofulguration
electrocoagulation
electrosection.
 DIATHERMY Contd..
• Electrocautery: in which direct or high-
frequency alternating current heats an element,
which causes thermal injury by direct heat
transference.
• Unlike electrosurgery, the element in
electrocautery is hot
 ***surgical diathermy**
• High current density
results in greater tissue
injury, and is the basis
of surgical diathermy
 ***tissue warming***
• increasing the cross-
sectional area of the
electrode by a
sufficient amount  decrease
current density to a level of
nondestructive tissue
warming.
 Principles of Electrosurgery
Principles of Electrosurgery in the OR (Operating Room)
• Same as that in electricity.
• The electrosurgical generator is the source of the
electron flow and voltage.
• The circuit is composed of the generator, active
electrode, patient, and patient return electrode.
• Pathways to ground are numerous but may include the
OR table, stirrups, staff members, and equipment.
• The patient’s tissue provides the impedance, producing
heat as the electrons overcome the impedance.
 Principles of Electrosurgery

• Unipolar
 2 Types of electrosurgery
MONOPOLAR/UniPolar
ELECTROSURGERY
– The active electrode is in the wound.
– The patient return electrode is
attached somewhere else on the patient.
– The current must flow through the
patient to the patient return electrode.
 Types of electrosurgery
Monopolar Circuit (Cf Bipolar Small Diagram)
• Generator.
• Active Electrode.
• Patient.
• Patient Return Electrode.
 Two Types of electrosurgery

Two types : Unipolar and Bipolar

Bipolar Electrosurgery
– Active output and patient return functions
are both accomplished at the site of surgery.
– Current path is confined to tissue grasped
between forceps tines.
– Patient return electrode not required/ be
applied for bipolar only procedures.
 Bipolar Circuit
Bipolar Circuit (cf Unipolar or Left Side Smaller picture)
• Generator.
• Active and return electrodes.
• Patient.
**Effects of modified waveforms in
tissue******
COAGULATING AND CUTTING
Effects of modified waveforms in tissue
 Electrosurgical Tissue Effects
• Fulguration
– Electrosurgical fulguration (sparking with
the coagulation waveform) coagulates
and chars the tissue over a wide area
• Desiccation
– Less heat is generated and no cutting
action occurs. The cells dry out and form
a coagulum rather than vaporize and
explode.
 Grounded Electrosurgical Systems
• Originally, generators used grounded current from a wall
outlet.
• It was assumed that, once the current entered the
patient’s body, it would return to ground through the
patient return electrode.
• But electricity will always seek the path of least
resistance. When there are many conductive objects
touching the patient and leading to ground, the current
will select as its pathway to ground the most conductive
object—which may not be the patient return electrode.
• Current concentration at this point may lead to an
alternate site burn.
Grounded Electrosurgical Systems
 Patient Return Electrodes

Dangerous Return Electrode Contact with Current

Concentration
• Surface area impedance can be compromised by:
– excessive hair,
– adipose tissue.
– bony prominences.
– fluid invasion,
– adhesive failure.
– scar tissue
 Patient Return Electrodes
Assessment of Pad Site Location
• Choose: -Well vascularized muscle mass

• Avoid: -Vascular insufficiency

-Irregular body contours
-Bony prominences

• Consider: -Incision site/prep area

-Patient position
-Other equipment on patient
 Grounded Electrosurgical Systems
Current Division
Alternate Site Burn
• This picture shows an alternate site burn that occurred when a grounded electrosurgical
generator was used with a ground referenced ECG device. The ECG electrode provided the
path of least resistance to ground; however, it did not disperse the current over a large
enough area. The heat produced an alternate site burn under the ECG electrode due to
current concentration.
 Electrosurgery Safety C

• Plastic Cannula System

 Electrosurgery Safety Considerations
During MIS (Minimum Invasive Surgery
Hybrid Cannula System
 OR Safety Precautions

• Insulated electodes
CRYOSURGERY _Introduction

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 ***What is Cryosurgery ?**
Cryosurgery (also called cryotherapy
or cryoablation ) is the use of
extreme cold produced by
liquid nitrogen (or argon
gas) to destroy abnormal tissue.
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Comparision with
DIATHERMY.
 Brief history

The first cryogens were liquid air and

compressed carbon dioxide snow.
Liquid nitrogen became available in
the 1940s and currently is the most
widely used cryogen.

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 **Mechanism of Action**
liquid nitrogen or argon gas is circulated
through a hollow instrument.
The doctor uses ultrasound or MRI to
guide the cryoprobe.
A ball of ice crystals
forms around the probe,
freezing nearby cells .
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 Cryosurgery an alternative to SUrGERY for :
Prostate
•Early-stage skin cancers
•Precancerous conditions of the
cervix
•liver cancer
•Colon
•Breast
•Eye Retinoblastoma
•tumors of the bone
•Parkinson
NEXT SLIDES on
CRYOSURGERY being details
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 primary liver cancer

The tumor and a half inch margin of normal liver

are frozen to -190°C for 15 minutes, which is
lethal to all tissues. The area is thawed for 10
minutes and then re-frozen to -190°C for
another 15 minutes.

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 skin cancer

Cryosurgery has been used to treat skin lesions

for approximately 100 years.
Benign skin lesions that are suitable for freezing
include actinic keratosis, solar lentigo,
seborrheic keratosis, viral wart, molluscum
contagiosum, and Dermatofibroma.

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 New advantages

• Simple pencil type grip for

• easy use.
• Very accurate application. 
• Freezes to -89ºC and to a depth of 3mm.
• Interchangeable ‘contact’ heads for special
applications including GUM, Podiatry &
Dermatology.
• Avoids all of the storage and transport problems
associated with traditional cryotherapy 39
 Cervical cryosurgery

• Cervical cryosurgery or cryotherapy is a

gynecological treatment that freezes a section
of the cervix.
• Is also used for the treatment of cervicitis or
inflammation of the cervix

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 Cervical cryosurgery

• Cryosurgery is not a treatment for cervical

cancer.

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 prostate cancer

can be used to treat men who have early-

stage prostate cancer that is confined to the
prostate gland.
Long-term outcomes are not known
is not used to treat prostate cancer that has
spread outside the gland

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prostate cancer

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 ***What is cryosurgery?**
Uses
Cryosurgery (also called cryotherapy or
cryoablation ) is the use of extreme
cold produced by liquid nitrogen
(or argon gas) to destroy abnormal
tissue.
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 Advantages
• Cryosurgery requires little time and fits easily
into the physician's office/OPD schedule
• low risk of infection
• Short recovery times
• Minimal wound care suture removal
• cryosurgery requires no expensive supplies or
injectable anesthesia.
• treat AIDS-related Kaposi’s sarcoma when the
skin lesions are small and localized
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 Disadvantage of CRYO

• Scarring
• loss of sensation
• loss of pigmentation
• loss of hair in the treated area

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 **Cryosurgery USED IN :
an alternative to SUrGERY for :
Prostate
•Early-stage skin cancers
•Precancerous conditions of
the cervix
•liver cancer
•Colon
•Breast
•Eye Retinoblastoma
•tumors of the bone
•Parkinson

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Laser
its medical applications
***APPLICATION OF LASER**
 Surgical laser: removing tumors, making incisions.
 Cosmetic treatments: resurfacing, removal of birth
mark, age spots, spider veins, hair, tattoos,
 Ophthalmology: inner eye surgery in removing
cataract, repairing retina, correct nearsightedness.
 Very useful in Skin and Eye due to Small depth of
penetration 1mm(Argon) 20mm (YAG)
Laser
repairing retina
Laser removal of port-wine stain
Laser skin rejuvenation
 *****What is a laser? *****
Laser is Acronym of
=
Light Amplification by Stimulated Emission of Radiation

Two Componants
•Stimulated Emission Process of Radiation
producing Identical Protons
•Amplification
 What is a laser?
Laser is Acronym of
Light Amplification by Stimulated Emission of Radiation
The basic scientific principle behind a laser was first put forward
by DR. charles H.townes in 1954. The efforts of several
scientists laser led to the development of the first laser called
pulsed laser in 1960.

We need to know
•The physics of laser
•The interaction of laser light with human tissue
******Characteristics of laser*****
• The second photon has the same energy, i.e.
the same wavelength and color as the first
– laser has a pure color
• It travels in the same direction and exactly in
the same step with the first photon
– laser has temporal coherence

Comparing to the conventional light, a laser is

differentiated by three characteristics. They are:
Directionality,
pure color,
temporal coherence.
VARIOUS TYPES OF LASERS (general Not
Medical only ) CAN BE BROADLY
CLASSIFIED INTO :-
SOLID STATE LASERS

EX: RUBY LASER

LIQUID AND DYE LASERS

GASEOUS LASERS

EX:HE-NE LASER
Laser
its medical applications
(Next Slides are Details)
 Mechanisms of laser interaction
with human tissues

THESE RAYS ARE USED IN MANY

AREAS, LIKE
INDUSTRIAL,SCIENCE&TECHNOLOGY,M
EDICINE,DEFENCE AND SPACE
SCIENCE Etc.
Shown in Intro Slides above
LASERS ARE USED NOW FOR
CUTTING, DRILLING AND
WELDING OF METALS AND
OTHER MATERIALS.

LASER LIGHT IS USED TO

COLLECT THE INFORMATION
ABOUT THE PREFIXED PRICES
OF VARIOUS PRODUCTS IN
SHOPS AND BUSINESS
ESTABLISHMENTS FROM THE
BAR-CODE PRINTED ON THE
PRODUCT.
LASERS ARE USED IN VARIOUS GUIDED MISSILES
AND ALSO FOR DETECTION OF ENEMY TARGETS.
HOW LASER WORKS
Two Componants
1…Stimulated Emission
Process of Radiation
producing Identical Protons

2…..Amplification
 Spontaneous emission and stimulated
emission

An excited electron may gives off a photon and decay to the

ground state by two processes:
•spontaneous emission: neon light, light bulb
•stimulated emission : the excited atoms interact with a pre-
existing photon that passes by. If the incoming photon has the
right energy, it induces the electron to decay and gives off a
new photon. Ex. Laser.
 LASER VERSUS ORDINARY LIGHTS: DIRECTIONALITY,
PURE COLOR,TEMPORAL COHERENCE

The directionality of laser beam offers a great advantage over

ordinary lights since it can be concentrate its energy onto a very
small spot area. This is because the laser rays can be considered as
almost parallel and confined to a well-defined circular spot on a
distant object.
When a laser beam projected to tissue

Five phenomena:
•reflection,
•transmission,
•scattering,
•re-emission,
•absorption.

Laser light interacts with

tissue and transfers energy
of photons to tissue
because absorption occurs.
 Photocoagulation
What is a coagulation?
• A slow heating of muscle and other tissues is like a
cooking of meat in everyday life.
• The heating induced the destabilization of the proteins,
enzymes.
• This is also called coagulation.
• Like egg whites coagulate when cooked, red meat turns
gray because coagulation during cooking.

A Laser heating of tissues above 50 oC but below 100oC induces

disordering of proteins and other bio-molecules, this process is
called photocoagulation.
 Consequence of photocoagulation

When lasers are used to photocoagulate tissues during surgery,

tissues essentially becomes cooked:

• they shrink in mass because water is expelled,

• the heated region change color and loses its mechanical
integrity
• cells in the photocoagulated region die and a region of
dead tissue called photocoagulation burn develops
• can be removed or pull out,
 **Applications of photocoagulation**

• destroy tumors
• treating various eye conditions like retinal disorders
caused by diabetes
• hemostatic laser surgery - bloodless incision, excision:
due to its ability to stop bleeding during surgery. A
blood vessel subjected to photocoagulation develops
a pinched point due to shrinkage of proteins in the
vessel’s wall. The coagulation restriction helps seal
off the flow, while damaged cells initiate clotting.
 Photo-vaporization
With very high power densities, instead of cooking, lasers will
quickly heat the tissues to above 100o C , water within the
tissues boils and evaporates. Since 70% of the body tissue is
water, the boiling change the tissue into a gas. This
phenomenon is called photo-vaporization.
Photo- vaporization results in complete removal of the tissue,
making possible for : • hemostatic incision,or
excision.
• complete removal of thin
layer of tissue.
Skin
rejuvenation, resurfacing
 Conditions for photo-vaporization

1.the tissue must be heated quickly to above the boiling

point of the water, this require very high intensity lasers,
2.a very short exposure time TE, so no time for heat to
flow away while delivering enough energy,

highly spatial coherence

(directionality) of lasers
over other light sources is
responsible for providing
higher intensities
Selective absorption of laser light
by human tissues
Selective absorption occurs when a given color of light is
strongly absorbed by one type of tissue, while transmitted by
another. Lasers’ pure color is responsible for selective
absorption.
The main absorbing components of tissues are: (Picture in Next Slide)
• Oxyhemoglobin (in blood): the blood’s oxygen carrying
protein, absorption of UV and blue and green light,
• Melanin (a pigment in skin, hair, moles, etc): absorption
in visible and near IR light (400nm – 1000nm),
• Water (in tissues): transparent to visible light but strong
absorption of UV light below 300nm and IR over 1300nm
Selective absorption of laser light by human tissues
 Lasers in beauty therapy

Lasers application in beauty therapy are based on:

• selective absorption of absorbing components.

• photo-vaporization process for removal of the treated
components.
 Laser skin rejuvenation

IR lasers are used to remove extremely thin layer of skin

(<0.1 mm). In the absence of pigment in general, they take
advantage of the presence of water in the skin to provide an
ability to remove skin and body tissue.
 Laser hair removal

selective absorption : absorbing component being melanin

pigment in hair and follicle, it is best worked with a red light
ruby laser. White hair can not be treated with any laser due to the
lack of absorbing component.
Laser removal of port-wine stain
Yellow laser
is absorbed
by the
presence of
hemoglobin
in blood
vessels.
Laser removal of tattoo

tattoo can be removed with

variety of laser depending
on the presence of inks in
the tattoo.
 Lasers in ophthalmology
For retina operation, visible laser can be used. Visible light is
transparent to the cornea and crystalline lens, and can be focused with
eye’s lens on the retina. The most popular visible laser is the green
argon laser. • Treatment of glaucoma: Argon laser is
focused externally on iris to make
incision, creating drainage holes for
excess aqueous humors to release
pressure,
• Retina tear: photocoagulation burn to
repair retina tears due to trauma to the
head.
• Diabetic retinopathy: inadequate
blood supply to the retina due to
diabetes. Small photocoagulation
burn by green argon laser.
 **Characteristics of laser**
• The second photon has the same energy, i.e.
the same wavelength and color as the first
– laser has a pure color
• It travels in the same direction and exactly in
the same step with the first photon
– laser has temporal coherence

Comparing to the conventional light, a laser is

differentiated by three characteristics. They are:
Directionality,
pure color,
temporal coherence.
 Dr. Satvir Chaudhary,
M.S. (Surg), MISFS, FCGP,
LLB, PgDMC.PgDHRD (PU Chd.)
Retd. Director Gen Health Services,
Haryana,
Panchkula 134109,
dr_satvir@yahoo.com
94166-12664
Ass. Prof. (Surgery)

dr_satvir@yahoo.com .... Phone 94166-12664

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