Electrosurgery (diathermy) in general practice

Re: Electrosurgery (diathermy) in general practice

Martin Atkinson — Mon, 05 Nov 2012 10:50:47 GMT

[quote user="Nicola Lawlor"][/quote]

How are those of you using these systems sterilising the handles etc?

I have an autoclavable handpiece for sterile ops and a standard one for dirty ops, the electrodes are autoclaved in a little metal box. Top tip for cleaning the tips to avoid damaging them, just hold the tip inside a small wad of wet cotton wool and press the pedal it steam cleans them . Another tip is to make a holder for the handpiece from a pocket cut from an old cotton garment, so it will hang from your instrument tray to stop is sliding off, then then pocket can be autoclaved.

Re: Electrosurgery (diathermy) in general practice

Moira Hamilton — Sun, 04 Nov 2012 18:31:41 GMT

I have no idea of the make of diathermy we use, it is a little antiquated! However it is very useful for haemostasis, though in very vascular areas, if you're not careful you can end up causing the underlying vessels damage. Our version isn't great for very delicate work, would never consider using it for entropions, etc, but it is a very useful bit of kit, though I wouldn't spend a fortune on it! I use it probably the most on epulids and hyperplastic gingivitis, though it is true that you have to be careful not too cause thermal damage as has been mentioned previously in the post. Do your homework on getting the options you would use most frequently at the best price you can, good luck. I think you'll be glad you went ahead with this purchase.

Re: Electrosurgery (diathermy) in general practice

Gerry Henry — Sun, 04 Nov 2012 12:52:25 GMT

Ellman will sell you a "box" which plugs into the unit, so that you can have both bipolar and monopolar plugged in and just switch between the two. Don't bother unless you enjoy being ripped off.

Didn't know that Evelyn, thanks. The pukka Ellman kit never fails to astonish me with its expense. lead for monopolar £130 !

Re: Electrosurgery (diathermy) in general practice

Gerry Henry — Sun, 04 Nov 2012 12:50:20 GMT

The "Single Use" hand-pieces can be cleaned and autoclaved many, many times and if you have access to Ethylene oxide sterilisation, they will last almost for ever.

LOL, I was going to add that too but didn't want to seem too much of a tight wad; the single use forceps tend to split where the wire joins the forcep so we reinforce with heat resistant tape on first use, last for ever.

Can you let me have the 'cheap' suppliers contact Malc as we're running low.

Re: Electrosurgery (diathermy) in general practice

Malcolm Ness — Sat, 03 Nov 2012 17:06:46 GMT

We use Valley Labs Force 2 in each of our theatres. Widely available second hand for 1000-1500. The machines we have are very reliable and the performance is excellent. They are widely used in human surgery in UK, Europe and US. More expensive than the Ellmann machine but much more powerful, controllable an user-friendly.

Unipolar hand-pieces and bipolar forceps are available from Valley Labs (expensive) or a range of other suppliers (cheap). The "Single Use" hand-pieces can be cleaned and autoclaved many, many times and if you have access to Ethylene oxide sterilisation, they will last almost for ever.

Despite having them available for "routine" surgery, they tend not to get used much for that though we do use them every time for cruciates, fractures, joint replacements and much cancer surgery.

Re: Electrosurgery (diathermy) in general practice

Evelyn Barbour-Hill — Sat, 03 Nov 2012 16:05:35 GMT

[quote user="Gerry Henry"]Not sure what Evelyn means by a conversion kit, our bipolars just plug into the black/green sockets.[/quote]

Ellman will sell you a "box" which plugs into the unit, so that you can have both bipolar and monopolar plugged in and just switch between the two. Don't bother unless you enjoy being ripped off.

[quote user="Gerry Henry"]To do the distichitic follicles you need excellent magnification (x 10 at least IMHO) and the special teflon coated needle; a word of warning, to avoid scarring a tap on the foot pedal should suffice.[/quote]

Well, perhaps I should try again, but I could never guarantee getting the special electrode into the follicle even with watchmaker's eyeglass.

Re: Electrosurgery (diathermy) in general practice

Gerry Henry — Sat, 03 Nov 2012 13:54:28 GMT

I use my Ellman every day, monopolar or bipolar. The forceps are packed separately and also routinely in the bigger kits. Not sure what Evelyn means by a conversion kit, our bipolars just plug into the black/green sockets. The Ellman bipolar handpieces are too fine pointed for me I prefer the broader spatulate ended ones. To do the distichitic follicles you need excellent magnification (x 10 at least IMHO) and the special teflon coated needle; a word of warning, to avoid scarring a tap on the foot pedal should suffice.

Re: Electrosurgery (diathermy) in general practice

Evelyn Barbour-Hill — Sat, 03 Nov 2012 01:02:23 GMT

But unlike Martin I could never get it to do distichiasis follicles like it's supposed to.

Re: Electrosurgery (diathermy) in general practice

Evelyn Barbour-Hill — Sat, 03 Nov 2012 00:59:50 GMT

What Martin said, except that I use it (Ellman Surgitron) for practically everything, all the time. It's no hassle at all to set up, it's there all the time. I believe the correct frequency is vital to get the very minimal tissue damage that you do on the "cutting" (fully filtered) setting (in a sense it's radiosurgery rather than electrosurgery ). So other cheaper makes with lower frequencies may not be as good.

It's great for plastic surgery of any kind because there's no drag to distort the skin and take the incision off somewhere other than what you intended. Also, in my opinion, it makes a truly sterile incision through skin rather than having a scalpel blade carry in bacteria from the surface and the sebaceous glands.

Oddly enough, I don't find the haemostatic option as useful as I thought I would. However the bipolar forceps work jolly well if you use them for haemostasis. Just don't waste the ridiculous amount of money you would pay for Ellman's crude plug-in monopolar/bipolar switch. If you really want such a switch, knock up something the same or better with the expense of a fiver on a few cheap bits from Halfords and a little solder.

I immerse the handpiece with electrode already on, and its cable, and the bipolar forceps, in MedDis for 30 minutes before commencing the operation. That appears to be adequate. The business bit of the electrode itself is of course self-sterilising.

Re: Electrosurgery (diathermy) in general practice

Hanna Bennett — Fri, 02 Nov 2012 21:42:35 GMT

not off the top of my head but can find out - wouldn't be surprised if it was vet instrumentation as they are local to us but we must have had it not far off ten years so it isn't new - replace the handpieces occasionally but the main box still works fine so they do last.

Re: Electrosurgery (diathermy) in general practice

Michael Woodhouse — Fri, 02 Nov 2012 21:33:10 GMT

Hannah - do you know what make the machine is and where you got it from?

Thanks

Re: Electrosurgery (diathermy) in general practice

Hanna Bennett — Fri, 02 Nov 2012 20:55:55 GMT

we have a lovely diathermy machine which is both bi and mono polar - monopolar for cutting and cautery, ie. entropion and pinnectomies. Bipolar is for cautery, as above, mamm strips, and bleeding vessels that are too small to tie off. i am not a big surgical type, but i absolutely love it, and it takes the nurses 2 mins to set up so no reason not to use it. The handpiees and cords are sterilisable so no issues there.

Re: Electrosurgery (diathermy) in general practice

Michael Woodhouse — Fri, 02 Nov 2012 20:46:31 GMT

[quote user="Nicola Lawlor"]

How are those of you using these systems sterilising the handles etc?

[/quote]

The Vet Inst ones are listed as 'autoclavable'

Re: Electrosurgery (diathermy) in general practice

Nicola Lawlor — Fri, 02 Nov 2012 20:37:54 GMT

How are those of you using these systems sterilising the handles etc?

Re: Electrosurgery (diathermy) in general practice

Rajat — Fri, 02 Nov 2012 19:57:20 GMT

Pretty much what Martin said

Is amazing for mammary strips and such ops. Also for gingivectomies tho can cause thermal necrosis easily. Ours gets used a lot for laparoscopic neuters etc too. Otherwise not worth the hassle setting up and all that.

Re: Electrosurgery (diathermy) in general practice

Martin Atkinson — Fri, 02 Nov 2012 19:21:10 GMT

I have an Ellman Surgitron and use it in situations where I want a fine cut with no drag or skin distortion like entropian, electrolysis of distichiasis follicles, cautery of adventitious corneal blood vessels, removal of little lumps like warts which require no suturing, gingivectomies and large wounds where I want coagulation at the same time like mastectomies. Occasionally I'll use it to cauterise little bleeders but half the time, unless its already set up, by the time the nurses have got it out they've stopped bleeding! I feel it perhaps should be used a lot more but the electrodes are fragile and expensive so it doesn't get used routinely plus although removal of potentially haemorrhagic masses seems a good indication, histopathologists don't like it because it cooks the edges of the sample. Mine is bipolar (some say I am as well!) but I very rarely use the bipolar forceps, I wouldn't pay for that feature if it wasn't standard on the kit. Hope that helps.