Seattle disposable blades

Proper care and maintenance is a must for surgical tools like safety scalpels in Seattle. They need to be sterilized and disinfected before and after use. When it comes to instruments like scalpel, forceps, retractors etc. it is understandable that they will be used on vital body organs so you must ensure that they are completely germ free and disinfected before you end up using them. If the surgical instruments are cleaned and disinfected properly there is little to no chance of infections.

surgical scissor

Correct Use of ultrasonic scalpel in Seattle

Proper maintenance of these instruments are required in Seattle, and it also increases the life span of the instruments. This results in reducing extra costs like repairs and replacements. Also you need to make sure that the instruments which are disposable are being disposed in a proper way as per the health regulations of Seattle. You do not want them to get used by someone else. So ensure that all needles and other disposable surgical instruments are gathered and properly disposed off, since failure to do so will allow microorganisms to spread to and cause further diseases. These are some of the factors which everyone who uses operating room instruments must keep in mind; they will help in ensuring the safety of the patient as well as the other people in the Seattle area. Hospitals have proper procedures for disposing off such medical devices as well.

Laprascopy With the Harmonic Scalpel

scalpel handle types

Electrosurgery is the application of a high-frequency (radio frequency) alternating polarity, electrical current to biological tissue as a means to cut, coagulate, desiccate, or fulgurate tissue. Its benefits include the ability to make precise cuts with limited blood loss. Electrosurgical devices are frequently used during surgical operations helping to prevent blood loss in hospital operating rooms or in outpatient procedures.

In electrosurgical procedures, the tissue is heated by an electric current. Although electrical devices that create a heated probe may be used for the cauterization of tissue in some applications, electrosurgery is usually used to refer to a quite different method than electrocautery. Electrocautery uses heat conduction from a probe heated to a glowing temperature by a direct current (much in the manner of a soldering iron). This may be accomplished by direct current from dry-cells in a penlight-type device.

Electrosurgery, by contrast, uses radio frequency (RF) alternating current to heat the tissue by RF induced intracellular oscillation of ionized molecules that result in an elevation of intracellular temperature. When the intracellular temperature reaches 60 degrees C, instantaneous cell death occurs. If tissue is heated to 60-99 degrees C, the simultaneous processes of tissue desiccation (dehydration) and protein coagulation occur. If the intracellular temperature rapidly reaches 100 degrees C, the intracellular contents undergo a liquid to gas conversion, massive volumetric expansion, and resulting explosive vaporization.

Appropriately applied with electro surgical forceps, desiccation and coagulation result in the occlusion of blood vessels and halting of bleeding. While the process is technically a process of electrocoagulation, the term "electrocautery" is sometimes loosely, nontechnically and incorrectly used to describe it. The process of vaporization can be used to ablate tissue targets, or, by linear extension, used to transect or cut tissue. While the processes of vaporization/ cutting and desiccation/coagulation are best accomplished with relatively low voltage, continuous or near continuous waveforms, the process of fulguration is performed with relatively high voltage modulated waveforms. Fulguration is a superficial type of coagulation, typically created by arcing modulated high voltage current to tissue that is rapidly desiccated and coagulated. The continued application of current to this highly impedant tissue results in resistive heating and the achievement of very high temperatures - enough to cause breakdown of the organic molecules to sugars and even carbon, thus the dark textures from carbonization of tissue.

Diathermy is used by some as a synonym for electrosurgery but in other contexts diathermy means dielectric heating, produced by rotation of molecular dipoles in a high frequency electromagnetic field. This effect is most widely used in microwave ovens or some tissue ablative devices which operate at gigahertz frequencies. Lower frequencies, allowing for deeper penetration, are used in industrial processes.

RF Electrosurgery is commonly used in virtually all surgical disciplines including dermatological, gynecological, cardiac, plastic, ocular, spine, ENT, maxillofacial, orthopedic, urological, neuro- and general surgical procedures as well as certain dental procedures.

RF Electrosurgery is performed using a RF electrosurgical generator (also referred to as an electrosurgical unit or ESU) and a handpiece including one or two electrodes - a monopolar or bipolar instrument. All RF electrosurgery is bipolar so the difference between monopolar and bipolar instruments is that monopolar instruments comprise only one electrode while bipolar instruments include both electrodes in their design.

The monopolar instrument called an "active electrode" when energized, requires the application of another monopolar instrument called a "dispersive electrode" elsewhere on the patient's body that functions to 'defocus' or disperse the RF current thereby preventing thermal injury to the underlying tissue. This dispersive electrode is frequently and mistakenly called a "ground pad" or "neutral electrode". However virtually all currently available RF electrosurgical systems are designed to function with isolated circuits - the dispersive electrode is directly attached to the ESU, not to "ground". The same electrical current is transmitted across both the dispersive electrode and the active electrode, so it is not "neutral". The term "return electrode" is also technically incorrect since alternating electrical currents refer to alternating polarity, a circumstance that results in bidirectional flow across both electrodes in the circuit.

Bipolar instruments generally are designed with two "active" electrodes, such as a forceps for sealing blood vessels. However, the bipolar instrument can be designed such that one electrode is dispersive. The main advantage of bipolar instruments is that the only part of the patient included in the circuit is that which is between the two electrodes, a circumstance that eliminates the risk of current diversion and related adverse events. However, except for those devices designed to function in fluid, it is difficult to vaporize or cut tissue with bipolar instruments.

Neural and muscle cells are electrically-excitable, i.e. they can be stimulated by electric current. In human patients such stimulation may cause acute pain, muscle spasms, and even cardiac arrest. Sensitivity of the nerve and muscle cells to electric field is due to the voltage-gated ion channels present in their cell membranes. Stimulation threshold does not vary much at low frequencies (so called rheobase-constant level). However, the threshold starts increasing with decreasing duration of a pulse (or a cycle) when it drops below a characteristic minimum (so called chronaxie). Typically, chronaxie of neural cells is in the range of 0.1–10 ms, so the sensitivity to electrical stimulation (inverse of the stimulation threshold) decreases with increasing frequency in the kHz range and above. (Note that frequency of the alternating electric current is an inverse of the duration of a single cycle). To minimize the effects of muscle and neural stimulation, electrosurgical equipment typically operates in the radio frequency (RF) range of 100 kHz to 5 MHz.

Operation at higher frequencies also helps minimizing the amount of hydrogen and oxygen generated by electrolysis of water. This is especially important consideration for applications in liquid medium in closed compartments, where generation of gas bubbles may interfere with the procedure. For example, bubbles produced during an operation inside an eye may obscure a field of view.

There are several commonly used electrode configurations or circuit topologies:

With "bipolar" instruments the current is applied to the patient using a pair of similarly-sized electrodes. For example, special forceps, with one tine connected to one pole of the RF generator and the other tine connected to the other pole of the generator. When a piece of tissue is held by the forceps, the RF alternating polarity electrical current oscillates between the two forceps tines, heating the intervening tissue by the previously described synchronous oscillation of intracellular ions.

In monopolar configuration the patient is attached to the dispersive electrode, a relatively large metal plate or a flexible metalized plastic pad which is connected to the RF generator or electrosurgical unit (ESU). The surgeon uses a pointed or blade shaped electrode called the "active electrode" to make contact with the tissue and exert a tissue effect...vaporization, and it's linear propagation called electrosurgical cutting, or the combination of desiccation and protein coagulation used to seal blood vessels for the purpose of Hemostasis. The electric current oscillates between the active electrode and the dispersive electrode with the entire patient interposed between the two. Since the concentration of the RF current reduces with distance from the active electrode the current density rapidly (quadratically) decreases. Since the rate of tissue heating is proportional to the square of current density, the heating occurs in a very localized region, only near the portion of the electrode, usually the tip, near to or in contact with the target tissue.

On an extremity such as a finger, there is limited cross-sectional area to disperse the current, a circumstance which might result in higher current density and some heating throughout the volume of the extremity.

Another bipolar instrument is characterized with both electrodes on the same design, but the dispersive electrode is much larger than the active one. Since current density is higher in front of the smaller electrode, the heating and associated tissue effects take place only (or primarily) in front of the active electrode, and exact position of the dispersive electrode on tissue is not critical.

History and Use of Scalpels in Surgery

Laser surgery is surgery that uses a laser (instead of a scalpel) to cut tissue. Examples include the use of a laser scalpel in otherwise conventional surgery, and soft-tissue laser surgery, in which the laser beam vaporizes soft tissue with high water content. Laser resurfacing is a technique in which covalent bonds of a material are dissolved by a laser, a technique invented by aesthetic plastic surgeon Thomas L Roberts, III using CO2 lasers in the 1990s. The CO2 (carbon dioxide) laser remains the gold standard for the soft tissue surgery because of the ease of simultaneous photo-thermal ablation and coagulation (and small blood capillary hemostasis).

Laser surgery is commonly used on the eye. Techniques used include LASIK, which is used to correct near and far-sightedness in vision, and photorefractive keratectomy, a procedure which permanently reshapes the cornea using an excimer laser to remove a small amount of tissue. Types of surgical lasers include carbon dioxide, argon, Nd:YAG laser, and Potassium titanyl phosphate.

  1. Photochemical effect: clinically referred to as photodynamic therapy. Photosensitizer (photophrin II) is administered which is taken up by the tumor tissue and later irradiated by laser light resulting in highly toxic substances with resultant necrosis of the tumor. Photodynamic therapy is used in palliation of oesophagial and bronchial carcinoma and ablation of mucosal cancers of Gastrointestinal tract and urinary bladder.
  2. Photoablative effect: Used in eye surgeries like band keratoplast, and endartectomy of peripheral blood vessels.
  3. Photothermal effect: this property is used for endoscopic control of bleeding e.g. Bleeding peptic ulcers, oesophagial varices
  4. Photomechanical effect: used in intraluminal lithotripsy

A range of lasers such as erbium, dye, and CO2 are used to treat various skin conditions including scars, vascular and pigmented lesions, and for photorejuvenation.

Various types of laser surgery are used to treat refractive error:

Lasers are also used to treat non-refractive conditions, such as:

Laser endarterectomy is a technique in which an entire atheromatous plaque in the artery is excised. Laser recanalization of blocked arteries. other applications include laser assisted angioplasties and laser assisted vascular anastomosis.

Lasers are used to treat several disorders in foot and ankle surgery. They are used to remove benign and malignant tumors, treat bunions, debride ulcers and burns, excise epidermal nevi, blue rubber bleb nevi, and keloids, and the removal of hypertrophic scars and tattoos.

A carbon dioxide laser (CO2) is used in surgery to treat onychocryptosis (ingrown nails), onychauxis (club nails), onychogryposis (rams horn nail), and onychomycosis (fungus nail).

  1. Peritoneum-Laser is used for adhesiolysis.
  2. Peptic ulcer disease and oesophageal varices - Laser photoablation is done.
  3. Coagulation of vascular malformations of stomach, duodenum and colon.
  4. Lasers can be effectively used to treat early gastric cancers provided they are less than 4 cm and without lymph node involvement. Lasers are also used in treating oral submucous fibrosis.
  5. Palliative laser therapy is given in advanced oesophageal cancers with obstruction of lumen. Recanalisation of the lumen is done which allows the patient to resume soft diet and maintain hydration.
  6. Ablative laser therapy is used in advanced colorectal cancers to relieve obstruction and to control bleeding.
  7. Laser surgery used in hemorrhoidectomy, and is a relatively popular and non-invasive method of hemorrhoid removal.
  8. Laser-assisted liver resections have been done using carbon dioxide and Nd:YAG lasers.
  9. Ablation of liver tumors can be achieved by selective photovaporization of the tumor.
  10. Endoscopic laser lithotripsy is a safer modality compared to electrohydraulic lithotripsy.

The CO2 laser is used in oral and dental surgery for virtually all soft-tissue procedures, such as gingivecomies, vestibuloplasties, frenectomies and operculectomies. The CO2 10,600 nm wavelength is safe around implants as it is reflected by titanium, and thus has been gaining popularity in the field of periodontology. The laser may also be effective in treating peri-implantitis.

Laser spine surgery first began seeing clinical use in the 1980s and was primarily used within discectomy to treat lumbar disc disease under the notion that heating a bulging disc vaporized enough tissue to relieve pressure on the nerves and help alleviate pain.

Since that time, laser spine surgery has become one of the most marketed forms of minimally invasive spine surgery, despite the fact that it has never been studied in a controlled clinical trial to determine its effectiveness apart from disc decompression. Evidence-based data surrounding the use of lasers in spine surgery is limited primarily due to the presence of a number of challenging factors including patient selection, operative indications in the type of laser used in the procedure. As a result, the official Blue Cross of Idaho position on laser disc surgery concluded:

"Evidence on decompression of the intervertebral disc using laser energy consists of observational studies. Given the variable natural history of back pain and the possibility of placebo effects with this treatment, observational studies are insufficient to permit conclusions concerning the effect of this technology on health outcomes."

The CO2 laser is also used in gynecology, genitourinary, general and thoracic surgery, otorhinolaryngology, orthopedic, and neurosurgery.


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