Reasonable Application of Medical High-frequency Electric knife and Argon Plasma ESU

Reasonable Application of Medical High-frequency Electric knife and Argon Plasma ESU

Medical high-frequency electric knife and argon plasma ESU have been widely used in both open surgery and endoscopic surgery.

Each type of electric knife has its own characteristics, and different electric knives are selected to achieve different surgical effects for different lesions

1.Benefits of using medical high-frequency electric knives under endoscopy:

Through the endoscope interface, the use of high-frequency electric knife under endoscope has obvious advantages, which can reduce a lot of unnecessary pain. 

Besides less trauma, it can also speed up the operation process, reduce the labor intensity of medical staff, reduce or avoid surgical bleeding, and alleviate the pain of patients. 

High frequency electrocautery is also effective in removing lesions, achieving the goal of radical cure.

2.Advantages of using argon gas knife under endoscopy

Argon knife is a non-contact surgical treatment method, which works by spraying argon ions onto the surface of the lesion in a radial pattern, with a large area of action and tissue damage depth not exceeding 1mm, for treatment. For some diseases discovered under endoscopy, what instruments should be used for treatment, and how to use the advantages of high-frequency electric knife and argon gas knife to perform surgery under endoscopy, so as to remove the lesions with minimal damage, requires close cooperation between the electric knife host and various accessories.

3.Precautions for using high-frequency electric knives under endoscopy

Taking argon gas knife as an example, the "mixed cutting" mode is generally selected, and a snare is connected for polyp resection, with a power of less than 30W; For incisions or wounds, adjust the electrocoagulation mode to spray coagulation, and use argon gas spray coagulation with a power of less than 25W.

In addition, it is important to note that during endoscopic surgery, the entire surface of the neutral electrode must be tightly and reliably attached to the appropriate part of the patient's body as much as possible.

4.Precautions for using high-frequency argon gas knife under endoscopy

Generally, the argon gas is set at 1-2L/min, and the coagulation power is 5-25W. The argon electrode probe is inserted through the endoscope clamp channel, and the coagulation electrode must extend out of the endoscope clamp channel, otherwise it will cause damage to the endoscope. At a distance of about 2-3mm from the lesion, argon gas should be sprayed for 1-3 seconds each time until the lesion turns golden brown. Try to choose smaller power and control.

5.Through several specific cases, we can intuitively understand how to choose specific instruments

(1) Cervical polyps: High frequency electrocautery is generally suitable, and a snare should be inserted under endoscopy. The cross-sectional area of the electrocautery should be close to the polyp side and not tightly attached to the intestinal wall. For long pedunculated polyps, it should be tightened at a distance of more than 3mm from the intestinal wall.

The position selection of the snare is crucial. When the snare has not been selected for the electric cutting position, do not tighten it too tightly. If it is tightened too tightly, it can cause premature mechanical cutting and bleeding. It is important to control the tip of the mirror to keep the trapped polyp within the field of view.

(2) Cervical polyps: Some broad-based polyps with a diameter less than 0.5cm can be removed using hot biopsy forceps or directly coagulated with argon gas. Grasp the polyp with a hot biopsy forceps, then cut off the polyp, or use an argon knife to apply argon gas spray coagulation until the polyp turns a burnt yellow color.

It is appropriate to use a snare to remove sessile polyps with a diameter of 0.5-1.0cm.

For sessile polyps with a diameter greater than 2.5cm, the method of using a snare to cut them in blocks and stages should be adopted, generally divided into 3-6 stages, with continuous block cutting. Block cutting involves placing one side of the snare wire at the connection between the polyp and normal mucosa, and the other side resting on the high part of the polyp. Tighten the majority surrounding the head of the polyp, apply electrocoagulation current, and cut it off.

The specific type of electric knife to be used in clinical practice depends on the specific situation, so high-frequency electric knives and argon gas knives should be used reasonably in endoscopic surgery.