Jinekolojik Cerrahide Kullanılan Enerji Modaliteleri
Özet
Bu çalışma, jinekolojik cerrahide kullanılan elektrocerrahi tekniklerini, temel mekanizmalarını, klinik uygulamalarını ve güvenlik protokollerini kapsamlı bir şekilde incelemektedir. Elektrocerrahi, yüksek frekanslı elektrik akımı kullanarak dokunun kesilmesi ve koagüle edilmesi esasına dayanır; bu süreç monopolar veya bipolar sistemlerle gerçekleştirilir. Monopolar cerrahide akım hastanın vücudundan geçerek döngüyü tamamlarken, bipolar cerrahide akım sadece aletin iki elektrotu arasındaki dokuyla sınırlıdır. Cihazlarda "cut" (kesme) ve "koagülasyon" olmak üzere iki ana mod bulunur; kesme modu sürekli düşük voltajla vaporizasyon sağlarken, koagülasyon modu kesintili yüksek voltajla desikasyon oluşturur. Klinik başarıyı artırmak ve lateral termal yayılım, kapasitif kuplaj ile yalıtım hataları gibi komplikasyon risklerini en aza indirmek için geri dönüş elektrotu izleme sistemleri ve aktif elektrot izleme gibi güvenlik araçlarının kullanımı kritik önem taşır. Ayrıca, kardiyak implantı olan hastalarda elektromanyetik paraziti önlemek için alternatif hemostatik yöntemlerin tercih edilmesi önerilir.
This study comprehensively examines electrosurgical techniques used in gynecological surgery, their basic mechanisms, clinical applications, and safety protocols. Electrosurgery is based on cutting and coagulating tissue using high-frequency electrical current, which is performed through monopolar or bipolar systems. In monopolar surgery, the current passes through the patient's body to complete the cycle, whereas in bipolar surgery, the current is restricted to the tissue between the two electrodes of the instrument. The devices feature two primary modes, "cut" and "coagulation"; the cut mode provides vaporization via continuous low voltage, while the coagulation mode creates desiccation through intermittent high voltage. To optimize clinical outcomes and minimize the risk of complications such as lateral thermal spread, capacitive coupling, and insulation failures, utilizing safety tools like return electrode monitoring systems and active electrode monitoring is of critical importance. Furthermore, choosing alternative hemostatic methods is recommended to prevent electromagnetic interference in patients with cardiac implants.
Referanslar
Massarweh NN, Cosgriff N, Slakey DP. Electrosurgery: history, principles, and current and future uses. J Am Coll Surg. Mart 2006;202(3):520-30.
Tucker RD, Schmitt OH, Sievert CE, Silvis SE. Demodulated low frequency currents from electrosurgical procedures. Surg Gynecol Obstet. Temmuz 1984;159(1):39-43.
Wu MP, Ou CS, Chen SL, Yen EY, Rowbotham R. Complications and recommended practices for electrosurgery in laparoscopy. Am J Surg. Ocak 2000;179(1):67-73.
Alkatout I, Schollmeyer T, Hawaldar NA, Sharma N, Mettler L. Principles and safety measures of electrosurgery in laparoscopy. JSLS. Mart 2012;16(1):130-9.
Lu S, Xiang J, Qing C, Jin S, Liao Z, Shi J. Effect of necrotic tissue on progressive injury in deep partial thickness burn wounds. Chin Med J (Engl). Mart 2002;115(3):323-5.
Sutton PA, Awad S, Perkins AC, Lobo DN. Comparison of lateral thermal spread using monopolar and bipolar diathermy, the Harmonic Scalpel and the Ligasure. Br J Surg. Mart 2010;97(3):428-33.
Emam TA, Cuschieri A. How safe is high-power ultrasonic dissection? Ann Surg. Şubat 2003;237(2):186-91.
Mayooran Z, Pearce S, Tsaltas J, Rombauts L, Brown TIH, Lawrence AS, vd. Ignorance of electrosurgery among obstetricians and gynaecologists. BJOG. Aralık 2004;111(12):1413-8.
Taheri A, Mansoori P, Sandoval LF, Feldman SR, Pearce D, Williford PM. Electrosurgery: part I. Basics and principles. J Am Acad Dermatol. Nisan 2014;70(4):591.e1-591.e14.
Taheri A, Mansoori P, Sandoval LF, Feldman SR, Pearce D, Williford PM. Electrosurgery: part II. Technology, applications, and safety of electrosurgical devices. J Am Acad Dermatol. Nisan 2014;70(4):607.e1-607.e12.
LeBlanc KA. Laparoscopic incisional and ventral hernia repair: complications-how to avoid and handle. Hernia. Aralık 2004;8(4):323-31.
Vilos GA. Intrauterine surgery using a new coaxial bipolar electrode in normal saline solution (Versapoint): a pilot study. Fertil Steril. Ekim 1999;72(4):740-3.
Nduka CC, Super PA, Monson JR, Darzi AW. Cause and prevention of electrosurgical injuries in laparoscopy. J Am Coll Surg. Ağustos 1994;179(2):161-70.
Presthus JB, Brooks PG, Kirchhof N. Vessel sealing using a pulsed bipolar system and open forceps. J Am Assoc Gynecol Laparosc. Kasım 2003;10(4):528-33.
Jacobs VR, Morrison JE, Paepke S, Kiechle M. Body piercing affecting laparoscopy: perioperative precautions. J Am Assoc Gynecol Laparosc. Kasım 2004;11(4):537-41.
American Society of Anesthesiologists. Practice advisory for the perioperative management of patients with cardiac implantable electronic devices: pacemakers and implantable cardioverter-defibrillators: an updated report by the american society of anesthesiologists task force on perioperative management of patients with cardiac implantable electronic devices. Anesthesiology. Şubat 2011;114(2):247-61.
Carbonell AM, Joels CS, Kercher KW, Matthews BD, Sing RF, Heniford BT. A comparison of laparoscopic bipolar vessel sealing devices in the hemostasis of small-, medium-, and large-sized arteries. J Laparoendosc Adv Surg Tech A. Aralık 2003;13(6):377-80.
Manouras A, Markogiannakis HE, Kekis PB, Lagoudianakis EE, Fleming B. Novel hemostatic devices in thyroid surgery: electrothermal bipolar vessel sealing system and harmonic scalpel. Expert Rev Med Devices. Temmuz 2008;5(4):447-66.
Lyons SD, Law KSK. Laparoscopic vessel sealing technologies. J Minim Invasive Gynecol. Haziran 2013;20(3):301-7.
Verdaasdonk RM, van Swol CF. Laser light delivery systems for medical applications. Phys Med Biol. Mayıs 1997;42(5):869-94.
Hulka JF, Levy BS, Parker WH, Phillips JM. Laparoscopic-assisted vaginal hysterectomy: American Association of Gynecologic Laparoscopists’ 1995 membership survey. J Am Assoc Gynecol Laparosc. Şubat 1997;4(2):167-71.
Feldman LS, Brunt LM, Fuchshuber P, Jones DB, Jones SB, Mischna J, vd. Rationale for the fundamental use of surgical EnergyTM (FUSE) curriculum assessment: focus on safety. Surg Endosc. Kasım 2013;27(11):4054-9.
Vilos G, Latendresse K, Gan BS. Electrophysical properties of electrosurgery and capacitive induced current. Am J Surg. Eylül 2001;182(3):222-5.
Montero PN, Robinson TN, Weaver JS, Stiegmann GV. Insulation failure in laparoscopic instruments. Surg Endosc. Şubat 2010;24(2):462-5.
