Principles of Electrosurgery

Simulation

Note: These activities cause smoke. Best to perform in mock operating room or other area with good ventilation, such as gross anatomy lab. Always check first with building regarding sensitivity of smoke detectors.

Station 1 - Laparoscopy

Personnel Needed: Two people

1. Turn on bovie generator and hook in foot pedal.
2. Place a flat inexpensive fatty steak on a grounding pad inside a laparoscopy trainer box.
3. Place scope in trainer and scissors and grasper in lower port.
4. Use cutting current to make incisions in meat, starting with 25 W and then work up to 50 to demonstrate different power.
5. Do with scissors open and also closed so as to use tip as bovie. Try with J hook or monopolar needle also.
6. Use cutting current to dissect fat/fascia off of the muscle using the scissors with both closed tip and then open – applying current with each cut.
7. Use coag current to see how it affects tissue.
8. Create direct coupling by touching your active electrode to your other instrument while it’s touching the meat.
9. Create capacitive coupling using "Coag" with 50 W by activating your scissors before you touch the meat. Try holding them close to your other instrument.
10. Assistant suctions smoke and holds camera.

Station 2: LEEP

Personnel needed: Two people (one person holds cup/sausage)

1. Use the sausage in the stryofoam cup to practice LEEP. (poke a cooked hot dog or sausage (cervix) about an inch through the bottom of a Styrofoam cup (vagina). One person holds this while other performs LEEP on it through colposcope.
2. Use cutting mode and vary power from 30 to 60 to 90W to see the difference in how fast it cuts and how much char/thermal damage with each current. (higher current = less char).
3. Try blend and see that it doesn’t move as fast through the tissue.

Station 3: Bovie Use for Open Cases

Personnel needed: Two people

• Set up your bovie machine.
• Use the pencil to test the currents on the chicken breasts or steak by carving your undergrad school (such as WFU, UNC, etc) letters on the meat. Do each letter differently:
  • Pure cut – low power such as 20 and higher power such as 50
  • Coag: vary power
  • Create a fulgaration effect using a pure coag current and holding the electrode a few mm away from the tissue (most generators have a fulgurate or spray button)
    • See the difference between how the current affects fat vs muscle vs fascia

Developed in association with The Association of Professors of Gynecology and Obstetrics.