止血鑷子を用いた接触凝固時の電気メス熱傷原因とその防止対策に関する研究

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Electrosurgery is one of the most useful methods of surgical treatment for skin-tissue incision under hemostasis. The monopolar output of electrosurgery is primarily designed for the cutting and coagulation of skin-tissue by flowing high-energy radio-frequency current between the active electrode and the dispersive electrode. There are two kind of techniques used for electrosurgical coagulation, i. e., fulguration and desiccation. Fulguration is electronic sparking to tissue without significant cutting for the purpose of coagulating large bleeders. Desiccation is low power coagulation without sparking.The portion of the dispersive electrode having a small area presents a high current density to the patient tissue, often causing burn injuries.It is usually assumed that latex surgical gloves are good protection as an isolator against the low frequency of the power supply, but having electrosurgery the surgeon's or assistant's hand can be often burned or shoked through surgical gloves.When the surgeon makes contact with the active electrode to the hemostatic forceps under poor conditions the assistant has created when the touching the tissue of patient, the capacitive leakage current can return to dipersive electrode via the assistant's hands causing burn injuries.In this paper, we studied some causes of burn injuries on the assistant's hand by metal forceps when using the electrosurgical dessication technique.We tride to make the following isolated forceps : teflon coated forceps (<350 μm), nylon coated forceps (<450 μm) and teflon composite forceps (2 mm).The results obtained are mainly as follows : 1) When the assistant removes these forceps for tissue during electrosurgery, the leakage current throgh his handtends to radically increase.2) We tried to make the teflon or nylon coating as thick as possible to decrease the leakage current through the assistant's hand.3) Special composite forceps made thick for a low dielectric constant are the most useful to protect against burn injuries to the assistant.4) By double gloving we can expect to decrease the leakage current by about 17 percent as compared with single gloving.
日本医療機器学会の論文
1993-06-01

止血鑷子を用いた接触凝固時の電気メス熱傷原因とその防止対策に関する研究

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