Operation Manual
20 Pages
Preview
Page 1
English
Endoscopes
530/590 Series
OPERATION MANUAL (Electrosurgical Instruments)
Thank you for purchasing our product. Read this manual carefully before use to avoid unexpected accidents, and take full advantage of the product’s capabilities.
Important Safety Information
Important Safety Information 1. Warning The items that must be observed for safety when performing endoscopy or electrosurgery are identified by “ WARNING” or “ CAUTION”. Read and understand the warning information carefully, and perform the procedures correctly.
WARNING Improper use or operation of the equipment may injure patients, physicians, or people in the vicinity. Read and understand this manual carefully before operating the equipment. Improper operations that will damage only the equipment are identified by “CAUTION”.
2. About Clinical Procedures This manual assumes that the product will be used by medical specialists who have received proper training in endoscopic procedures. It does not provide information about clinical procedures. Regarding clinical procedures, use proper clinical judgment.
3. Treatment with Electrosurgical Instruments Before electrosurgery, basic in vitro experiments must be performed to learn how to tighten the snare wire properly and how repeated use affects the cutting quality of instruments.
4. Operation of the Endoscope Endoscope is a precision instrument. Unnatural force or impact on its insertion portion, flexible portion, or distal end may not only damage the instrument but also injure the inside of the patient. If you encounter any resistance, insert or operate it slowly. Do not force it in.
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Contents
Contents Important Safety Information...2 Preface...4 Conventions Used in This Manual...4 Chapter 11 Treatment with Electrosurgical Instruments... 11-1 11.1 Preparing and Inspecting Equipment and Materials... 11-2 11.1.1 Equipment and Materials to Prepare... 11-2 11.1.2 Inspecting High-Frequency Surgical Instrument... 11-4 11.1.3 Connecting Electrosurgical Instruments... 11-4 11.1.4 Setting the Conditions of Surgery... 11-6 11.2 Polypectomy... 11-7 11.2.1 Removing Polyps... 11-7 11.2.2 Extracting Removed Polyp... 11-10 11.3 Papillotomy... 11-11 Index... Index-1
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Preface
Preface This manual describes how to manipulate electrosurgical instruments when using them with the 530/590 Series Endoscopes.
Conventions Used in This Manual This manual uses the following conventions to make it easy to understand operations.
General conventions Convention
Meaning Indicates a potential danger that may harm to people.
WARNING
Explains the dangerous conditions that may cause to death or serious accident unless it is avoided.
CAUTION
Explains the conditions that may cause to light or medium injury unless it is avoided.
CAUTION
Explains the conditions that may damage to equipment unless it is avoided.
(1), (2), (3), ...
Consecutive numbers in operating procedures indicate the sequence of successive operations.
[Note]
Indicates a comment or supplementary information. Indicates a reference.
4
Chapter 11 Treatment with Electrosurgical Instruments This chapter describes procedures for using electrosurgical instruments (electric cauteries).
11.1 Preparing and Inspecting Equipment and Materials...11-2 11.1.1 Equipment and Materials to Prepare...11-2 11.1.2 Inspecting High-Frequency Surgical Instrument...11-4 11.1.3 Connecting Electrosurgical Instruments...11-4 11.1.4 Setting the Conditions of Surgery...11-6 11.2 Polypectomy...11-7 11.2.1 Removing Polyps...11-7 11.2.2 Extracting Removed Polyp...11-10 11.3 Papillotomy...11-11
11-1
Chapter 11 Treatment with Electrosurgical Instruments
Chapter 11 Treatment with Electrosurgical Instruments 11111Preparing and Inspecting Equipment and Materials
WARNING The operation of the pacemaker will be malfunctioned by the electrosurgical instruments. Always keep pacemaker users away from electrosurgical instruments. Ignition and explosion may be occurred. Replace any flammable gas in body cavities with nonflammable gas before using the electrosurgical instruments. Never use the electrosurgical instruments in atmosphere of flammable gas. [Note] Injection of excess nonflammable gas may cause gas-embolism. The injection gas volume and pressure should be determined by professional judgment.
CAUTION Burns may occur. Do not apply the current when the electrode of high-frequency surgical instrument and the metal part at the distal end of the Endoscope are in contact with each other. [Note] Check that the back end of electrode of high-frequency surgical instrument is inside the field of view of the Endoscope before applying the current.
1111111 Equipment and Materials to Prepare Prepare following equipment and materials. •• Endoscope system •• High-frequency power supply: ERBOTOM ICC 200 (made by ERBE) •• High-frequency surgical instruments •• A-Cord: Cable AC •• P-Cord: designated by ERBE •• P-Plate: designated by ERBE •• Foot switch: designated by ERBE •• Rubber gloves
11-2
Chapter 11 Treatment with Electrosurgical Instruments
High-frequency power supply: ICC 200
Endoscope system
P-Cord
Foot switch A-Cord: Cable AC
P-Plate
High-frequency surgical instrument
Rubber gloves
The S connector currently provided for the endoscope was designed to be connected to high-frequency power supply of other brands that require the S-cord for connection. For ICC 200 and other high-frequency power supply listed in the Operation Manual, there is no safety problem even if the S-cord is not connected.
11-3
Chapter 11 Treatment with Electrosurgical Instruments
1111111 Inspecting High-Frequency Surgical Instrument (((( Before using high-frequency surgical instrument, inspect •• wires for fraying and disconnection, •• tubes for cracks, and •• A-Cord for disconnection. Do not use frayed, disconnected, or cracked parts.
(((( Make sure the tip of the snare wire enters the tube with high-frequency handle pulled to the full. If the snare wire is sticking out, do not use the snare: it is defective.
1111111 Connecting Electrosurgical Instruments
WARNING Wrong connection will cause electric shock accident and burns. Connect surgical instruments correctly in accordance with the operation manual. This section describes how to connect electrosurgical instruments with FUJINON Endoscopes, taking the electric cautery ICC 200 (manufactured by ERBE GmbH) and 530/590 Series an example.
11-4
Chapter 11 Treatment with Electrosurgical Instruments
(((( Switch off high-frequency power supply.
(((( Insert power plug of high-frequency power supply into receptacle.
(((( Connect the A-Cord, P-Cord and foot switch to the high-frequency power supply.
P-Cord
A-Cord
Foot switch
(((( Firmly attach P-Plate to the skin of the patient.
11-5
Chapter 11 Treatment with Electrosurgical Instruments
(((( Connect A-Cord to A-Cord connector on high-frequency handle.
1111111 Setting the Conditions of Surgery
CAUTION Leakage current may cause burns. Operate the instruments within specified output range. Set the output of high-frequency power supply before surgery. Use the following settings. Output : 175 W or less Frequency : 500 kHz or less Voltage : 1.5 kVp-p or less
11-6
Chapter 11 Treatment with Electrosurgical Instruments
11111Polypectomy
WARNING Ignition and explosion may be occurred. Replace any flammable gas in body cavities with nonflammable gas before using the electrosurgical instruments.
CAUTION Leakage current may cause burns. Prevent patient’s body from touching electric conductor such as metal part of bed. Physicians and assistants should wear rubber gloves. Burns may occur. Do not apply the current when the electrode of high-frequency surgical instrument and the metal part at the distal end of the Endoscope are in contact with each other. 1111111 Removing Polyps (((( Bring polyp to be removed into field of view.
(((( Pull snare handle and insert snare wire at the tip into tube.
11-7
Chapter 11 Treatment with Electrosurgical Instruments
(((( Insert snare slowly through forceps inlet, checking the process on monitor.
(((( When the wire appears from distal end of the Endoscope, stop insertion.
(((( Push high-frequency handle toward distal end of the Endoscope to let snare wire out of tip of tube.
(((( Pass snare wire around polyp, and pull handle to eliminate play between snare wire and polyp.
11-8
Chapter 11 Treatment with Electrosurgical Instruments
(((( Move tube near forceps inlet to check that snare wire is gripping the polyp.
(((( To prevent a high-frequency current from flowing to any other area than the area to be cauterized, check the following four points: •• The back end of wire is inside the field of view. •• No excess mucus adheres to the wire. •• No excess substance adheres to the lens and the view is clear. •• The polyp to be removed and the snare wire are not in contact with any mucous membranes that are not targeted. (((( Set current waveform and output for cauterization. “11.1.4 Setting the Conditions of Surgery” (p.11-6)
ERBE
ICC 200
AUTO CUT
AUTO COAG
EFFECT
4 FORCED
3 MAX. WAT T FEHLDOSIERUNG OUTPUT ERROR
2
EINSCHALTDAUER TIME LIMIT
1
NESSY
MAX. WATT SOFT
BIPOLAR
AUTO START
ENDO-CUT
NEUTRAL
CUT / COAG
BIPOLAR
(((((Press foot switch to apply current. Current flows only while the foot switch is being pressed. While pressing foot switch, pull handle slowly to close snare wire gradually. The polyp is removed.
11-9
Chapter 11 Treatment with Electrosurgical Instruments
(((((Pull out the snare wire after inserting tip of snare wire into tube by pulling high-frequency handle.
1111111 Extracting Removed Polyp (((( Insert a grasper (basket forceps, alligator forceps, threejaw forceps, etc.) through forceps inlet, monitoring the process on screen.
(((( Grip polyp to extract, with grasper.
(((( Draw gripped polyp to distal end of the Endoscope.
11-10
Chapter 11 Treatment with Electrosurgical Instruments
(((( Pull out scope with polyp held at its distal end.
(((( Take out polyp by opening the grasper.
11111Papillotomy
WARNING Ignition and explosion may be occurred. Replace any flammable gas in body cavities with nonflammable gas before using the electrosurgical instruments.
CAUTION Leakage current may cause burns. Prevent patient’s body from touching electric conductor such as metal part of bed. Physicians and assistants should wear rubber gloves. Burns may occur. Do not apply the current when the electrode of high-frequency surgical instrument and the metal part at the distal end of the Endoscope are in contact with each other.
11-11
Chapter 11 Treatment with Electrosurgical Instruments
(((( Bring papilla into field of view.
(((( Loosen and straighten wire at tip of papillotomy knife by operating the handle of high-frequency surgical instrument.
(((( Raise forceps elevator of the Endoscope.
(((( Insert papillotomy knife slowly through forceps inlet, checking endoscopic image.
11-12
Chapter 11 Treatment with Electrosurgical Instruments
(((( When papillotomy knife hits forceps elevator, stop insertion.
(((( Put forceps elevator down, and let tube of papillotomy knife protrude 3 to 5 mm.
(((( Raise forceps elevator, and bring tip of papillotomy knife into field of view.
(((( Insert tip of papillotomy knife into papilla.
11-13
Chapter 11 Treatment with Electrosurgical Instruments
(((( To prevent a high-frequency current from flowing to any other area than the area to be cauterized, check the following three points: •• The back end of wire is inside the field of view. •• No excess mucus adheres to the wire. •• No excess substance adheres to the lens and the view is clear.
(((((Set current waveform and output for cautery. “11.1.4 Setting the Conditions of Surgery” (p.11-6)
ERBE
ICC 200
AUTO CUT
AUTO COAG
EFFECT
4 FORCED
3 MAX. WAT T FEHLDOSIERUNG OUTPUT ERROR
2
EINSCHALTDAUER TIME LIMIT
1
NESSY
(((((Pull the end wire of papillotomy knife out after loosening it until it is straight by operating the high-frequency handle.
11-14
BIPOLAR
AUTO START
ENDO-CUT
NEUTRAL
(((((Orient papillotomy knife with respect to papilla. Press foot switch to apply current. Current flows only while foot switch is being pressed. While pressing foot switch, operate papillotomy knife to cut papilla.
MAX. WATT SOFT
CUT / COAG
BIPOLAR
Index
Index <A> A-Cord...11-3, 11-5, 11-6 <C> Caution...2, 4 Clinical procedures...2 Conditions of surgery... 11-6 Connection... 11-4 Current waveform... 11-9 <E> Electrosurgical Instruments... 11-2 <F> Foot switch... 11-3, 11-5 <H> Handle... 11-4 High-frequency power supply... 11-3, 11-5 High-frequency surgical instrument... 11-3 <I> ICC 200... 11-4 <P> P-Cord... 11-3, 11-5 P-Plate... 11-3, 11-5 Papillotomy... 11-11 Papillotomy knife... 11-12 Polypectomy... 11-7 <S> Snare... 11-4 <W> Warning...2, 4
Index-1