Basic knowledge in plasma surgery Argon plasma coagulation

Principles of plasma surgery Argon gas Argon plasma with arc beam Schematic illustration of monopolar argon plasma coagulation The argon gas is ignited at the electrode of the APC probe, the ionized argon plasma transfers the energy to the target tissue ARGON PLASMA COAGULATION Argon plasma coagulation (APC) is an electrosurgical procedure. Here, high frequency alternating current is transferred to the target tissue from the tip of the probe via the ionized argon gas. This procedure reliably arrests bleeding with an effective and metered surface coagulation and devitalizes tissue. The APC is...

Tissue effects The tissue effect of the APC is provided by the current which flows through the tissue and the resulting endogenous heating. One distinguishes between various thermal effect zones in the tissue, depending on the achieved target temperature. 1. Hyperthermia, 2. Ablation 3. Coagulation/Dessication, 4. Carbonization and 5. Vaporization. above approx. 1 Hyperthermia 2 Ablation 3 Coagulation/Desiccation The tissue effect spreads radially in depth.4 FACTORS INFLUENCING THE TISSUE EFFECT1,4 The degree of the thermal effect of the APC on the tissue depends on several factors. The most...

Tissue effects Duration of application APPLICATION TIME – THE MOST IMPORTANT FACTOR 2-7 The longer the APC is activated, the deeper the effect on the target tissue. For this reason, we recommend starting with short activation times and to increase the duration step by step up until the desired effect is achieved. In case of longer APC application at a single point, the depth effect increases strongly and if the application duration is too long, the tissue may be carbonized and perforated. The coagulation depth is dependent on the power setting and should be set according to the localization and...

Probe distance to tissue [mm] ● pulsedAPC/E1/25 W ● pulsedAPC/E2/25 W ● preciseAPC/E2 PROBE DISTANCE 2-7 The greater the probe distance, the lower the penetration depth. If the probe distance increases, a point can be reached where ignition is no longer possible. FURTHER FACTORS: TYPE OF TISSUE 2-7 The structures of biological tissue differ in their sensitivity, which has to be considered with electrosurgery and particularly with APC in the power setting and application duration. 2 Eickhoff A, Repici A, Manner H, Enderle, MD. Electrosurgical Pocket Guide for GI Interventions; Erbe Elektromedizin...

APC modes The constant voltage control of the plasma modes enables consistent quality and reproducibility of the tissue effects.22 Effective devitalization with forcedAPC The preciseAPC® mode used in thin-walled structures The pulsedAPC® mode used for tissue ablation and coagulation This mode offers effective coagulation and devitalization. The HF power is voltage-controlled up to 120 Watt and is applied as a continuous energy transfer. Unlike forcedAPC, preciseAPC® operates in the lower energy range. This allows uniform coagulation effects to be precisely adjusted in the target tissue, which...

Applications Applications in flexible endoscopy, gastroenterology and pneumology 5 Taghavi SA, Soleimani SM, Hosseini-Asl SM et al. Adrenaline injection plus argon plasma coagulation versus adrenaline injection plus hemoclips for tre-ating high-risk bleeding peptic ulcers: a prospective, randomized trial. Can J Gastroenterol 2009; 23(10): 699 – 704. 6 Wang HM, Hsu PI, Lo GH et al. Comparison of hemostatic efficacy for argon plasma coagulation and distilled water injection in treating high-risk bleeding ulcers. J Clin Gastroenterol 2009; 43(10): 941 – 945. 7 Herrera S, Bordas JM, Llach J et al....

Extensive homogenous coagulation with APC Applications in gynecology, urology and general surgery Low smoke formation in argon-assisted cutting ☑☑ Coagulation of extensive bleeding in breast surgery (Fig. 1) ☑☑ Argon-assisted resection of mammary layers and mammary gland tissue (Fig. 2) ☑☑ Coagulation of a resection base in partial nephrectomy (Fig. 3) ☑☑ Coagulation of the liver bed base with the APC function of the APCapplicator (Fig. 4) ☑☑ The liver capsule is opened with an argon-assisted incision. (Fig. 5) Diffuse surface coagulation with APC Extensive homogenous coagulation with APC Good...

Erbe products* for plasma surgery The Erbe equipment for plasma surgery consists of the workstation with VIO® 3 and APC 3 as well as open surgical, laparoscopic and endoscopic probes and applicators. The workstation supports the instruments and applications with the forcedAPC, preciseAPC® and pulsedAPC® modes. Virtually all indications can be treated with these modes, ranging from selective flat coagulation of minor bleeding to the devitalization of extensive lesions. FiAPC®probes in various lengths and designs. Beam forms The APCapplicator and its functions covers numerous procedures in the...

The electrosurgery workstation with the electrosurgery unit VIO® 3 and APC 3 on a Cart. The APC 3 is operated via the display of the VIO® 3. THE DIRECT LINK TO THE WEBCAST "THE FUNDAMENTALS OF ELECTROSURGERY IN ENDOSCOPY" BY PD DR. AXEL EICKHOFF Further products can be found on our website at www.erbe-med.com

Important information We have prepared this document with care. Nonetheless, we cannot completely rule out errors in this document. The information, recommendations and other data („Information“) contained in this document reflect our state of knowledge and the state of science and technology at the time of preparing the document. The information is of a general nature, non-binding and serves solely for general information purposes and does not represent instructions for use or notes on application. The information and recommendations contained in this document do not constitute any legal obligations...