HARMONIC SCALPEL PROBE
What is harmonic scalpel ? how to do its assemble?
Harmonic scalpel probe
Harmonic scalpel its means it work like and cut like scalpel (blade) but this name is trade name which belongs to the ethicon company but it technically name is ultrasonic generator or ultrasonic dissector which is correct name we used.
Harmonic scalpel produce energy like friction energy for example we rub our both hand and its proceduce heat. Exactly same way energy proceduce in this.
It has friction energy due to which there is no chance of burn means electrical burn there may be heat but not electric current.
Harmonic scalpel has a transducer and it has piezoelectric crystal once it particular frequency of electric current is transfer to this, then there is a knob which has vibrating and there is linear vibration as we know piezoelectric crystal is even your hand watch even in many use of technology piezoelectric crystal is very one good property of that its vibrate at 50000Hz vibration per second. This may use to produce ultrasound that is in ultrasound machine also.
Probe of the ultrasound machine there is piezoelectric crystal and one its vibrate it produce ultrasound once its enter into the abdomen or any where then there is a fluid medium like stones like bone it reflected back and that over ultrasound machine is sensing as a black and gives, we different image.Same technology inside the harmonic machine in its piezoelectric crystal linear vibrate and due to which vibration, have the coagulation and cutting.
-Parts of harmonic forcep:
Harmonic scalpel has two jaws first is vibrating jaw and second is teflon jaw. vibrating jaw is straight and its active jaw and another is moving jaw this is intactive jaw. only for bring the and hold the tissue and helps to comes to near active jaw.
one surgeon will close the forcep handle, and press it will keep the tissue the contracting the vibrating jaw and here is the hold it. With the help of three finger and thumb and three finger close the handle and open and index finger for rotate the jaw then tip of scalpel rotate in 360° in all direction.
Maximum and Minimum written in the forcep handle,Maximum option is for cutting and minimum option is for coagulation but always remember that harmonic scalpel never cut alone and never coagulate alone cutting and coagulation both done parallel to each other thats why cutting and coagulation both written here.
Minimum can set 50,000Hz to 25,000Hz
and 35,000 to 45,000 vibration per second. Its depends on surgeon choice and which frequency is comfortable and good for cutting and coagulation.
Maximum is always 55,000Hz vibration per second. When will press minimum there will be more coagulation delayed cutting and surgeon will press maximum there will be faster cutting and less coagulation.
How to assemble the harmonic scalpel with harmonic machine :
Transducer cableFirst we Take a transducer and attach behind the forcep probe after that you will rotate it to just fix the transducer with probe.
After the fix the transducer there is a tightner or key, insert the key from the tip of scalpel inside till the end part of the forcep shaft then hold the transducer and than this key rotate three times after that should be three click sound its enough no more rotate than three times than take out and key.
After that attach the probe another end part of the cable to the machine don't rotate the it will be fix insert straight end part of the transducer than attached. once attached machine have to switch on machine. Remember always attach and assemble first than switch on and start the machine. 
After the switch on machine before starting the surgery device test and instrument test when its on and now it will become switch on then its ready for performing surgery. And foot switch keep on the right or left foot of the surgery where surgeons ask to place.
Then machine asking for activate the
instruments then keep the jaw open and then press it and if the probe is broken, shaft is band and having blood resistance, it will reject the hand instruments that why test it before starting the surgery.
Once keep it pressing it will give sound and it will checked. Now its ready surgeon can perform the surgery instruments and probe is ready.
After that we have a only one adjustment in this machine that can adjust frequency of minimum from 10000Hz to 50000Hz. maximum we cannot change, frequency of maximum always will be 50000Hz and frequency of minimum can change.
At the time of cutting uterine artery or hard tissue and that time we have not bipolar or ligasure and surgeon wants to use harmonic that frequency of minimum should be keep it 1 (10, 000) vibration per second than hold the tissue in between the jaw and keep it press it maximum and cut.
When touch the teflon jaw nothing happens so active jaw is only vibrating jaw and you hold it tissue teflon jaw towards the safer area you can see some smoke is due to the heat produce and that will give white smoke means water vapours and fractured cytoplasm because its breake hydrogen bond it will do the dissection so. It is very good to cut tissue and coagulate.
Harmonic scalpel probe used in:
Laparoscopic cholecystecyomy
Laparoscopic myomectomy
Laparoscopic hysterectomy
Laparoscopic colpectomy
Laparoscopic nephrectomy etc.
Precautions during the surgery :
Active jaw will never touch any other surrounding tissue for example surgeon using for cystic duct and active jaw just near and touching the cystic artery then it can be fracture the artery then bleeding can start that can called knocking effect of harmonic.
When active jaw touching the bowel can perforate the bowel.
Harmonic scalpel doesn't work is active bleeding or lots of bleeding if during the surgery have lots of active bleeding this instruments doesn't work those suitation can be use bipolar or ligasure it is not a vessel siller it is dissector it is a basically scalpel.
Harmonic seal upto 7mm up to vessels, lymphatic and tissue bundles.
-Benefits of harmonic scalpel :
Reduce blood loss compared to sutures and clips
Reduce patient length of compared to suture
Reduce procedure time compared to suture.
-Don't use this forcep for blunt dissection
Disclaimer : This content for education purpose only and is not intended as a medical advice while we strive for 100% accuracy, error may occur, technology and protocols can change over time.
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