Background

Bipolar coagulation is a common electrosurgery technique for hemostasis.

In microvascular and hand surgery, it requires precise hemostasis to prevent adjacent structure injury.

A specialized electrosurgical instrument uses closely spaced electrodes to create a controlled electrical current through tissue.

Bipolar coagulation uses electrical current between electrodes in forceps-like instruments to achieve coagulation.

Current flows through tissue between electrodes converts electrical energy into heat for protein coagulation.

The electrical circuit is restricted to the area between the two electrodes.

It minimized electrical current prevents complications with implanted devices.

Superior for controlling bleeding in small areas with reduced charring and sticking.

Indications

Neurosurgery

Ophthalmology

Gynecology

Urology

Cardiovascular and Thoracic Surgery

Otolaryngology

Oncology

Orthopedic Surgery

Contraindications

Presence of Flammable Substances

Inappropriate Target Tissue

Proximity to Critical Structures

Patients with Coagulation Disorders

Near Prosthetic Implants

Heat generated by the device

Implanted Electronic Devices

Inadequate Visualization

Outcomes

It achieves quick hemostasis for small vessels to minimize blood loss.

Better hemostasis reduces intraoperative and postoperative transfusions.

Bipolar coagulation limits thermal damage to surrounding tissues.

Lower burn risk than monopolar techniques enhance patient safety in surgeries.

Effective vessel sealing reduces postoperative bleeding and infection risk through coagulated tissue barriers.

Equipment required

Bipolar Electrosurgical Unit

Bipolar Instruments

Foot Pedal or Hand Switch

Insulated Cables

Visualization Tools

Ancillary Equipment

Patient Preparation

It includes medical history and diagnostic tests as part of patient preparation.

Informed Consent:

Explain the procedure’s purpose, risks, and potential complications clearly to the patient or guardians.

Patient Positioning

Position the patient to provide optimal access to the surgical site. Ensure the surgical field is dry, if alcohol-based antiseptics are used.

Technique

Step 1: Identify Target Tissue:

Locate the specific blood vessel or tissue for coagulation.

Step 2: Apply Instrument:

Gently grasp the target tissue between the tips of the bipolar instrument. Ensure a firm grip to facilitate even energy transfer.

Step 3: Activate the Bipolar Unit:

Use a foot pedal or hand switch to deliver energy. Start with the lowest effective energy setting and adjust it.

Step 4: Observe Tissue Response:

Monitor for color change and vessel collapse, which indicates successful coagulation.

Avoid overapplication of energy to prevent thermal spread.

Figure. Bipolar coagulation forceps

Complications

Tissue Damage

Charring

Persistent Bleeding

Incomplete Vessel Sealing

Instrument Malfunction

Sticking

Electrical Burns

Postoperative Scarring

Adhesion Formation

Direct Burns

Delayed Healing

Surgical Site Infection

References

Bipolar coagulation in microvascular surgery – PubMed

Bipolar coagulation in neurosurgery – PubMed

References

Bipolar coagulation in microvascular surgery – PubMed

Bipolar coagulation in neurosurgery – PubMed