The difference between unipolar and bipolar resection

一、 Traditional monopolar electric resection

1. The use of hypertonic solution is prone to the risk of "water poisoning", and the operation time should be strictly controlled; The dilutional hyponatremia caused by the large amount of glucose solution absorbed by the surgical wound and rapidly metabolized into CO2 and water caused by TUR, which is the water poisoning just mentioned, is the most serious complication, with an incidence of 2.0~29.0%, which can endanger the patient's life in severe cases. Therefore, the indication for monopolar TUR will be limited by the size of the prostate and the length of the operation.

2. The surrounding tissues are greatly damaged, which significantly increases the amount of bleeding

3. In ordinary electroresection, a negative plate is required, and the current must flow through the human body in a long path, which is easy to stimulate the nerves, and the negative plate is easy to fall off and burn the patient.

4. It is easy to stimulate the obturator nerve, and when the tumor of the side wall of the bladder is resected with an electroresectoscope, the monopolar electroresection may cause the obturator nerve reflex due to the current passing through the human tissue, and if the current cannot be terminated in time, it may lead to accidental perforation.

5. With the working electrode as one pole and the human body as the one pole, the contact part between the electrode and the human body instantly forms a high temperature to produce a cutting effect. The temperature can reach 400 °C, and the heat damage is large, which can easily lead to urethral burns; When the tip of the prostate is removed, the external urethral sphincter may be damaged by thermal penetration, resulting in transient postoperative urinary incontinence.

6. Prone to electroresection syndrome.

7. Easy to stick to knives

8. There are many complications

9. Slow recovery and long hospital stay.

二、 Bipolar resectoscope

1. The use of normal saline perfusion solution during surgery, even if the liquid enters the circulatory system, may increase the heart and circulatory load, but because normal saline is compatible with the human body, it will not cause dilution hyponatremia, which has been confirmed in theory and clinical practice to reduce the occurrence of TURS and prolong the patient's tolerable operation time; Broadened its surgical indications.

2. It shortens the postoperative recovery time of patients, and reduces postoperative bladder irritation due to the limited thermal penetration of plasma electrosection, less charring of the cut surface, and less damage to the surrounding tissues.

3. Because there is no heat conduction effect, there is no current passing through adjacent organs and tissues, therefore, the tissues are not damaged, the chance of obturator nerve reflex is reduced, the patient's urinary tract irritation symptoms are also mild, and the postoperative irrigation time and indwelling urinary catheter time are significantly shorter than those of the vaporization resection group, which shortens the postoperative recovery time of patients.

4. Low temperature cutting, the surface temperature of the target tissue of plasma electrodissection cutting is only 40~70 °C, the energy is concentrated, the cutting is accurate, the hemostasis effect is good at the same time, the tissue produces a uniform coagulation layer of 0.3~1.0mm, the cutting wound is smooth, the surgical field is clear, the possibility of prostate capsular incision is reduced, and the occurrence of intraoperative tissue damage is reduced.

5. High security. The bipolar resecting mirror itself is a loop, and the high-frequency current no longer flows through the non-resecting parts of the human body, which avoids accidental electric shock accidents such as burns easily caused by monopolar resection.

6. Fast recovery and short hospital stay.

Basic principles of resectoscope

Although the appearance of the sheath, mirror and working hand piece of monopolar resection and bipolar resection is the same, the bipolar resectoscope is equipped with a surgical sheath with high perfusion flow, which is flexible in insertion operation, lightweight, superior in performance, and enhances the safety of examination and surgery. It can meet the various needs of bipolar resection surgery; Therefore, many people now use bipolar electrical cutting instead of monopolar electric cutting.

The article is excerpted from: Resectoscope Science Popularization