ALSA Excell 400 MCDSe User manual

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USER MANUAL FOR EXCELL 400 MCDSe
BIPOLAR
BIP
EXCELL
400 MCDS
PED
PED-BIPPED PED-2PED-1
MAN-2MAN-1
BIPOLARMONOPOLAR
N.P.MONOPOLAR
alsa
PED-2
MAN-2
PED-1
MAN-1
BIP
MONO
HF LEAKAGE
MICRO
MACRO
MICRO AUTOBLEND
PURE
PIN POINT CONTACT
FULG FORCED
SPRAY
SOFT
BLEND-1
PURE
BLEND-2
ENDO
N.P. PROGRAM BIPOLARMONOPOLAR
46538721
H
G
FEDCBA
I
COAG
CUT
COAGCOAG
CUT
e
Control devices, Connection sockets, and Symbols
AAlarm Led for the neutral plate safety circuit (red)
BArea for memories setting (storage key and selection/shifting keys )
CArea of selection and regulation of the Monopolar Cut/Coagulating Cut
DArea of selection and regulation of the Monopolar Coagulation
EArea of selection and regulation of the Bipolar Cut/Coagulating Cut
FArea of selection and regulation of the Bipolar Coagulation
GAlarm Led for the HF leakage currents control circuit
HSetting of the standard twin foot-switch pedal functioning PED
ILed for bipolar output
1Socket PED for the twin foot-switch pedal connection (standard for the activation of the monopolar or bipolar currents)
2Socket PED-BIP for the twin foot-switch pedal connection (non standard, and only for the activation of the bipolar currents)
3Socket MAN-1 for the connection of the monopolar hand-switch handles
4Socket MAN-2 for the connection of the monopolar hand-switch handles
5Socket PED-1 for the connection of the monopolar electrodes cables with activation by foot-switch pedals
6Socket PED-2 for the connection of the monopolar electrodes cables with activation by foot-switch pedals
7Socket N.P for the connection of the neutral electrode cable
8Socket BIP for the connection of the bipolar electrodes cable
b1 At disposal
b2 General mains switch (green-0/I)
b3 Socket for the mains cable with fuse block
b4 Plug for the equipotential connection
b5 Rotating regulator of the start delay of the bipolar Micro Auto coagulation (from instantaneous mode to 5sec max.)
b6 Rotating regulator of the acoustic signals intensity for the activation of the cut and coagulation
b7 Connector for interconnection to the Argon gas module
Earth protection (inside) Alternating current Attention: read the user manual
Apparatus of Class I Type CF, protected against the defibrillator effects (a CF type unit guarantees the highest safety level against direct and
indirect contacts, notably for the allowable leakage currents). The applied part type F (floating) is protected from the earth at high and low
frequencies. This kind of unit is especially indicated for direct heart application.
b1
b7

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This unit is manufactured by ALSA Apparecchi Medicali s.r.l. – via C. Bonazzi, no.16 – 40013 Castel Maggiore (Bologna - Italy), which is
responsible for its safety, reliability, and performances, but only if the additions, the recalibrations, the alterations or the repairs are carried
out by its authorized personnel who uses original spare parts, and only if the unit is installed according to the given instructions in an area
that meets the norms IEC/CEI.
On request, ALSA can provide the user with the electric diagrams and/or any further information which is necessary.
Keep this manual with the unit, read it carefully before using the equipment, and ask for it again in case of loss. If it is not
exhaustive for the specific needs of the application field, get in touch with the Manufacturer, directly or through the local
distributor, before using the apparatus.
According to the requirements of the European Directive for Medical Devices 93/42 CEE, and in compliance with the procedures of
the Company Quality System for the after-sale control of the production, the users are kindly invited to inform ALSA about any
problem, even the smallest one, related to the unit, in order to allow ALSA to intervene as soon as possible.
INTRODUCTION
In a biological tissue crossed by the electric current, three effects are usually generated: Thermal, Faradic, and Electrolytic.
By using high frequency electric current, higher than 300kHz, the faradic effect is almost completely eliminated, while the electrolytic one is
kept, even if with no practical result. So, the most used is the thermal one. When an electric current having such characteristics crosses with
sufficient density the cellular liquid of the tissues, it warms it and generates what follows:
1) a heating, which is so rapid that the vapour pressure into the cells breaks their membranes and provokes their division (pure cut);
2) a heating, which is slower, and which permits to the liquid to evaporate very slowly; in this way, the coagulating parts of the tissues can
coagulate (coagulation);
3) a process which is in the middle between the two phenomena described above (coagulating cut).
The use of the HF current presents also some risks that must be known, because their possible reduction depends also on users’ behaviour:
-undesired burns on the patient tissues (i.e. where the neutral electrode is placed because of non homogeneous / insufficient contact, or
in any other zone because of anomalous contacts / use of water mattresses / contacts of patient with the metallic parts of the operating
table )
-undesired burns on the operator tissues (i.e. into the hand, because of an insulation leakage into the coagulation monopolar forceps);
-interferences with the functioning of other equipments (i.e. video systems) or implanted devices (pace-makers);
-slight neuromuscular stimulations, notably with coagulation currents, both in the contact point of the active electrode and in the contact
point of the neutral electrode. These stimulations are felt by patients as “electrical discharges”.
DIRECTIONS FOR USE
In the field of normal electro-surgery, with only the High Frequency currents, the Excell 400MCDSe allow to perform all kinds of
Monopolar Cut (Pure or Coagulating), Monopolar Coagulation (at low, medium, and high voltage), Bipolar Cut (Pure or Coagulating),
Bipolar Coagulation (Micro, Macro, sealing of vessels, etc.), during major and medium surgery interventions into the operating theatre (open
sky surgery, minimum invasive surgery, endoscopic surgery), or in any other similar place. The application medical fields of this model are
the following ones:
GYNAECOLOGY, HEART SURGERY, ORTHOPAEDICS, NEUROSURGERY, OTORHINOLARYNGOLOGY, UROLOGY,
MAXILLOFACIAL SURGERY, DERMATOLOGY, PLASTIC SURGERY, VASCULAR SURGERY, GENERAL and THORACIC
SURGERY, PAEDIATRIC SURGERY, EMERGENCY SURGERY, GASTROENTEROLOGY, VETERINARY, and OTHER.
GENERAL PRECAUTIONS – It is dangerous to ignore the following warnings!
1. Every electro-surgical unit has its own characteristics and therefore, before using it, it is advisable to check its functioning, without
taking into consideration the previous experiences with other devices only. Anyway, start always with very low powers, and then raise
them until the required one is reached;
2. It is extremely dangerous to use the device if the electrical plant and the installations of the operating theatre do not comply with the
current safety standards. Never use extensions for the mains cable and, if many devices are connected at the same time, ask for their
compatibility to the Technical Service;
3. It is extremely dangerous to use accessories or instruments which are not perfectly compliant with all the applicable technical or
legislative Rules, and which are not suitable for the working voltages of the device (approx. 7600Vpp “4000Vp” for the monopolar
currents with crest factors equal or higher than 2; 3600Vpp “1800Vp” for the monopolar currents with crest factors lower than 2;
approx. 1100Vpp “550Vp for the bipolar currents with crest factors equal or lower than 2). Moreover, the accessories and instruments
must not be old nor worn. Check always their status before the use, notably if for endoscopy. Bear in mind that:
-All the old/worn active electrodes, accessories and cables do not work properly, and do not guarantee the perfect insulation. In
addition, their unstable functioning can lead the operator to increase the output powers at dangerous levels;
-In the user manual, for each current, the maximum output voltage “Vpp” and its variation (see the curves) according to the output
power adjustment are specified. This allows the operators to choose the maximum output power that must not be overcome, in
order to not exceed the rated HF insulation voltage, which is possible for each accessory;
-The standard monopolar active electrodes for normal surgery have a stem with Ø 2.3mm (so, the standard electrode-holder handles
are suitable for the electrodes having stems with this diameter).
4. Do not activate the outputs before the active electrode is in contact with the tissues, as electrical arcs can be created. They burn the
tissues superficially and prevent the good effect ;
5. Keep the active electrode always clean, because otherwise it can provoke sparks or superficial carbonizations on the tissues. A dirty
active electrode, an electrode in bad conditions, or an electrode with connection defects causes a reduction of the output power, as it
does not have any good contact with the tissues;
6. Remember that, even if compliant with all the current standards about the electromagnetic compatibility, the unit can have interferences
with other electro-medical equipments;
7. Bear in mind that, when operating on patients with pace-makers or other implanted active devices, an interference with their
functioning can occur (fibrillations, etc.), and they can even be damaged (in this case, it is advisable to ask for a specific qualified
advice from the Cardiology Division);
8. Never use an electro-surgical unit in presence of flammable anaesthetic gases (i.e. oxygen and nitrogen protoxide, etc.), notably when
operating in cavities like thorax, abdomen, trachea, head, etc. Do not use any cleaning substances, disinfectants or flammable solvents;

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if used, let them evaporate before the intervention. Always remove their remaining traces from the hollow parts of the body or the
cavities (i.e. umbilicus, vagina, etc.), and from underneath the patient. Remember that during the use a spark may cause the explosion
of endogenous gases (intestine), or the fire of oxygen saturated materials (cotton, gauze, etc.);
9. Take always all the metallic objects off the patient (rings, etc.), and be sure he is not in contact with any metallic part connected to the
earth, or which may conduct electricity (table, supports, etc.). Insulate with dry towels the strongly secreting parts of the body and the
contacts skin-to-skin (i.e. between the arm and the body);
10. Place always all the monitoring electrodes, which are not specifically protected, as far away as possible from the electrodes of the
electrosurgical unit. It is not advisable to use needle type or very small monitoring electrodes;
11. Use and place the neutral electrode as follows:
-Bear in mind that, if the neutral electrodes “Split” type double section are not used, the neutral electrode safety circuit of the unit
cannot control the contact between the electrode and the patient tissues (that is, it does not grant the safety of a good contact);
-Make sure it is in perfect conditions (the worn/old neutral electrodes are extremely dangerous for the risk of the burns on the
patients), and choose an area of the body as close as possible to the intervention point (the ideal would be a soft part without hairs,
nor protuberant bones or superficial differences). Clean this area, shave it and massage it, in order to favour the circulation;
-Fix it in a reliable way, without placing anything in-between, nor pressing too much, in order to avoid ischemic zones. Establish
the best possible contact over the entire surface, and make sure it remains constant, especially if the patient is moved or when
liquids are poured. As a matter of fact, a non homogeneous and/or insufficient contact of the neutral electrode generates both an
increase of the current density in the contact points (which produces a higher temperature into the tissues, and creates burns), and a
decrease of the output power into the application point (which leads the operator to raise it, dangerously);
-Never exceed 1/3 of the max. output power for each monopolar current when using the paediatric neutral electrodes, or 1/5 when
using the electrodes for babies;
-Use the disposable neutral electrodes only once, by paying attention to the instructions on the packaging. Make sure they have the
right dimensions (standard for adults with “weight body higher than 15 Kg”: approx. 136cm2; standard for children with “weight
body from 5 to 15 Kg”: approx. 84cm2);
-As the space between the neutral electrode and the operating area represents a sort of “path” for the HF current, be sure that it is
not diagonal as regards the body, nor on the heart. Remember also that the metallic elements (prosthesis, catheters, etc.) on the
path of the current may cause accumulations of current with consequent heating/burns of the surrounding tissue;
12. Position the cables of the electrodes in a way that they do not touch the patient or any other conducting part.
During the operations, place the unused active electrodes on insulating materials, far away from the patient;
13. Always use the lowest possible power. Bear this warning in mind when intervening on patients (children or babies) for whom small
neutral electrodes are used (see also point 11);
14. Choose the bipolar technique, when operating on small portions of tissue or in cavities;
15. Try to respect as much as possible the suggested working times, and avoid useless short-circuits between the active electrode and the
neutral one;
16. Get in contact with the Technical Service for the use of the “disposable” electrodes;
17. When the device is switched on, check all the settings before using it on the patient, and remember that a failure can provoke an
undesired increase of the power;
18. Remember that also the use of too low powers, if combined with some particular electrodes or accessories, can cause side effects: for
example, when using the Argon gas, the risk of embolism raises if the power of the spray coagulation is not able to produce quickly a
rapid and impermeable eschar on the target tissues;
19. The unit must not be used for final purposes other than those listed in this manual.
THE HF LEAKAGE CURRENTS CONTROL CIRCUIT
The unit is equipped with a leakage currents to earth control circuit because these currents represent one possible source for undesired burns
on the patient or the operators (i.e. a patient who gets in touch with a metallic part of the operating table or with wet/damp towels, a patient
who is placed on a water mattress for surgical needs, an operator who gets in touch with instruments or endoscopes, etc. They all are
possible causes of the increase of such currents).
When the leakage currents to earth overcome 150mA (limit established by the rules), the circuit intervenes as follows:
-It automatically reduces the output power, so that the currents come back within the agreed limits;
-It gives an alarm signal to the operators (red Led G-HF LEAKAGE on).
SAFETY CIRCUIT OF THE NEUTRAL ELECTRODE
The neutral electrode connection control circuit (area A with 3 Led) operates in the three following manners:
1) With disposable/reusable electrodes with one single section (non split). The circuit controls if the neutral electrode is connected to
the cable, and if the latter is integral and correctly connected to the unit (socket N.P-7). If this is not the case, it stops the delivery of the
power and gives a luminous alarm signal (all the Led are lit, Error Code “no Np”) and a buzzer (loud, intermittent);
2) With disposable/reusable electrodes with twin section (split). The circuit works as described above at point 1, but it also checks if
the quality of the contact between the electrode and the patient tissues is good enough. It operates as follows:
a) When the contact is optimum, the circuit does not intervene;
b) When the contact is not optimum (approx. 70/80% of the surface of a standard electrode for adults is well attached), the circuit
intervenes by giving a first indication to the operators (the first small Led lights up);
c) When the contact decreases to approx. 50/60% of the surface of a standard electrode for adults well attached, the circuit intervenes
by giving a second indication to the operators (the 2 first small Led light up);
d) When the contact decreases to less than approx. 50% of the surface of a standard electrode for adults well attached, the circuit
intervenes by giving a third indication to the operators (the 2 first small Led light up, and the third bigger red Led blinks), and by
automatically reducing to max. 200W the output powers (if higher levels have been selected);
e) When the contact further decreases, the circuit completely stops the delivery of the power, by giving a luminous alarm signal (all
the Led light up, Error Code “no Np”) and also a buzzer (loud, intermittent).
3) When only the memory for the bipolar use (it does not require any neutral electrode) is selected (memory 9), the circuit does not
intervene (the 3 Led are lit, but only to show that the electrode is not connected).

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INITIAL CHECKS
Initial checks
1. Make sure that the mains power supply corresponds to the technical data (see the data label on the backside of the unit), and connect
the unit with the mains switch (b2-green- on the backside of the unit) off;
2. For a possible equipotential connection, use the plug (b4 on the backside of the unit),
3. Adjust the functioning acoustic signals by the specific rotating control (b6 on the backside of the unit) – the max. is clockwise - . The
alarm signals cannot be regulated.
DATA STORING AT THE SWITCHING ON
When switched on, or after a temporary leak of current:
The unit always stores all the settings/regulations used when switched off (see also Par. “PROGRAMS and MEMORIES”);
The unit does not keep the selection of the bipolar coagulation Micro Auto, and it automatically sets the coagulation Micro
The operators must select the current Micro Auto every time the device is switched on, as the safety rules for the electro-surgical units do
not allow that, when switching on, a current with automatic start/stop system is applied without having been intentionally chosen by
the users.
CONNECTION and USE OF THE FOOT-SWITCH PEDALS
The unit is equipped with a standard twin foot-switch pedal (DS/E), which allows to activate the monopolar currents (cut/coagulating cut or
coagulations) or the bipolar currents (cut/coagulating cut or coagulations).
On request, the unit can also be equipped with another foot-switch pedal (DS/B = twin foot switch pedal to activate cut/coagulating
currents), which allows to activate the bipolar currents only, and therefore it can be very useful in the following cases:
-When surgeons want to continuously alternate the use of monopolar and bipolar currents by simply pressing on the different pedals at
each time (notably in laparoscopic procedures);
-When surgeons want to use the bipolar currents through an independent pedal foot-switch, which is not the one used for the monopolar
currents.
Use of the standard twin pedal foot-switch (DS/E)
Connect the pedal to the socket PED (1) and, by pressing on the key of the area PED- H, select the functioning mode:
-MONO to activate the monopolar currents of cut/coagulating cut (yellow pedal), or coagulation (blue pedal);
-BIP to activate the bipolar currents of cut/coagulating cut (yellow pedal), or coagulation (blue pedal), except for the coagulation Micro
Auto (which is not activated by any pedal foot-switch).
Use of two twin pedal foot-switches (DS/E and DS/B)
Connect the pedal DS/E to the socket PED (1) and the pedal DS/B to the socket PED BIP (2). When the pedal DS/B is connected, the Led of
the area PED – H automatically sets itself on MONO mode, and the unit works as follows:
-The pedal DS/E activates the monopolar currents of cut/coagulating cut (yellow pedal), or coagulation (blue pedal);
-The pedal DS/B activates the bipolar currents of cut/coagulating cut (yellow pedal), or coagulation (blue pedal), except for the
coagulation Micro Auto (which is not activated by any foot-switch pedal).
FUNCTIONING, NUMBER OF USABLE ELECTRODES, and ACTIVATION MODES
1. Monopolar functioning
The monopolar functioning requires the use of two electrodes (an active one, and a neutral one). The current flows from the active
electrode towards the neutral electrode, so that the process concerns all the tissues around the specific point where the active electrode
operates.
For the open sky surgery or the laparoscopy, the unit can be used:
-With 1 or 2 electrodes-holder handle/s (they can be both hand-switch type with twin key cut/coag, or just one can be hand-switch
type with twin key cut/coag, while the other is normal type for use by twin pedal foot-switch cut/coag).
It can be used with two electrodes-holder handles (as above described) at the same time by two different operators. In order
to use the unit in this way, it must be selected a coagulation mode without contact (Fulg – Forced or Spray), as stated by the
International Safety Rules for the HF electro-surgical equipments (IEC 60601-2-2, par. 46.103).
When the unit is on, the bipolar modes are always possible, as specified here below at point 2).
For the flexible endoscopic surgery, the unit can be used:
-With 1 flexible electrode (i.e. loop for polipectomy) by twin pedal foot-switch cut/coag;
When the unit is on, the bipolar modes are always possible, as specified here below at point 2).
For the endoscopic surgery under liquid in urology or gynaecology (TUR), the unit can be used:
-With the monopolar resectoscope by twin pedal foot-switch cut/coag;
When the unit is on, the bipolar modes are always possible, as specified here below at point 2).
2. Bipolar functioning
The bipolar functioning does not require the use of the neutral electrode, as the current flows between the tips of the bipolar electrode,
and it only affects the tissues of this specific area.
The unit always allows this kind of use as follows:
-With 1 bipolar electrode (for cut/coagulating cut and/or coagulation) by twin pedal foot-switch cut/coag;

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-With 1 bipolar electrode (for coagulation) with automatic start/stop system (impedance sensing), by selecting the coagulation
Micro Auto;
All the electrodes mentioned above can be used at the same time and independently, but not simultaneously, except for the two monopolar
electrodes-holder handles, as specified at point 1). In this case, the first activation stops the other ones avoiding all possible errors and giving
the right signal to the users (See Par. “SELF-DIAGNOSIS and SELF-TEST” – Self-diagnosis system = Error Code uSr Act and block of
the unit).
MONOPOLAR MODE FOR ELECTROSURGERY
CONNECTION and USE of the ACCESSORIES
1. Socket (3-MAN-1): hand-switch handle (forceps for coagulation with hand-switch for coag only)
** in alternative **
Socket (5- PED-1): handle (forceps for coagulation, laparoscopy instrument) for the use by pedal foot-switches
(See Par. “CONNECTION and USE of the PEDAL FOOT-SWITCHES”)
Use only this socket to connect the instruments specified here above. If other sockets are used, a failure into the unit could occur.
Just in case of a cable with a different plug from Alsa standard type, ask for:
- ALSA cables, by specifying the model and the instrument connector type
- Adaptor (RD/5, for the cables with non insulated plugs from 2 to 8mm, or with insulated plug 4mm);
2. Socket (4-MAN-2): second hand-switch handle (forceps for coagulation with hand-switch for coag only)
** in alternative ** (by selecting the pre-set programs 6, 7)
Socket (6- PED-2, lit Led): second handle (forceps for coagulation) for the use by pedal foot-switches
(See Par. “CONNECTION and USE of the PEDAL FOOT-SWITCHES”);
3. Socket (7- N.P.): neutral electrode.
According to the connection possibilities specified here above, the operator can use:
AObviously, one single active electrode (handle, forceps, instrument, etc.) by hand-switches or pedal foot-switches (press the mode
cut for the pure cut/coagulating cut currents, or the mode coag for the coagulation currents);
BAlternatively, two active electrodes (two handles, or one handle and one forceps for coagulation, or other), both of them by hand-
switches, or just one of them by hand-switches and the other by pedal foot-switches (press the mode cut for the pure
cut/coagulating cut currents, or the mode coag for the coagulation currents);
CAt the same time, two active electrodes by two operators, both of them by hand-switches, or just one of them by hand-switches
and the other by pedal foot-switches, (This possibility is allowed only selecting the coagulation modes without contact “Fulg-
Forced and Spray”, as stated by the International Safety Rules for the HF electro-surgical equipments -IEC 60601-2-2, par. 46.103);
DAlternatively, two active electrodes (two handles, or one handle and one forceps for coagulation, or other), both of them by pedal
foot-switches (This mode is possible by selecting the pre-set programs 6 and 7 “See Par. “PROGRAMS and MEMORIES”);
E. !!! BIPOLAR FUNCTIONING !!!
The unit can always be used for the bipolar functioning. See Par. “BIPOLAR MODE”.
MONOPOLAR CURRENTS, ELECTRODES, ADJUSTMENT of the POWERS, ADVICE
CURRENTS for CUT and COAGULATING CUT
PURE CUT (PURE) – Cut without coagulating effect
This current is controlled by an automatic system (ADC System) for the self regulation of the functioning, which guarantees that the power
selected by the operators remains constant according to the characteristics of the tissues.
Control devices to be used (area C):
-With the selection key, select the current PURE, then adjust the power with the regulation keys;
-For the delivery (loud acoustic signal, and yellow Led), press on the yellow pedal of the twin foot-switch pedal, or the yellow key of
the hand-switch handle. Instructions for use, adjustments and electrodes
Use cutting electrodes (blade, needle, loop, hook type, or the external part of the dissector, in laparoscopy) from 30-40W.
COAGULATING CUT (BLEND-1) – Cut with soft coagulating effect
This current is controlled by an automatic system (ADC System) for the self regulation of the functioning, which guarantees that the power
selected by the operators remains constant according to the characteristics of the tissues.
Control devices to be used (area C):
-With the selection key, select the current BLEND-1, then adjust the power with the regulation keys;
-For the delivery (loud acoustic signal, and yellow Led), press on the yellow pedal of the foot-switch pedal, or the yellow key of the
hand-switch handle. Instructions for use, adjustments and electrodes
Use cutting electrodes (blade, needle, loop, hook type, or the external part of the dissector, in laparoscopy) from 30-40W.
COAGULATING CUT (BLEND-2) – Cut with a very strong spray coagulating effect
This current is controlled by an automatic system (ADC System) for the self regulation of the functioning, which guarantees that the power
selected by the operators remains constant according to the characteristics of the tissues.
Control devices to be used (area C):
-With the selection key, select the current BLEND-2, then adjust the power with the regulation keys;
-For the delivery (loud acoustic signal, and yellow Led), press on the yellow pedal of the foot-switch pedal, or the yellow key of the
hand-switch handle. Instructions for use, adjustments and electrodes
Use cutting electrodes (blade, needle, hook type, or the external part of the dissector, in laparoscopy) from 30-40W.

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COMBINATED CUT (CUT ALTERNATED TO COAGULATION) (ENDO) – For flexible endoscopy with cutting phases
alternated to coagulation phases
This is a constant voltage current and it is controlled by aspecial automatic power self adjustment system (ADC System)
according to the characteristics of the tissues.
Control devices to be used (area C):
-With the selection key, select the current ENDO, then adjust the power with the regulation keys;
-For the delivery (loud acoustic signal, and yellow Led), press on the yellow pedal of the foot-switch pedal, or the yellow key of the
hand-switch handle. Instructions for use, adjustments and electrodes
Ideal only for flexible endoscopic surgery (i.e. polipectomy or papillotomy).
CURRENTS for COAGULATION
“FULGURATION” COAGULATION (FULG FORCED) – Strong superficial sparkling effect, and optimum deep coagulating effect
This current guarantees a strong coagulating effect, both deep and superficial, and therefore it is suitable both for coagulations performed
with forceps/surgical instrument, and for coagulations performed by grazing the tissues with the active electrode.
This current is controlled by an automatic system (ADC System) for the self regulation of the functioning, which guarantees that the power
selected by the operators remains constant according to the characteristics of the tissues.
Control devices to be used (area D):
-With the selection key, select the current FULG FORCED, then adjust the power with the regulation keys;
-For the delivery (acute acoustic signal, and blue Led), press on the blue pedal of the twin foot-switch pedal, or the blue key of the
hand-switch electrodes-holder handle. It is also possible to deliver the current by simply closing the coagulation forceps, just in case a
hand-switch forceps is used (PMI/P or PMI/B).
Instructions for use, adjustments and electrodes
It can be used with all types of electrodes (ball, blade, or needle type, insulated coagulation forceps, loop electrodes in conization,
hook electrodes, dissectors, and forceps in laparoscopy) from 40-50W.
“PIN POINT CONTACT” COAGULATION (PIN POINT CONTACT) – Medium-Low superficial sparkling effect, and optimum
deep coagulating effect
This current guarantees a strong deep coagulating effect and a normal superficial coagulating effect. It is suitable both for coagulations
performed with forceps/surgical instrument and for coagulations performed directly with the active electrode, just in case the operators
prefer a superficial effect which is less strong than the one of the FULG FORCED coagulation.
This current is controlled by an automatic system (ADC System) for the self regulation of the functioning, which guarantees that the power
selected by the operators remains constant according to the characteristics of the tissues.
Control devices to be used (area D):
-With the selection key, select the current PIN POINT CONTACT, then adjust the power with the regulation keys;
-For the delivery (acute acoustic signal, and blue Led), press on the blue pedal of the twin foot-switch pedal, or the blue key of the
hand-switch electrodes-holder handle. It is also possible to deliver the current by simply closing the coagulation forceps, just in case a
hand-switch forceps is used (PMI/P or PMI/B).
Instructions for use, adjustments and electrodes
It can be used with all types of electrodes (ball, blade, or needle type, insulated coagulation forceps, loop electrodes in conization,
hook electrodes, dissectors, and forceps in laparoscopy) from 40-50W.
“SOFT” COAGULATION (SOFT) – Low superficial sparkling effect, and good deep coagulating effect
This current guarantees a good deep coagulating effect, and a very low superficial coagulating effect. It is suitable above all for the
coagulations performed with forceps/surgical instrument, and for coagulations performed by touching the tissues with an active ball
electrode of at least 4-5mm.
This current is controlled by an automatic system (ADC System) for the self regulation of the functioning, which guarantees that the power
selected by the operators remains constant according to the characteristics of the tissues.
Control devices to be used (area D):
-With the selection key, select the current SOFT, then adjust the power with the regulation keys;
-For the delivery (acute acoustic signal, and blue Led), press on the blue pedal of the twin foot-switch pedal, or the blue key of the
hand-switch electrodes-holder handle. It is also possible to deliver the current by simply closing the coagulation forceps, just in case a
hand-switch forceps is used (PMI/P or PMI/B).
Instructions for use, adjustments and electrodes
Use coagulation electrodes (ball type, coagulation insulated forceps in laparoscopy) from 50-60W.
“SPRAY” COAGULATION (SPRAY) – Very strong superficial sparkling effect, and good deep coagulating effect
This current guarantees a good deep coagulating effect, and a very strong superficial coagulating effect. It is suitable both for the
coagulations performed with forceps/surgical instrument, and for coagulations performed directly with the active electrode, even far away
from the tissues.
This current is controlled by an automatic system (ADC System) for the self regulation of the functioning, which guarantees that the power
selected by the operators remains constant according to the characteristics of the tissues.
Control devices to be used (area D):
-With the selection key, select the current SPRAY, then adjust the power with the regulation keys;
-For the delivery (acute acoustic signal, and blue Led), press on the blue pedal of the twin foot-switch pedal, or the blue key of the
hand-switch electrodes-holder handle. It is also possible to deliver the current by simply closing the coagulation forceps, just in case a
hand-switch forceps is used (PMI/P or PMI/B).
Instructions for use, adjustments and electrodes
Use cutting and coagulation electrodes (blade, needle, ball type, and coagulation insulated forceps, in laparoscopy,

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conization electrodes in gynaecology) from 40-50W.
ADVICE
OPEN SKY SURGERY
For the Cut, use as follows:
Current PURE, from 40-50W, for a cut without the coagulating effect (it is not very common in surgery, where the coagulating cut is
preferred);
Current BLEND-1, from 40-50W, for a cut with a medium coagulating effect;
Current BLEND-2, from 40-50W, for a cut with a very strong superficial coagulating effect, spray type;
For the Coagulation, use as follows:
Current FULG FORCED, from 40-50W, for superficial coagulations or deep coagulations with the active electrode or the forceps. It is the
most suitable coagulation mode when a forceps or an electrode is used;
Current PIN POINT CONTACT, from 40-50W, for superficial coagulations or deep coagulations with the active electrode or the forceps, if
a softer superficial effect is desired, compared to the FULG FORCED coagulation;
Current SOFT, from 40-50W, for superficial or deep coagulations, which are softer than those of the PIN POINT CONTACT coagulation,
which is not suitable at all for the use with small electrodes with which it tends to cut;
Current SPRAY, from 40-50W, for a very strong superficial coagulation with the active electrode (without any contact with the tissues), and
a good deep coagulation with the forceps (it is the ideal coagulation mode for the operators who prefer the active electrode to coagulate).
LAPAROSCOPIC SURGERY
For the Cut, use as follows:
See above “OPEN SKY SURGERY” PURE, BLEND-1, BLEND-2. The current BLEND-2 is very efficacious when using the hooks or the
external part of the forceps/dissectors to cut with a strong coagulating effect.
For the Coagulation, use as follows:
See above “OPEN SKY SURGERY” FULG FORCED, PIN POINT CONTACT, SPRAY. The current SPRAY is very efficacious when
using the hooks or the external part of the forceps/dissectors to coagulate.

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FUNCTIONING for the FLEXIBLE ENDOSCOPIC SURGERY
(See Par. “PROGRAMS and MEMORIES”, program nr. 8).
CONNECTION and USE of the ACCESSORIES
1. Socket (5-PED-1): flexible electrode with pedal foot-switch (See Par. “CONNECTION and USE of the PEDAL FOOT-
SWITCHES”).
Use only this socket to connect the above mentioned instruments. The use of different sockets provokes a damage to the unit.
Just in case, ask for:
ALSA cables for the flexible electrodes:
- CEP3, 3mt long or CEP3/5, 5mt long, for the disposable instruments with male connector 3mm;
- CEP4, 3mt long or CEP4/5, 5mt long, for the reusable instruments with female connector 4mm.
The adaptors for the cables with different plug:
- RD/5, for cables with non insulated plugs from 2 to 8mm, or with insulated plug 4mm;
2. Socket (7- N.P.): neutral electrode.
According to the connection possibilities listed above, the unit allows to:
A. Use the flexible electrode by foot-switch activation (See Par. “CONNECTION and USE of the PEDAL FOOT-SWITCHES”).
Just press on the yellow pedal for the pure/coagulating cut currents, and on the blue pedal for the coagulation currents.
B. !!! BIPOLAR FUNCTIONING!!!
The bipolar functioning is always possible. See Par. “BIPOLAR MODE”.
MONOPOLAR CURRENTS, ELECTRODES, ADJUSTMENT of the POWERS, ADVICE
CURRENTS for CUT
PURE CUT (PURE) – Cut without coagulating effect
This current is controlled by an automatic system (ADC System) for the self regulation of the functioning, which guarantees that the power
selected by the operators remains constant according to the characteristics of the tissues.
Control devices to be used (area C):
-With the selection key, select the current PURE, then adjust the power with the regulation keys;
- For the delivery (loud acoustic signal, and yellow Led), press on the yellow pedal of the twin foot-switch pedal
Instructions for use, adjustments and electrodes
Use the flexible electrodes of the endoscopes, from 20-30W for the papillotomy, from 20-30W for the polipectomy with polypus
5mm, and from 40-50W approx. for polypus 6mm or more.
COAGULATING CUT (BLEND-1) – Cut with soft coagulating effect
This current is controlled by an automatic system (ADC System) for the self regulation of the functioning, which guarantees that the power
selected by the operators remains constant according to the characteristics of the tissues.
Control devices to be used (area C):
-With the selection key, select the current BLEND-1, then adjust the power with the regulation keys;
-For the delivery (loud acoustic signal, and yellow Led), press on the yellow pedal of the twin foot-switch pedal .
Instructions for use, adjustments and electrodes
Use the flexible electrodes of the endoscopes, from 20-30W for the papillotomy, from 20-30W for the polipectomy with polypus
5mm, and from 40-50W approx. for polypus 6mm or more.
COAGULATING CUT (BLEND-2) – Not suitable at all.
COMBINATED CUT (CUT ALTERNATED TO COAGULATION) (ENDO) – For flexible endoscopy with cutting phases
alternated to coagulation phases
This is a constant voltage current and it is controlled by a special automatic power self adjustment system (ADC System) according to the
characteristics of the tissues.
Control devices to be used (area C):
-With the selection key, select the current ENDO, then adjust the power with the regulation keys;
-For the delivery (loud acoustic signal, and yellow Led), press on the yellow pedal of the twin foot-switch pedal .
Instructions for use, adjustments and electrodes
Use the flexible electrodes of the endoscopes, from 70-80W for the papillotomy, from 70-80W for the polipectomy with polypus
5mm, and from 90-100W approx. for polypus 6mm or more.
CURRENTS for COAGULATION
“FULGURATION” COAGULATION AT HIGH VOLTAGE (FULG FORCED) - Strong superficial sparkling effect, and optimum
deep coagulating effect
This current guarantees a strong coagulating effect, both deep and superficial, and therefore it is suitable both for coagulations performed
with forceps/surgical instrument, and for coagulations performed by grazing the tissues with the active electrode.
This current is controlled by an automatic system (ADC System) for the self regulation of the functioning, which guarantees that the power
selected by the operators remains constant according to the characteristics of the tissues.
Control devices to be used (area D):
-With the selection key, select the current FULG FORCED, then adjust the power with the regulation keys;
-For the delivery (acute acoustic signal, and blue Led), press on the blue pedal of the twin foot-switch pedal.
Instructions for use, adjustments and electrodes
Use the flexible electrodes of the endoscopes, from 20-30W.

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“PIN POINT CONTACT” COAGULATION AT MEDIUM VOLTAGE (PIN POINT CONTACT) – Medium-Low superficial
sparkling effect, and optimum deep coagulating effect
This current guarantees a strong deep coagulating effect, and a normal superficial coagulating effect. It is suitable both for coagulations
performed with forceps/surgical instrument, and for coagulations performed by grazing the tissues with the active electrode, just in case the
operators prefer a superficial effect which is less strong than the one of the FULG FORCED coagulation.
This current is controlled by an automatic system (ADC System) for the self regulation of the functioning, which guarantees that the power
selected by the operators remains constant according to the characteristics of the tissues.
Control devices to be used (area D):
-With the selection key, select the current PIN POINT CONTACT, then adjust the power with the regulation keys;
-For the delivery (acute acoustic signal, and blue Led), press on the blue pedal of the twin foot-switch pedal.
Instructions for use, adjustments and electrodes
Use the flexible electrodes of the endoscopes, from 20-30W.
“SOFT” COAGULATION AT LOW VOLTAGE (SOFT) – Low superficial sparkling effect, and good deep coagulating effect
This current guarantees a good deep coagulating effect, and a very low superficial coagulating effect. Is suitable above all for coagulations
performed with forceps/surgical instrument, and for coagulations performed by touching the tissues with an active ball electrode of 4-5mm
at least.
This current is controlled by an automatic system (ADC System) for the self regulation of the functioning, which guarantees that the power
selected by the operators remains constant according to the characteristics of the tissues.
Control devices to be used (area D):
-With the selection key, select the current SOFT, then adjust the power with the regulation keys;
-For the delivery (acute acoustic signal, and blue Led), press on the blue pedal of the twin foot-switch pedal.
Instructions for use, adjustments and electrodes
Use the flexible electrodes of the endoscopes, from 30-40W.
“SPRAY” COAGULATION AT VERY HIGH VOLTAGE (SPRAY) – Very strong superficial sparkling effect, and good deep
coagulating effect
This current guarantees a good deep coagulating effect, and a very strong superficial coagulating effect. It is suitable both for the
coagulations performed with forceps/surgical instrument, and for coagulations performed directly with the active electrode, even far away
from the tissues.
This current is controlled by an automatic system (ADC System) for the self regulation of the functioning, which guarantees that the power
selected by the operators remains constant according to the characteristics of the tissues.
Control devices to be used (area D):
-With the selection key, select the current SPRAY, then adjust the power with the regulation keys;
-For the delivery (acute acoustic signal, and blue Led), press on the blue pedal of the twin foot-switch pedal.
Instructions for use, adjustments and electrodes
Use the flexible electrodes of the endoscopes, from 20-30W.
ADVICE
For the Cut, use as follows:
Current PURE, for a cut without coagulating effect and constant delivery of the power (from 20-30W for papillotomy or polipectomy with
polypus until 5mm, and from 30-40W with polypus 6mm or more);
Current BLEND-1, for a cut with a soft coagulating effect and constant delivery of the power (from 20-30W for papillotomy or polipectomy
with polypus until 5mm, and from 30-40W with polypus 6mm or more);
Current ENDO,for a cut-coagulation combination (alternated phases of cut and coagulation), and self regulation of the power (from 70-80W
for papillotomy or polipectomy with polypus until 5mm, and from 90-100W with polypus 6mm or more).
For the Coagulation, use as follows:
Current FULG FORCED, from 30-40W;
Current PIN POINT CONTACT, from 40-50W, for a superficial effect which is softer than the one of the FULG FORCED coagulation.
FUNCTIONING for the UNDER LIQUID ENDOSCOPIC SURGERY
(TUR, TURP, TURV, etc.)
(See Par. “PROGRAMS and MEMORIES”, program nr. 8).
CONNECTION and USE of the ACCESSORIES
1. Socket (5-PED-1): electrode of the monopolar resectoscope for the use by foot-switch pedal (See Par. “CONNECTION and USE of
the PEDAL FOOT-SWITCHES”).
Use only this socket to connect the above mentioned instrument. The use of different sockets provokes a damage to the unit.
Just in case of a cable with a plug which is different from ALSA standard type, ask for:
- Adaptor (RD/5, for cables with non insulated plugs from 2 to 8mm, or with insulated plug 4mm).
2. Socket (7- N.P.): neutral electrode.
According to the connection possibilities listed above, the unit allows to:
A. Use the resectoscope by foot-switch activation (See Par. “CONNECTION and USE of the PEDAL FOOT-SWITCHES”).
Just press on the yellow pedal for the pure/coagulating cut currents, and on the blue pedal for the coagulation currents.
C. !!! BIPOLAR FUNCTIONING!!!
The bipolar functioning is always possible. See Par. “BIPOLAR MODE”.

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MONOLAR CURRENTS, ELECTRODES, ADJUSTMENT of the POWERS
CURRENTS for CUT
PURE CUT (PURE) – Cut without coagulating effect
This current is controlled by an automatic system (ADC System) for the self regulation of the functioning, which guarantees that the power
selected by the operators remains constant according to the characteristics of the tissues.
Control devices to be used (area C):
-With the selection key, select the current PURE, then adjust the power with the regulation keys;
-For the delivery (loud acoustic signal, and yellow Led), press on the yellow pedal of the twin foot-switch pedal.
Instructions for use, adjustments, and electrodes
Use the specific electrodes for the resectoscope from:
70-80W with wire loop electrodes, for soft tissues (i.e. into the bladder);
90-100W with wire loop electrodes, for strong tissues (i.e. TUR);
90-100W with ribbon loop (cutting/vaporization) electrodes, for soft tissues (i.e. into the bladder);
100-110W with ribbon loop (cutting/vaporization) electrodes, for strong tissues (i.e. TUR);
100-120W with vaporisation electrodes of small dimensions;
150-170W with vaporisation electrodes of big dimensions.
COAGULATING CUT (BLEND-1) – Cut with soft coagulating effect
This current is controlled by an automatic system (ADC System) for the self regulation of the functioning, which guarantees that the power
selected by the operators remains constant according to the characteristics of the tissues.
Control devices to be used (area C):
-With the selection key, select the current BLEND-1, then adjust the power with the regulation keys;
-For the delivery (loud acoustic signal, and yellow Led), press on the yellow pedal of the twin foot-switch pedal
Instructions for use, adjustments, and electrodes
As per the current PURE.
COAGULATING CUT (BLEND-2) – Not suitable at all.
COMBINATED CUT (CUT ALTERNATED TO COAGULATION) (ENDO)– Not suitable at all.
CURRENTS for COAGULATION
“FULGURATION” COAGULATION AT HIGH VOLTAGE (FULG FORCED) - Strong superficial sparkling effect, and optimum
deep coagulating effect
This current guarantees a strong coagulating effect, both deep and superficial. It is suitable both for coagulations performed with
forceps/surgical instrument, and for coagulations performed by grazing the tissues with the active electrode.
This current is controlled by an automatic system (ADC System) for the self regulation of the functioning, which guarantees that the power
selected by the operators remains constant according to the characteristics of the tissues.
Control devices to be used (area D):
-With the selection key, select the current FULG FORCED, then adjust the power with the regulation keys;
-For the delivery (acute acoustic signal, and blue Led), press on the blue pedal of the twin foot-switch pedal.
Instructions for use, adjustments, and electrodes
Use the specific electrodes for the resectoscope from 60-70W.
“PIN POINT CONTACT” COAGULATION AT MEDIUM VOLTAGE (PIN POINT CONTACT) – Medium-Low superficial
sparkling effect, and optimum deep coagulating effect
This current guarantees a strong deep coagulating effect and a normal superficial coagulating effect. It is suitable both for coagulations
performed with forceps/surgical instrument, and for coagulations performed by grazing the tissues with the active electrode, just in case the
operators prefer a superficial effect which is less strong than the one of the FULG FORCED coagulation.
This current is controlled by an automatic system (ADC System) for the self regulation of the functioning, which guarantees that the power
selected by the operators remains constant according to the characteristics of the tissues.
Control devices to be used (area D):
-With the selection key, select the current PIN POINT CONTACT, then adjust the power with the regulation keys;
-For the delivery (acute acoustic signal, and blue Led), press on the blue pedal of the twin foot-switch pedal.
Instructions for use, adjustments, and electrodes
Use the specific electrodes for the resectoscope from 60-70W.
“SOFT” COAGULATION AT LOW VOLTAGE (SOFT) – Not suitable.
“SPRAY” COAGULATION AT VERY HIGH COLTAGE (SPRAY) – Very strong superficial sparkling effect, and good deep
coagulating effect
This current guarantees a good deep coagulating effect, and a very strong superficial coagulating effect. It is suitable both for the
coagulations performed with forceps/surgical instrument, and for coagulations performed directly with the active electrode, even far away
from the tissues.
This current is controlled by an automatic system (ADC System) for the self regulation of the functioning, which guarantees that the power
selected by the operators remains constant according to the characteristics of the tissues.
Control devices to be used (area D):