Hologic CYNOSURE ELLMAN SURGITRON 4.0 Dual RF/90 IEC User manual

4.0 Dual RF™/90 IEC
Instruction Manual
(English-English)

NEW PRODUCT WARRANTY
New products manufactured by Cynosure, are warranted against any defects in
material or workmanship for a period of one (1) year following the date of shipment
to the Buyer. Cynosure, at its option, will repair or replace the same without charge,
provided Buyer ships the product to Cynosure, transportation charges prepaid.
Buyer must call Cynosure in advance at 888.523.2233 to request a Return
Merchandise Authorization (RMA) number.
Warranty shall not apply to product that was not properly installed, maintained and
operated within the limits of rated and normal usage. Warranty shall not apply to
product that has been subjected to an accident, tampering, alteration, misuse,
abuse, negligence, fire or water damage. Warranty does not cover defects or
damage caused, directly or indirectly, as a result of service by unauthorized
personnel and/or the use of unauthorized replacement parts or accessories.
Cynosure’s liability under this warranty, or any other warranty, whether express or
implied in law or fact, is limited to repair or replacement of defective material and
workmanship, and in no event shall Cynosure be liable for consequential or indirect
damages.
PATENTS
Ellman brand high frequency energy sources are covered by one or more of the
following patents: 5,954,686
6,652,514
6,994,707
7,094,231
7,479,140
Copyright Information
© 2019 Cynosure, LLC. All Right Reserved
Caution
Federal law restricts this device to sale by or on the order of a Physician

CONTENTS
I. INTRODUCTION Page 2
1.0 Introduction to Radiosurgery®
1.1 Intended Use
II. SAFETY Page 2
2.0 Warnings
2.1 Precautions
III. TECHNICAL INFORMATION Page 5
3.0 Packing List
3.1 Supplier’s Information
3.2 Cleaning, Disinfecting and Sterilizing the Unit and Accessories
IV. DESCRIPTION OF CONTROL ELEMENTS Page 6
4.0 Interface Accessories
4.1 Rear Panel Control Elements
4.2 Front Panel Control Elements
4.3 Symbol definitions
V. PREPARATION FOR USE Page 12
5.0 Preparation for Use
5.1 Waveform Selection
5.2 Smoke Hazard
VI. SURGICAL DESCRIPTION AND USE Page 14
6.0 Learning to Use Radiosurgery®
6.1 Pre-Operative Cutting Practice
6.2 Pre-Operative Coagulation Practice
VII. POWER OUTPUT CHARACTERISTICS Page 17
7.0 Power Output vs. Digital Setting (500 Ohms Resistive Load)
7.1 Cut Mode Power Output vs. Resistive Load
7.2 Blend Mode Power Output vs. Resistive Load
7.3 Coag Mode Power Output vs. Resistive Load
7.4 Fulgurate Mode Power Output vs. Resistive Load
7.5 Bipolar Mode Power Output vs. Resistive Load
7.6 Monopolar/Bipolar Modes Voltage Output vs. Digital Setting
CONTENTS (Continued)

CONTENTS
VIII. TECHNICAL SPECIFICATIONS Page 21
8.0 Output Characteristics
8.1 Preventive Inspection and Maintenance
8.2 Safety Features
8.3 Input Characteristics
8.4 Size and Weight
8.5 Operating Conditions
8.6 Transportation & Storage Conditions
8.7 Error Codes Table
IX. ELECTROMAGNETIC COMPATIBILITY Page 24
9.0 Warning
9.1 Precautions

2
I. INTRODUCTION
1.0 INTRODUCTION TO RADIOSURGERY®
Radiosurgery®with Ellman’s Surgitron®4.0 Dual RF™/90 IEC system (Surgitron®
Dual/EMC) is an excellent method of cutting and coagulating soft tissue. With five
waveforms (4 monopolar and 1 bipolar) and a wide selection of electrode tips, the user can
easily configure the system for a wide array of applications.
1.1 INTENDED USE
The intended use for the Surgitron®Dual/EMC is:
1.1.1 Cutting: snoring, submucosal palatal shrinkage, traditional uvulopalatoplasty
(RAUP), myringotomy with effective hemorrhage control, epistaxis treatment,
turbinate shrinkage, skin incisions, biopsy, cysts, abscesses, tumors, development
of skin flaps, skin tags and blepharoplasty.
1.1.2 Blended cutting and coagulation: snoring, submucosal palatal shrinkage, traditional
uvulopalatoplasty (RAUP), myringotomy with effective hemorrhage control,
epistaxis treatment, turbinate shrinkage, skin tags, papilloma keloids, keratosis,
verrucae, basal cell carcinoma, nevi, fistulas, epithelioma, cysts, abscesses, and
development of skin flaps.
1.1.3 Hemostasis: control of bleeding, epilation, telangiectasia.
1.1.4 Fulguration: basal cell carcinoma, papilloma, cyst destruction, tumors, verrucae,
hemostasis.
1.1.5 Bipolar: pinpoint precise coagulation, pinpoint hemostasis in any field (wet or dry),
snoring, submucosal palatal shrinkage, traditional uvulopalatoplasty (RAUP),
myringotomy with effective hemorrhage control, epistaxis treatment and turbinate
shrinkage.
NOTE: The Surgitron®Dual/EMC generator is not designed to withstand the
demands of lengthy wrinkle treatment procedures. The generator will overheat and
possibly fail. Such failures will not be covered by warranty.
II. SAFETY
Improper use of this, or any high frequency surgical instrument, can result in a patient injury.
Read and become familiar with all directions before using this product.
2.0 WARNINGS
2.0.1 High frequency surgical equipment should be used only by persons having
adequate training and familiarity with high frequency surgical equipment and
related techniques. A thorough understanding of the use of high frequency surgical
equipment is essential to avoid shock and burn hazards to both patient and
medical personnel and damage to the device or other medical equipment. Consult
medical literature relative to related techniques, complications, and hazards prior
to use of high frequency surgical equipment.
2.0.2 Never increase the power settings without first checking both the active electrode
and the neutral plate.
2.0.3 Ocular Shields (plastic, non-conductive) must be used for any radiofrequency
surgical procedure involving the eyelid and the immediate surrounding areas.
2.0.4 Use only with Ellman accessories including Ellman handpieces, neutral plates,
cables, and electrodes.
2.0.5 When using an active electrode near a metal (conductive) accessory, ensure the
electrode does not come into contact with the metal accessory.
2.0.6 Failure of high frequency surgical equipment could result in an unintended
increase of output power.
2.0.7 Use a compatible neutral electrode with a contact quality monitor to ensure the
auditory alarm will sound in the event of loss of safe contact between the neutral
electrode and patient.
2.0.8 Risks resulting from neuromuscular stimulation can occur, especially with modes
producing electrical arcs between active electrode and tissue.
2.0.9 Do not maintain or service equipment while in use. Maintaining or servicing
equipment while in use may result in possible injury to the operator or patient.

3
2.1 PRECAUTIONS
2.1.1 General
2.1.1.1 Electrical shock hazard. Do not remove cover. Refer to authorized
personnel for service.
2.1.1.2 Surgitron®Dual/EMC may present a hazard to patients with
pacemakers. Consult qualified medical personnel.
2.1.1.3 The manufacturer-supplied accessories should be used to ensure the
proper operation of safety monitoring circuit.
2.1.1.4 If higher than normal power settings are required, examine all cables,
handpieces and the neutral plate for damage and confirm that cables are
not wrapped around metal objects or touching the floor. In the event that
higher power is still required, replace the neutral plate and handpieces.
2.1.1.5 WARNING: No modification of this equipment is
allowed.
2.1.1.6 The patient should not come into contact with metal parts which are
earthed or which have appreciable capacitance to earth. The use of
antistatic sheeting is recommended for this purpose.
2.1.1.7 Physician to patient skin to skin contact should be avoided. Use of
insulating gloves is recommended. Patient skin-to-skin contact (eg,
between the arms and body of the patient) should be avoided (eg, by
insertion of dry gauze).
2.1.1.8 When used simultaneously with physiological monitoring equipment, the
monitoring electrodes on the patient should be placed as far as possible from
the surgical electrodes. Do not use metal needle monitoring electrodes or
EKG clip electrodes as burns may occur. Monitoring systems incorporating
high-frequency current-limiting devices are recommended.
2.1.1.9 The cables to the surgical electrodes should be positioned in such a way
that contact with the patient or other leads is avoided. Temporarily
unused active electrodes should be stored segregated from the patient.
2.1.1.10 The output power selected should be as low as possible for the
intended purpose.
2.1.1.11 Apparent low output or failure of the surgical equipment to function
correctly at the normal operating settings may indicate faulty
application of the neutral plate or poor contact in its connection.
2.1.1.12 Before each use inspect the accessories, electrode cables
and probes for possible physical damage.
2.1.1.13 Do not obstruct air circulation vents on the rear or underside of
the generator.
2.1.1.14 Surgical gloves should be worn to prevent the User from
becoming a part of the RF energy return pathway.
2.1.1.15 Use caution when treating subjects with metal implants. Metal implants in
the electrical pathway (between the neutral plate and electrode) have the
capacity to conduct energy and/or become warm.
2.1.1.16 High frequency surgical equipment output from either active
electrode may change when operating mode is changed.
2.1.1.17 Select associated equipment and active accessories that have rated
accessory voltages equal to or greater than the maximum output voltage.
Avoid high frequency voltage settings where maximum output voltage may
exceed rated accessory voltage.
2.1.1.18 For surgical procedures where the high frequency current could flow
through parts of the body having a relatively small cross-sectional area,
the use of bipolar techniques may be desirable to avoid unwanted
coagulation.
2.1.1.19 Similar to all energy sources, by-products such as tissue smoke plume
and aerosols, create a health concern about their carcinogenic and
infectious potential. Appropriate protective measures including effective
smoke evacuation should always be utilized.

4
2.1.2 Neutral Plate
NOTE: See Neutral Plate Instructions for Use for detailed device and use
information.
2.1.2.1 The use and proper placement of the neutral plate is essential to the safe
and effective use of this device in order to prevent burns from the neutral
plate. The neutral plate should be reliably attached with its entire area
attached to the patient’s body as close as possible to the operating field.
The neutral plate must make complete skin contact.
2.1.2.2 Use only Ellman supplied neutral plates.
2.1.2.3 To prevent burns at site of neutral plate, use lowest possible output
settings, ensure proper patient preparation, and/or limit duration of
activation.
2.1.2.4 When performing procedures requiring high power and long duration
(eg, wrinkle treatment), ensure use of the largest Ellman neutral
electrode available and that its entire surface area is adhered to the
patient.
2.1.2.5 Ensure the neutral pad is placed in closer proximity to the patient's
treatment area than any ground referenced patient contact points such as
monitoring electrodes.
2.1.3 Flammable Environment
2.1.3.1 Some materials, for example cotton, wool, and gauze when saturated with
oxygen may be ignited by sparks produced in normal use of the equipment.
2.1.3.2 Do not use the Surgitron®Dual/EMC in the presence of flammable
anesthetics or other flammable gases, flammable liquids, or flammable
objects.
2.1.3.3 Do not use this device in oxygen enriched atmospheres or in the
presence of nitrous oxide (N20).
2.1.3.4 Use only non-flammable agents for cleaning.
2.1.3.5 Flammable agents used as solvents for removing adhesives should be
allowed to evaporate before powering on the Surgitron®Dual RF™. Any
flammable fluid pooled under the patient or in the body depressions
should be mopped up prior to using the Surgitron®Dual RF™. Attention
should be called to the danger of ignition of endogenous gases.
NOTE: To ensure safe and reliable operation, the Surgitron®Dual/EMC unit
and relevant accessories should be checked for wear and tear before
operation.
A maintenance contract with the manufacturer or one of its authorized
service agents is recommended after the warranty period.
In the event of malfunction, the device must be returned or serviced by a
Cynosure-authorized technician for repair.

5
III.TECHNICAL INFORMATION
3.0 PACKING LIST
3.0.1 Surgitron®Dual/90 IEC (IEC3A-S30-90/110 or IEC3A-S30-90/220)
3.0.2 IEC Power cord 12ft (IEC-PC110, IEC-PCEU, IEC-PCUK, or IEC-PCANZ)
3.0.3 Instruction Manual (DIM-50-65)
ACCESSORIES (See Catalog)
3.0.4 Disposable Neutral Plates 9.5 ft (IEC-NPD)
3.0.5 Dual Footswitch & Cable 12 ft (DF-FSC#)
3.0.6 Cart (H156 or H157)
3.0.7 IEC Foot Controlled Handpiece, 1/16 shaft 11 ft (IEC-HP1)
3.0.8 Bipolar Cable 12 ft (IEC-JX/B)
3.0.9 3-Button Fingerswitch Handpiece 12 ft (IEC-3FHPB)
3.0.10 Disposable 3-Button Fingerswitch Handpieces 12 ft (IEC-3FHPB/D)
3.0.11 Disposable Electrodes (DSEP40)
3.0.12 Electrode Set 1/16 Shaft (S10B)
3.0.13 Bipolar Forceps (J1)
3.1 SUPPLIER’S INFORMATION
Cynosure, LLC
5 Carlisle Road
Westford, MA 01886, USA
Tel: [phone] Fax: [phone].256.4888
Supplier will make the following available upon request; circuit diagrams,
component parts list, description, calibration instructions or other information
necessary to assist technical personnel. All Generators isolate their circuits
electrically from the supply mains on all poles simultaneously by using an input
power transformer. Dispose or recycle according to local regulations. Do not
dispose of this device in the unsorted municipal waste stream.
3.2 CLEANING, DISINFECTING AND STERILIZING THE UNIT AND ACCESSORIES
3.2.1 Cleaning and disinfecting the unit: Cleaning and disinfecting of the unit
should only be done with nonflammable and nonexplosive agents. Use
mild water-based detergents. Make sure that no moisture or detergents
enter the unit. If cleaning or disinfecting the unit with flammable or
explosive agents is unavoidable, these must be completely evaporated
before the Surgitron®Dual/EMC is switched on.
3.2.2 Handpiece and Electrodes.
Always clean and disinfect the electrodes prior to sterilization.
Tissue residue can be removed from the active electrode with a sterile
moist cloth, steel or copper wool. No scalpel, scissors or similar pointed
objects should be used for cleaning the electrodes, since they may
damage the electrode surface. Such damage increases adhesion of
tissue to the surfaces of the electrodes during use.
Disinfect and sterilize handpieces and electrodes according to the
directions supplied with them.
All autoclavable products should be routinely inspected for any wear,
breaks, or deterioration of the insulation, and should be discarded and
replaced if any of these occurrences exist.
3.2.3 The dual footswitch is a waterproof unit; it can be cleaned with regular
detergent.
ATTENTION: Alcohol must never be used to clean and disinfect the front panel

6
IV. DESCRIPTION OF CONTROL ELEMENTS
4.0 INTERFACE ACCESORIES
4.0.1 Two Pedal Footswitch
A heavy duty waterproof dual footswitch for CUT and COAG modes is
supplied. The mode selectors described in 4.2 determine the cut and coag
modes activated by the respective footswitch. The footswitch indicators
described in 4.2, and will indicated the activated mode. The yellow footswitch
indicator will be ON when the CUT footswitch is depressed. The blue
footswitch indicator will be ON when the COAG footswitch is depressed. The
footswitch indicators are normally OFF until one of the footswitch pedals is
depressed.
The footswitch may be used with any handpiece compatible with the Surgitron®
Dual/EMC.
4.0.2 Handpieces
A variety of handpieces are available for use with the Surgitron®Dual/EMC.
A three-button handpiece adds convenience by enabling the user to control
CUT, BLEND, and COAG modes via fingerswitch. The depressed button will
control output function and disregards the front panel display setting. The
fingerswitch operational features are as follows:
4.0.2.1 CUT button will activate CUT mode. When depressed, the Yellow
Light (CUT) Indicator will be illuminated.
4.0.2.2 BLEND button will activate BLEND mode. When depressed, The
Yellow Light (BLEND) Indicator will be illuminated.
4.0.2.3 HEMO button will activate COAG mode. When depressed, the Blue
Light (COAG) indicator will be illuminated.
4.0.3 IEC-NPD disposable neutral plate
The IEC Neutral plate must be used with the RF Generator during activation.
To use, insert the molded plug of the Neutral Plate into the RF Generator as
shown in Figure 4.2.
4.0.4 Power Cord
The power cord connects the RF Generator to the supply mains.

7
4.1 REAR PANEL CONTROL ELEMENTS
Figure 4.1 Rear Panel
Power Cord: The Surgitron®Dual/EMC unit is shipped with a hospital grade
power cord. WARNING: To avoid the risk of electric shock, this equipment must
only be connected to a supply mains with protective earth.
Power Socket: The Surgitron®Dual/EMC unit must be connected to correctly
installed sockets with a grounded earth conductor using the power cord
supplied by the manufacturer.
Line Fuses: The unit is protected with two line fuses. If a fuse blows, the unit
should be checked for possible faults before the fuse is replaced and the unit
is operated again. Always replace with a fuse of the same rating. See 4.1.1 for
details.
Audio Volume Control: The volume of the acoustic signal should be set to a
volume that can easily be heard by the user.
Footswitch Receptacle: The Footswitch receptacle mates with the supplied
Ellman Surgitron®Dual/EMC Footswitch Pedal.
Dual Footswitch Pedal: The unit is shipped with a waterproof footswitch.
1
2
3
4
5
6

8
4.1.1 Line Fuse Replacement: Using a flat screwdriver, pry open the top of the line fuse door.
Remove two fuse holders. Replace fuses with the same value/size fuses ONLY. The fuse holder
arrows should be pointing towards the right. Snap the compartment back with the fuses inside. See
Figure 4.1.1 below.
Figure 4.1.1
Fuse Replacement

9
4.2 FRONT PANEL CONTROL ELEMENTS
Power Switch:
When the power switch is turned on, the unit automatically performs the following functions:
1 = ON
0 = OFF
•The audio signal is sounded.
•All start up sequences of tones on the front panel are activated during the
functional test.
•All front panel LEDS are illuminated.
•The patient return neutral plate is tested. If the neutral plate is not properly
connected to the patient and/or Surgitron®Dual/EMC, the Neutral LED Indicator
will turn red and the audio alarm will sound until the patient return neutral plate is
properly applied. The test is bypassed when the bipolar function is selected. All
power digital indicators shall be at the default state. If any error code is shown, the
error must be cleared prior to using the equipment. (For error code information,
see 8.7 - Error Codes Table).
Figure 4.2
Front Panel
FINGERSWITCH
HANDPIECE
BIPOLAR
HANDPIECE
NEUTRAL
PLATE
1

10
Units are shipped from the factory with default power levels of 0 and modes of
Cut and Hemo. To modify default values, simultaneously press and hold the
Cutting Mode and Coagulation Mode Select buttons while turning on the unit.
When CLR is displayed release the buttons and select the desired settings. Turn
off power.
Fault LED Indicator:
The Fault LED Indicator will be Red if any error is detected; otherwise, it is Green.
3 Neutral Plate Receptacle:
The neutral plate must be applied to the patient and connected to the equipment
for monopolar techniques. The Surgitron®Dual/EMC is equipped with a neutral
plate safety monitor which monitors the electrical connection between the neutral
plate and the unit, as well as between the neutral plate and the patient.
Neutral LED Indicator:
The indicator lights up Red and triggers an audible alarm if the neutral plate is not
properly applied. The LED indicator will turn to Green when the neutral plate is
correctly applied. This function is automatically bypassed if Bipolar mode is
selected.
Bipolar Cord Receptacle:
Bipolar function can be activated by footswitch only.
Fingerswitch/Handpiece Receptacle:
The Fingerswitch/Handpiece Receptacle accepts any monopolar handpiece that
is compatible with the Surgitron®Dual/EMC.
Yellow Footswitch Indicator: The light indicator will be ON only when the CUT
control footswitch pedal is depressed in Surgitron®Dual/EMC model.
Blue Footswitch Indicator:
The light indicator will be ON only when the COAG control footswitch pedal is
depressed in Surgitron®Dual/EMC model.
9 Cutting Mode Function Select Button: It is for selecting Cut or Blend functions.
Yellow Light (Cut) Indicator: The indicator illuminates when Cut function has
been selected.
Yellow Light (Blend) Indicator: The indicator illuminates when Blend function
has been selected.
Output Power Intensity Indicator for Cutting Mode: The default state is zero
when On/Off power switch is turned on. The output power will remain at the
selected level unless it is changed. The number displayed indicates the relative
power, which will be delivered to the patient when the mode is activated. For true
output power, see figures in Section 7.
Power-up Button for Cutting Mode: A single depression of the button switch
increases the power setting by one. Continuous depression gradually increases
the power to maximum - 100.
Power-down Button for Cutting Mode: A single depression lowers the power
setting by one. Continuous depression gradually decreases the power to
minimum - 0.
2
4
5
6
7
8
10
11
12
13
14

11
15 Coagulation Mode Function Select Button: It is for selecting Coag, Fulgurate, or
Bipolar function.
16 Blue Light (Coag) Indicator: The indicator illuminates when Coag function has been
selected.
17 Blue Light (Fulgurate) Indicator: The indicator illuminates when Fulgurate function
has been selected.
18 Blue Light (Bipolar) Indicator: The indicator illuminates when Bipolar function has
been selected.
19 Output Power Intensity Indicator for Coagulation Mode: The default state is zero
when On/Off power switch is turned on. The output power will remain at the selected
level unless it is changed. The number displayed indicates the relative power, which
will be delivered to the patient when the mode is activated. For true output power, see
figures in Section 7.
20 Power-up Button for Coagulation Mode: A single depression of the button switch
increases the power setting by one. Continuous depression gradually increases the
power to maximum - 100.
21 Power-down Button for Coagulation Mode: A single depression lowers the power
setting by one. Continuous depression gradually decreases the power to minimum - 0.
22 Yellow Energized Indicator: The Yellow energized indicator will be ON when
CUTTING MODE circuit is energized.
23 Blue Energized Indicator: The Blue energized indicator will be ON when
COAGULATION MODE circuit is energized.
4.3 SYMBOL DEFINITIONS
4.3.1 Type BF defibrillator protection
4.3.2 Refer to manual
4.3.3 Protective earth connection
4.3.4 Neutral electrode referenced to ground
4.3.5 Fingerswitch control
4.3.6 Footswitch control
4.3.7 Neutral plate
NOTE: To prevent cross-contamination, Cynosure highly recommends the
use of disposable electrodes and accessories.

12
4.3.8 Non-Ionization radiation
4.3.9 Equipotential Symbol
4.3.10 Refer to instruction manual/booklet
4.3.11 Keep dry
4.3.12
Serial Number Label with Fuse and Supply Ratings
V. PREPARATION FOR USE
5.0 PREPARATION FOR USE
5.0.1 On the Surgitron®Dual/EMC check to make sure that the power switch is in the OFF
position.
5.0.2 Connect the IEC power cord to a 3-wire ground AC power receptacle.
5.0.3 Insert the Neutral Plate male plug into the neutral plate receptacle on the front panel
marked Neutral.
5.0.4 The Neutral Plate should be reliably attached with its entire area attached to the patient’s
body as close as possible to the operating field, as per the Safety Instructions specified in
Section 2.1.4.
5.0.5 Select the desired electrode and handpiece and connect them as instructed by their
accompanying instructions for use.
5.0.6 Plug the handpiece into the appropriate receptacle on front panel.
5.0.7 Make sure that the electrode is seated fully so that no conductive shaft is exposed.
5.1 WAVEFORM SELECTION
Reference Section 8 –Power output characteristics for more details about waveforms.
5.1.1 CUT - For micro-smooth cutting:
Select CUT by pushing SELECT button on the Cutting Mode to turn on the CUT
indicator.
Push Power Up/Down Buttons on the Cutting Mode to select the desired power
level. Depress the CUT Footswitch pedal or Fingerswitch CUT button to activate
the output power.

13
The Fully Filtered Waveform is a pure continuous flow of high-frequency radiowaves.
This filtration results in a continuous non-pulsating flow of radiowaves which provides a
micro-smooth cutting flow. This wave produces the least amount of lateral heat and tissue
destruction.
5.1.2 BLEND - For cutting with coagulation:
Select BLEND by pushing SELECT button on the Cutting Mode to turn on the
BLEND indicator. Push Power Up/Down Buttons on the Cutting Mode to select
the desired power level. Depress the CUT Footswitch pedal or Fingerswitch
BLEND button to activate the output power.
The Fully Rectified Modulated Waveform produces a mild pulsating effect which can,
under certain conditions, slightly reduce the efficiency of the cutting effect. In additional to
a smooth cut, the Fully Rectified Modulated Wave is accompanied by a thin layer of
coagulation on the raw cut tissue surfaces.
5.1.3 COAG -For pure Hemostasis-Coagulation to control most forms of bleeding:
Select COAG by pushing Select button of the Coagulation Mode to turn on the
COAG indicator. Push Power Up/Down Buttons on the Coagulation Mode to select
the desired power level. Depress the COAG Footswitch pedal or Fingerswitch
HEMO button to activate the output power.
The Partially Rectified Modulated Waveform is an intermittent flow of the high-
frequency radiowaves that produces hemostasis. The Partially Rectified Modulated Wave
is also recommended for coagulating blood vessels via an indirect technique. To seal the
walls of a vessel, grasp it with a hemostat and lift it free of surrounding tissues. Next
contact the hemostat with the electrode, 1 to 2 inches from the hemostat’s tips.
5.1.4 FULGURATION - For desiccation or fulgurate spark-gap:
Select FULGURATE by pushing SELECT button of the Coagulation Mode
to turn on the FULGURATE indicator.
Push Power Up/Down Buttons on the Coagulation Mode to select the desired
power level. Depress the COAG Footswitch controller to activate the output
power. Note: Fulguration cannot be activated by use of the three button
fingerswitch.
The Fulguration or Spark-Gap Wave is a waveform that has been modulated to
simulate the effects of the Oudin current. The Fulguration wave produces a
potent dehydration effect on tissues.
5.1.5 BIPOLAR - For precise coagulation utilizing bipolar energy:
Select BIPOLAR by pushing SELECT button of the Coagulation Mode to
turn on the BIPOLAR indicator.
Depress the COAG Footswitch controller to activate the output
power.
5.2 SMOKE HAZARD
By-products of high frequency surgical procedures are an occupational exposure
hazard. Standards based policies and procedures must be developed in all
practice settings to protect personnel from the causative factors of smoke plume
and aerosols.

14
VI. SURGICAL DESCRIPTION AND USE
6.0 LEARNING TO USE RADIOSURGERY®
Before making contact with the tissue, the power intensity must be selected and the foot
pedal or fingerswitch must be activated. During the actual cutting, it is important to use a
smooth uninterrupted motion with even and light manually applied pressure. The
movement should not be too slow. If it is, the build-up of lateral heat in the tissue may
cause charring, followed by necrosis and sloughing (see Preoperative Cutting Practice
Section 6.1). When performing a second or third cut in the same surgical site, allow
approximately ten seconds for the tissue to cool between applications of the electrode to
the site. Radiosurgery®should be regarded as a new technique that will require learning
of new skills. All rules of good surgical technique and clinical judgment still apply.
The biggest difference to be learned is that, unlike a steel scalpel or standard
electrosurgery, radiosurgery does not use manually applied pressure to cut. Therefore,
a light, smooth, continuous, and brush-like stroke should be developed. Only then will
the surgeon appreciate the tremendous advantages inherent in Radiosurgery®.
Defining Good Technique: Tissue damage will occur if heat is allowed to accumulate to
the point where excessive dehydration occurs. Preventing the accumulation of such
heat is a basic objective of radiosurgical technique. The spread of lateral heat in tissue
depends upon various factors as indicated in the following formula:
Time x Power
Lateral Heat ∝ –––––––––––––––––
Frequency
Additionally the electrode type and selected waveform impact the thermal build up.
This formula may be broken down in the following manner:
A. Time of Electrode Contact
a. The slower the passage of the electrode, the greater the lateral
heat.
b. The more rapid the passage of the electrode, the less the
lateral heat.
B. Power Level
a.If power is too high there is a high accumulation of heat.
b.If power is set correctly, lateral heat reduced to the minimum necessary to volatize
tissue cells. Smooth flow through tissue with no sparking and no resistance through
tissue.
c.If power is set too low, drag is observed causing excessive contact time and
bleeding due to tissue being pulled and torn from its base.
C. Frequency –Tissue provides lower resistance to higher frequencies, reducing thermal
build up.
D. Electrode Type
a. A broader electrode tip requires more power and creates greater
thermal spread.
b. A narrower electrode tip requires less power and creates less thermal
spread.
E. Nature of the Waveform - See Section 5.1 for details
a. Fully Filtered (Continuous Wave - CW) - Least lateral heat.
b. Fully Rectified - Low lateral heat.
c. Partially Rectified - High lateral heat.
d. Fulgurate - Highest lateral heat.

15
6.1 PRE-OPERATIVE CUTTING PRACTICE
Since Radiosurgery®requires very little manually applied pressure to effect a cutting
action, the user may gain control by supporting his/her hand in some fashion. Gentle
touch, digital dexterity, a fluid wrist action, and a feather-light touch aid in
Radiosurgery®.
The tissue to be cut should be moist. If it is too dry, surface charring may occur.
Excessively dry tissue can be moistened with a wet gauze.
Prior to performing an operative procedure, the area should be studied in order to select
the correct electrode, waveform and power. Several practice strokes, with power off, are
recommended to determine the correct length, depth, and direction of cut.
Prepare the Surgitron®Dual/EMC for operations as described in Section 5-
PREPARATION FOR USE, then follow the steps below.
A. Select a piece of fresh, lean beef containing very little fat. Allow meat to
reach room temperature.
Note: Do not use veal because it does not change color when cut with an
electrode.
B. Place the meat on a Neutral Plate.
C. Insert the electrode of choice (Empire, Loop, Diamond, Vari-Tip, etc.) into the
handpiece.
D. Select CUT.
E. Set output power intensity to 10.
F. Depress the CUT Footswitch pedal or Fingerswitch CUT
button.
G. Using a smooth, brush-like motion, make several incisions of various lengths
and depths. If you notice that the electrode will not cut, cuts only with pulling
and dragging, or if tissue shreds adhere to the electrode while cutting, then
increase the power gradually until a smooth cut occurs.
H. If the setting is too high then you will notice sparking and discoloration along
the electrode path. Reduce power and repeat the procedure as outlined
above.
I. Continue to repeat the above procedure until such a point when no
discoloration occurs and there is no visible sparking. The Radiosurgical tip
should not encounter resistance. The cut should be micro-smooth without
sparking and without any drag. Continue to practice using slow, medium,
and fast strokes to acquire dexterity and confidence.
6.2 PRE-OPERATIVE COAGULATION PRACTICE
Surgitron®Dual/EMC can be used to seal off small blood vessels. Move to the COAG
mode (Partially Rectified Wave). The ball electrode is normally used since it provides
extended coverage of the tissue surfaces. Prior to performing coagulation, the tissue
should be wiped clean of blood so that the area needing treatment can be viewed. Direct
manually applied pressure will help to locate bleeders. Intermittent gentle contact with the
tissue is performed until bleeding stops.
The same meat specimen used for cutting may be used for coagulating practice. Effective
coagulation is achieved when the treated area appears on the meat as blanched spot of
approximately 2 mm diameter with a minimum penetration into the tissue.
NOTE: Feather-light touching of the ball electrode is recommended to coagulate bleeders
efficiently.
A. Select a piece of fresh, lean beef containing very little fat. Allow meat to
reach room temperature.
Note: Do not use veal because it does not change color when cut with an

16
electrode.
B. Place the meat on a Neutral Plate.
C. Insert a ball electrode into the Handpiece.
D. Select COAG.
E. Set the output power intensity to 10.
F. Position the ball electrode in light contact with the beef.
G. Depress the COAG Footswitch pedal or the Fingerswitch HEMO
button.
H. Repeat the above procedure with power settings of 20, 30, & 40.
Contact should be 2 to 3 seconds.
A wide range of coagulation or blood control can be obtained by utilizing the partially
rectified modulated wave with different techniques. Bleeding should be stopped by some
form of direct manually applied pressure. When bleeding has momentarily stopped, final
sealing of the vessels can be accomplished by brief application of the partially rectified
modulated waveform.
There are two types of hemo electrodes: ball electrodes and thick needle
electrodes.
Bipolar: The Surgitron®Dual/EMC can be used for bipolar coagulation
procedures. The power should be lowered to 10 or 20 depending on the
procedure.
Do not attempt to operate with electrodes if the protective insulation is cracked or worn. In
the event that the brass is exposed, a shock or burn may be felt by the operator or patient.

17
VII. POWER OUTPUT CHARACTERISTICS
Surgitron®Dual/EMC MONOPOLAR AND BIOPOLAR MODES
Figure 7.0
DIGITAL SETTING
Surgitron®Dual/EMC CUT MODE
Figure 7.1
RESISTIVE LOAD (OHMS)
POWER (WATTS)
POWER (WATTS)
Half Setting –50
Full Setting - 100
Typical Nominal Plot
CUT MODE Power Output vs Resistive Load
Typical Nominal Plot
90w
Power Output vs Digital Setting
Monopolar:500 Ohm Load; Bipolar 200 Ohm Load
Cut
Cut/Coag
Hemo
Fulgurate
Bipolar