The drawbacks of two-polar electrocoagulation are widely recognised: - Passage of the electrical current causes the metal electrodes to adhere to body tissue
- Extensive necrosis around the surgical site is difficult to control
- The morphologically controlled electrical conductivity relationship varies between patients, and between different parts of the anatomy on each patient
Infra red coagulation eliminates these drawbacks and extends the range of indications in which hemostasis may be effectively employed.
The infrared coagulator consists of: - The base unit, containing a low-voltage (15V) halogen lamp in a gold reflector housing
- A rigid light guide (different sizes and geometries are available according to the procedure) on the end of a cable, through which the IR is applied to the tissue
- A single-patient-use tissue contact surface made from a Teflon polymer, transparent to infrared and non-adhesive to tissue
Red light and infrared leakage radiation are allowed to escape through the lamp casing. This prevents overheating even after continued use over several hours, and renders an expensive cooling system unnecessary. The operator may pre-set the optimal amount of energy to be transferred into the tissue precisely by means of a timer. This is then reproducible in all subsequent cases.
Advantages - Coagulation time only 1 – 5 seconds
- No tissue adhesion
- Precisely adjustable depth of necrosis
- Simpler and more effective treatment for haemorrhoids than sclerotherapy (injection)
- Suitable for staunching bleeding
- Interchangeable light guides in differing geometries and sizes
- No danger of explosion or burning
- No effect on cardiac pacemakers
- Can be used during pregnancy
- No active electrodes
- Single-use Teflon tips encourage infection control best practice
Sites suitable for IRC use
- Main Theatres
- DSU
- Hospital Outpatients’ Departments
- General Practice
Proctology The therapy ensures the successful throttling of the vessels by scar-tissue shrinkage. The pulse length selected determines the depth of necrosis, and the diameter of the light guide used determines its circumference.
Tissue penetration with IRC is limited to a depth of 3mm. It is almost impossible to control tissue penetration to this degree of precision with electrocoagulation or with hot and cold probes, and certainly impossible with sclerosing injections. IRC is suitable for haemorrhoids of 1st and 2nd degree, and particularly for bleeding haemorrhoids for which other therapies, such as sclerotherapy, are unsuitable and even dangerous.
Method
1. The haemorrhoids are first located via a proctoscope, through which the light guide is then inserted.The optimum light guide geometry for this therapy is 6-7mm in diameter and angled about 20% at the tip.
2 The light guide tip is positioned above the haemorrhoidal nodes and pressed onto the tissue. A pulse length of between 1 and 3.5 seconds is normally selected, and the infrared lamp then switched on to apply the coagulation
3. Three further coagulations of identical duration, at 90 intervals, are applied to the tissue around the haemorrhoid Results following Therapy
Since the probe tip is coated with a special Teflon polymer, it does not adhere to the mucous membrane after irradiation and may be easily removed with no tearing of tissue. The irradiated site appears as a greyish area of mucous membrane. After one week, it is still visible as a slightly indrawn spot with a reddish colour, due to capillarization. After two weeks, only a discrete scarred area of indrawn membrane is visible, and after 3-4 weeks this is no longer evident as normal mucosa grows over the site of the operation.
Comparison with patients treated with sclerosing drugs* have shown that the therapeutic effect could be achieved more rapidly by infrared coagulation with less stress on the organism. IRC is also effective in the event of bleeding following surgical intervention for the removal of papillary hypertrophies in the anal canal, or rectal polyps following mucosal biopsies. | 
