Improvement of patient return electrodes in electrosurgery by experimental investigations and numerical field calculations.

Numerical field calculations and experimental investigations were performed to examine the heating of the surface of human skin during the application of a new electrode design for the patient return electrode. The new electrode is characterised by an equipotential ring around the central electrode pads. A multi-layer thigh model was used, to which the patient return electrode and the active electrode were connected. The simulation geometry and the dielectric tissue parameters were set according to the frequency of the current. The temperature rise at the skin surface due to the flow of current was evaluated using a two-step numerical solving procedure. The results were compared with experimental thermographical measurements that yielded a mean value of maximum temperature increase of 3.4 degrees C and a maximum of 4.5 degrees C in one test case. The calculated heating patterns agreed closely with the experimental results. However, the calculated mean value in ten different numerical models of the maximum temperature increase of 12.5 K (using a thermodynamic solver) exceeded the experimental value owing to neglect of heat transport by blood flow and also because of the injection of a higher test current, as in the clinical tests. The implementation of a simple worst-case formula that could significantly simplify the numerical process led to a substantial overestimation of the mean value of the maximum skin temperature of 22.4 K and showed only restricted applicability. The application of numerical methods confirmed the experimental assertions and led to a general understanding of the observed heating effects and hotspots. Furthermore, it was possible to demonstrate the beneficial effects of the new electrode design with an equipotential ring. These include a balanced heating pattern and the absence of hotspots.