HFS95 100 Manuale E Rev08

MUB.
001
USER’S MANUAL Rev. 08 – Feb 2010
LIARRE S.r.l.
Establishment and Registered office:
Via G. di Vittorio, n°5
40020 Casalfiumanese (BO) – Italia
Tel. +39 / 542 / 667066 – Fax +39 / 542 / 668000
e-mail: info@liarre.it -- http://www.liarre.it
User's Manual
HIGH FREQUENCY ELECTROSURGERIES
HFS 95 – HFS 100
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LIARRE S.r.l.
Factory and Head Office:
Via G. di Vittorio, n° 5 – 40020 Casalfiumanese (BO) – Italy
Tel. +39 / 0542 / 667066 – Fax: +39 / 0542 / 668000
e-mail: info@liarre.it
internet:http://www.liarre.it
Heigty Edition, May 2006

Printed in Italy
Information regarding this manual
All information contained in this publication may be subject to modification for technical and commercial reasons
without prior notice.
Any necessary variations will be included in future editions of the manual.
This manual gives the necessary information for the high frequency electrosurgeries HFS 95 – HFS 100
installation and correct use. This is a fundamental reference book and guide for users, so it must be read carefully
before using the HFS, and kept nearby for quick reference. Even partial non-compliance with these instructions
could result in the unit's malfunction or damage, as well as injury to the user. The warranty will also be considered
null in this case. Therefore, the strict observance towards the producer’s instructions enables one to have the best
results from the equipment and if necessary receive rapid, efficient technical assistance.
Writing conventions used in this manual

Bold face type is used to highlight some sections of this document.
Note
The notes emphasize particular information in the text.
ATTENTION
This appears before certain operations which, if unobserved, may result in damage to the unit and/or its accessories.
WARNING
The warning notes indicate operations or situations which, if not known or carried out incorrectly, could
cause serious personal injury.
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Warranty
LIARRE guarantees all equipment for a period of 12 (twelve) months starting from the registration or sales date.
The warranty is valid provided that the equipment is used according to the instructions in the manual. For
warranty validity, it is also necessary to send the warranty coupon back to the manufacturer, along with a
photocopy of the sales receipt, within 8 (eight) days. If a product proves defective during warranty, LIARRE will
repair or replace it, at its own discretion.
This warranty will not be valid if the defect or damage is due to:
- User’s improper or inaccurate maintenance;
- Unauthorized opening of the external parts;
- Tampering, unauthorized modifications or incorrect use;
- Irregular functioning without respecting the product's environmental specifications;
- Use of non-original parts;
- Improper installation;
- Use of incorrect cleaning liquids;
- Use of non original packaging.
Goods under warranty are considered free LIARRE's warehouse (ex-works).

When goods are to be returned, after LIARRE's approval, please first carefully follow the below-mentioned
packing instructions and enclose a copy of the purchase receipt in the carton.
ATTENTION
The customer is responsible for damages caused by improper packing.

LIARRE advises to use EXCLUSIVELY the original packing materials
and insure goods during shipment.
Packing instructions:
- disconnect the power cord and separate the accessories;
- use the original carton and packing filler;
- enclose customer's comment or note specifying service needed, type of damage or malfunctioning or any
further information useful to the technician.
LIARRE S.R.L. remains at complete disposal of its customers for any information about its products.
LIARRE also grants a punctual and efficient assistance. LIARRE does not accept any responsibility for technical
operations made by non authorised personnel.
Many of the definitions and of the suggestions given in this manual are taken from the texts of the
harmonised norms EN 60601-1 (CEI 62-5), EN 60601-2-2 (CEI 62-11), concerning safety, the use and the
maintenance of the high frequency electrosurgeries. LIARRE high frequency electrosurgeries have been projected
and manufactured according to those norms.
DESTINATION FOR USE
HFS95 / HFS 100 are destined for use

in small precision surgery, in dental and veterinary field.
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Table of contents
CHAPTER 1 : INTRODUCTION PAGE 5
1.1 Historical background of high frequency surgery or RADIOSURGERY. PAGE 5
1.2 General information about HF units. PAGE 5
1.3 Nature of the dangers in HF surgical technique. PAGE 6
CHAPTER 2 : INSTALLATION OF THE UNIT PAGE 9
2.1 General features and working principle PAGE 9
of electrosurgeries HFS 95 and HFS 100.
2.2 Operation modes. PAGE 10
2.3 Basic information and general problems of HF surgery. PAGE 15
2.4 Clinical indications in dentistry. PAGE 16
CHAPTER 3 : DESCRIPTION OF THE CONTROL KNOBS AND BUTTONS, SIGNALS AND PAGE 17
CONNECTIONS
3.1 Front panel HFS 95. PAGE 17
3.2 Front panel HFS 100. PAGE 18
3.3 Back panel HFS 95 and HFS 100. PAGE 19
3.4 Sound signals of HFS 95 and HFS 100. PAGE 20
3.5 Graphic symbols on the panels of HFS 95 and HFS 100. PAGE 20
CHAPTER 4 : USE OF THE UNIT PAGE 21
4.1 Installing and using the electrosurgery HFS 95 and HFS 100. PAGE 21
4.2 Monitor circuit of neutral electrode PAGE 23
4.3 Particular precautions for use. PAGE 25
4.4 Maintenance after use. PAGE 25
4.5 Discharge after use and environment’s protection. PAGE 25
CHAPTER 5 : TECHNICAL FEATURES OF ELECTROSURGERIES HFS 95 AND HFS 100 PAGE 26
5.1 Electrosurgeries HFS 95 and HFS 100. PAG. 26
APPENDIX A PAGE 28
Graphic 1 HFS 95, HFS 100 output power according to the load. PAGE 28
Graphic 2 HFS 95, HFS 100 power setting in monopolar cut mode (load: 50 to 2000 ohm). PAGE 28
Graphic 3 HFS 95, HFS 100 power setting on a 1000 ohm load. PAGE 29
Graphic 4 HFS 95, HFS 100 power setting on a 200 ohm load. PAGE 29
ANNEX 1: EMC TABLES PAGE 30
Table 1 Emission aspects. PAGE 30
Table 2 Immunity aspects. PAGE 30
Table 3 RF immunity aspects. PAGE 31
Table 4 Reccomended separation distance between portable and mobile communication sets PAGE 31
and HFS 95 and HFS 100 electrosurgery units.
CONFORMITY DECLARATION PAGE 32
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Chapter 1
Introduction
1.1 – Historical background of HF SURGERY
The development of electrosurgery instruments and their specialized use in several fields of general
surgery basically derives from the evolution of the ancient cauterization techniques (from the Greek word
kauterion, a hot iron used for branding). Many doctors still use the word "thermocautery" or
"electrocautery" by mistake, when referring to HF surgical equipment, disregarding the remarkable
differences between the two. "Electrocautery" is the modern (electric) version of thermocautery, invented
by C. Paquelin in 1875; it used a resistive filament made white-hot by electric current flowing through it.
Cauterization (i.e. hot surgery) implies tissue removal and modification using white-hot devices
causing tissue burning. This results in local third-degree burns, with all resulting adverse effects on the
wound (irritations, difficult healing, tissue destruction, carbonization, tissue retraction etc.). Cauterization
is by no means similar to high-frequency surgery (also called radiosurgery, or HF electrosurgery), since
the latter is a "cold" technique: tissue is parted using high-frequency (HF) oscillations of suitable
amplitude. Hot surgery long survived before being totally replaced by electrosurgery. HF surgical
techniques has become successful as soon as it was understood that the use of frequencies higher than 0.5
Mhz caused no induced muscular contraction in the patients. These high-frequency currents could
therefore be used for both surgical and therapeutical purposes.
It was J. A. D'Arsonval with his experiments in 1891, who found out that the application to humans
of electric currents higher than 10 kHz in frequency, by considerably reducing the causes of
neuromuscular stimulation, could be successfully used for surgical purposes. While the first low-power
electrosurgery appliance (for dental applications) was developed in the United States in 1969. Since then,
the technology applied to this kind of equipment remarkably evolved, also thanks to the experience
acquired by doctors and manufacturers. As you will see, the HF surgical instruments manufactured by
LIARRE (HFS 95 and HFS 100), allow a total control of operation parameters, and represent the state of
the art in terms of surgery final quality, repeatability of operations, patient and operator safety.
1.2 – General information on HF (high-frequency) SURGERY

or RADIOSURGERY appliances
Radio knives are electromedical instruments supplying high-frequency (over 0.3 MHz) currents to
obtain body tissue modifications such as cut (electrotomy) or coagulation. HF currents can be applied to
the patient in the following ways:
MONOPOLAR TECHNIQUE:
by using a small-surface active electrode and a large-surface neutral electrode;
BIPOLAR TECHNIQUE:
by using a single bipolar electrode, such as a forceps whose halves are insulated one from the other.
The output power can considerably vary from one instrument to another, according to the
application fields: from a minimum of 10 W for special-purpose radio knives (ophthalmology and
dermatology) up to 400 W for general-purpose in-patient surgery (operating theatres). The general-
purpose radio knife peak output voltage can reach 10 KV.
Minor surgery instruments to be used for dental, ophthalmological, ENT, aesthetics, dermatological
applications usually have output power levels not exceeding 50 W. In minor and medium surgery usually
requires power values not exceeding 100 W.
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A few definitions are given herebelow referring to common words used in HF surgery:
ACTIVE ELECTRODE
electrode used in electrosurgery to produce physical effects on organic tissues such as cut and/or
coagulation, concentrating high HF energy density at tissue level.
NEUTRAL ELECTRODE
Relatively large-face electrode which is applied to the patient body and acts as the return circuit for
high-frequency current. The currents in the contact point between patient and neutral electrode are at
such a low level that there is no physical side effects like burns. The neutral electrode is also called
FLAT ELECTRODE, PATIENT PLATE, PASSIVE or DISPERSIVE ELECTRODE, RETURN
ELECTRODE or PATIENT ELECTRODE (GROUND PLATE).
BIPOLAR ELECTRODE
Assembly of two active electrodes on the same support, usual in the shape of a forceps, causing high-
frequency current to flow mostly between the two probes, while the instrument is working.
CUT (ELECTROTOMY)
dissection of biological tissues caused by the flow of high-frequency, high-density current (from the
active electrode), causing heat (temperatures exceeding100 °C) (instantaneous cell evaporation).
COAGULATION
Haemostasis of small vessels in the body tissue caused by the flow of high-frequency current causing
heat (temperatures not exceeding 100 °C).
APPLIED PART
all the applied parts, including the cables, which are put in contact with the patient for diagnostic or
therapeutical purposes. In the radio knife, the applied part include are the active, neutral and bipolar
electrodes and their cables.
1.3 – Nature of the dangers of HF surgery

The high currents and electric voltages supplied by the radio knife may represent hazard for the
patient and/or the operator, and may generate electromagnetic interferences to other devices in contact
with or implanted in the patient. Any sparks or electric arcs generated between the electrode and the body
tissues, or, for example, a metal forceps, may cause frequency currents (lower than 0.2 MHz), resulting in
unwanted neuromuscular stimulation.
A few examples are given herebelow of the most common hazards connected with use of a radio
knife.
1.3.1 – Burns
When a radio knife is used in the monopolar technique, it is implied that the physical effect only
takes place in the tip of the active electrode. The small surface of this electrode causes a very quick
increase in the body tissue temperature. The HF current flows through the patient to the neutral electrode,
or when the contact between this and the patient is not adequate, through any other alternative medium
offering low resistance to the HF currents. If the contact area where the current leaves the patient is not
large enough, the temperature of that area will considerably increase, resulting in a severe local burn.
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 BURNS CAUSED BY THE NEUTRAL ELECTRODE

If the neutral electrode is not in perfect contact with the patient, unwanted local heating may occur
in the surrounding tissue, possibly resulting in burns.
Improper neutral electrode contact may be caused by:
- neutral electrode surface too small for the specific application;
- neutral electrode not perfectly making contact with the patient;
- neutral electrode accidentally insulated from the patient because of interposed insulating film,
sterile cloths or other non-conductive material;
- discontinuous electrode contact.
 BURNS CAUSED BY ELECTRODES OR CABLES
They may be caused by:
- accidental activation of an active electrode left close to the patient. Sterile cloths do not usually
provide sufficient HF current insulation, especially if they are wet or damp;
- surgical clips used to fix the cloths around the patient and to the operating table should not be
used to support the cables: the terminals of these clips might penetrate the cables and damage
their insulation;
- the operator might burn his/her fingers while coagulating tissues or vessels with a non-insulated
forceps in contact with the active electrode. In this case, the radio knife high output voltage
might cause an electric arc piercing the surgical gloves.
WARNING
Higher pressure points (caused by bone protuberances or gaps in the neutral electrode surface) may
result into HF current higher densities and subsequent excessive temperature increase in those points.
Burn risks may also result from skin folds near the edges of the neutral electrode, as well as from
folding of small skin areas due to the relative sliding of the table below the patient who is not then
properly lifted.
WARNING
The heat which develops from contact with the neutral electrode is usually dissipated by the
subcutaneous blood circulation: the resulting temperature is therefore kept low. However, in the higher
pressure points or after prolonged patient pressure on the neutral electrode, blood circulation may
become difficult and heat may not be properly dispersed. Furthermore, it should be born in mind that
skin and blood flow in the body tissues may be altered by body temperature, anaesthetics and drugs
used during surgery.
WARNING
Devascularised patients may develop lesions near the neutral electrodes, even if they are correctly
applied, due to similar mechanisms. Special care is needed in these cases.
1.3.2 – Electrocution Hazard

Low-frequency electric voltage (usually lower than 0.2 MHz) caused by electric arcs or sparks may
cause unwanted neuromuscular stimulations. While coagulating tissues or blood vessels by using
uninsulated forceps, the operator may feel a current flow if an electric arc is produced between the active
electrode and the forceps, should his/her gloves become conductive because they are wet.
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1.3.3 – Fires and explosions

The electric sparks generated in the active electrode during normal use may cause fires, if they
occur in the presence of flammable products or if the radio knife is used in atmospheres with heavy
concentrations of oxygen, endogenous gases or nitrogen protoxide (flammable anaesthetic gases). When
anaesthetic gases are used, these should either be diverted or the operator should work outside their range
of action.
Make sure flammable products used for cleaning or hand disinfection purposes are thoroughly
evaporated before the radio knife is turned on.
WARNING
THE ELECTROSURGERIES HFS 95 AND HFS 100 MUST NOT BE USED NEARBY ANAESTHETICS OR
FLAMMABLE GASES.
1.3.4 – Electromagnetic Interferences

When the radio knife is working, electromagnetic interferences may occur with neighbouring
electromagnetic equiment, e.g. E.C.G. monitors, B.P. monitors and other monitoring devices, infusion
pumps, cardiac pacemakers. In fact, as you will see, one of the few serious obstacles not recommending
the use of HF surgery techniques is represented by cardiac stimulators implant receivers. Special care is
required in these cases because radiofrequency interferences coming from the knife might disturb or
prevent the stimulator normal operation, causing arhythmias in heart ventricles.
WARNING
THE ELECTROSURGERIES HFS 95 AND HFD 100 MUST NOT BE USED ON PATIENTS
WHO HAVE A HEART PACE-MAKER AND/OR OTHER LIFE SUPPORT DEVICES
BECAUSE THEIR WORK MIGHT BE COMPROMISED BY THE ELECTROMAGNETIC INTERFERENCE
OF THE ELECTROSURGERY.
ATTENTION
We recommend to check if there are electromagnetic interference problems
with other instruments near the electrosurgery when it is activated, and if there are,
try to reduce or eliminate the interference by taking away the electrosurgery
and its cables from the other instrument.
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CHAPTER 2
Installation of the unit
2.1 –General features and working principle of electrosurgeries
HFS 95 and HFS 100
The main working principle is the following: electric current oscillations having a frequency
exceeding 0.3 MHz (300,000 oscillations per second) can flow through organic tissues without causing
shock, muscular contractions and pain; on the contrary, they can generate considerable heat on the tissues.
Heat is generated by dissipation effect on the electric resistance offered by the tissue (Joule effect). High
frequency current is applied - in the monopolar technique - through a thin needle electrode (active
electrode) contained in a lightweight and handy handpiece. High density HF current (A/mm 2) is obtained
in this way in the chosen area only.
At the active electrode-to-tissue interface level, a certain amount of heat is developed (the heat rise
exceeding 100 °C), which causes instantaneous vaporization of the organic tissue layer rich of cell fluid,
while both the active electrode and the neutral electrode (or plate: it is used for return to the appliance of
the HF current supplied to the patient) will remain cold.
The frequency generally used for HF current is comprised between 0.4 and 3 MHz should be
chosen according to the average type of body tissue treated. LIARRE appliances HFS 95 and HFS 100
are optimized for minor and medium surgery precision applications, with quartz-controlled, 485 kHz
frequency (485,000 oscillations per second) HF emissions notwithstanding the operating mode, the
selected output power and the type of tissue be treated.
Frequency of the HF current oscillations
Simple harmonic current at HF Surgery output

This is the first critical parameter affecting the appliance performance overall quality relatively high
working frequency value is particularly indicated for highly sensitive tissues (for dental, ENT,
gynaecological, ophthalmological, aesthetic surgery, dermatological applications etc.) and will guarantee
suitable cutting depth without damaging the surrounding cellular layers, which would imply serious
complications during healing.On the other hand, too high frequency values would help HF dispersion: the
operation would not be easily controlled and patient risks would increase.
The three main electrosurgery working parameters, all operator-programmable, are described
herebelow:
 Operation mode: choice of HF current modulation percentage applied to the
patient.
 Output power adjustment.
 Activation time setting radio knife.
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Dissection effect due to the electric curent flowing at tissue level

1: Handpiece 2: Active electrode
3: Neutral electrode plate 4: Organic tissue
2.2 – Operation modes

As compared to the whole of the other currently marketed appliances, HFS 95 and HFS 100 offer a
choice from as many as 4 operation modes corresponding to as many different patient-applied HF simple
harmonic current amplitude modulation factors. This allows the whole range of monopolar and
bipolar HF surgical applications to be effectively covered, the operation modes being:
- CUT: pure cut
- CUT / COAG: cut and coagulation effect
- COAG: monopolar coagulation
- COAG BIPOLAR: micro and bipolar coagulation
The different possibilities and general application fields are listed herebelow, using as a reference
the HF output current which would be displayed by an oscilloscope.
It should be noted that the output power decreases proportionally to the applied modulation rate,
given the same position of the power control. Therefore, if the unit is set for a given output power in CUT
mode and then switched to another operating mode, the output power decreases accordingly, being at the
minimum in COAG BIPOLAR mode.
CUT (pure cut - electrotomy):
It corresponds to HF simple harmonic current unmodulated amplitude. In HFS 100 it is indicated by
a yellow light.
Unmodulated amplitude HF curent

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This function perfectly replaces pure cut made with traditional knives. The waveform represented
by the HF current is sinusoidal and tipified by unmodulated amplitude and high spectrum purity, and is
totally free from overlapped modulations, which as is it known will cause unwanted coagulation effects,
by inducing higher lateral heat on the electrode.
Thanks to these features, the HF surgery technique offers a number of critical advantages with
respect to the traditional cutting technique. Using a radio knife having suitable characterostics turns out to
be simpler and more relaxing, while better results can be obtained in a shorter time and with reduced
bleeding.
A precise cut must be made by using a thin needle electrode, THE INSTRUMENT SHOULD BE
STARTED A MOMENT BEFORE MAKING CONTACT TO THE TISSUE. In order to make sure
you are working under the ideal conditions, always check that the electrode is clean and polished (use
emery): the electrode must slide on tissue with no applied pressure or resistance. If there is any resistance,
slightly increase the instrument HF power level. A good way to always keep the electrode clean is to rub
a piece of gauze soaked in methylated spirits and water in equal proportions on the electrode working
part, which is often clogged by tissue residues, blood and sometimes pus.
If the electrodes are dirty, an insulating crust of carbonized blood and tissue residues will form on
them: this insulating layer causes electric arcs and sparks, resulting in underlying tissue carbonization
(fulguration).
It is vital that cutting speed is not too high: this might damage the most sensitive tissues, cause
unwanted coagulation or even burn the tissue. Most of all, electrode sparking (fulguration) should be
avoided, because sparks would imply an increase in lateral heat resulting in unwanted coagulation effects.
The wound edge should not become white.
Each incision should be made while paying special attention to the electrode position with
respect to the tissue: the electrode should be kept in a vertical position, whenever this is possible, to
avoid unwanted coagulation. The best thing to do before cutting is to carefully clean the involved area
with water, then dry up leaving the area slightly wet.
Cut using (thin and thick) needle electrodes and loop electrodes, of the type used for tissue removal,
biopsies, levelling and plastic modelling. Cuts made with thick needle electrodes will increase lateral heat
on the wound, thus helping haemostasis. However, primary healing is not always guaranteed in this case.
Fine tuning of the power level (allowing cuts of different depth to be made on very different tissue
types) and instrument quality will enhance this feature, and place HFS 95 and HFS 100 at the top end of
the scale in terms of final performance in this operation mode, because the current emission is
characterized by the highest stability and spectrum purity.
It is a good thing not to stop too long in the same area with the electrode and the instrument
on: this is critical to avoid internal heat build-up. It is also advisable to perform longer operations in
following stages, with frequent pauses of a few seconds between one cut and the following one. It is
certainly possible to take the electrode back to a previously made cut, provided that you touch the cut
with the activated electrode and you make frequent pauses (time between electrode-to-tissue repeated
contacts should not be shorter than 10 seconds). After cutting, it is necessary to remove any residue which
might affect wound healing, using a 3-15% H2O2 solution.
Any cut made with HFS 95 and HFS 100 in the CUT operation mode can be easily sutured;
perfect healing is guaranteed.
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In this operation mode, the instrument will supply HF current in the most suitable waveform for
pure cut, with very low superficial coagulation and no tissue retraction or lateral heat. Incisions made
with these instruments will give much better results than those obtained with a traditional knife:
aesthetically superior outcomes can be obtained in a shorter time, because even awkward and delicate
areas can be treated without any effort.
CUT/COAG (cut and coagulation effect):
It corresponds to30% (low modulation index) amplitude-modulated, HF simple harmonic current.
In HFS 100 it is indicated by a yellow light.
30% HF amplitude-modulated HF current

This operation mode (and the relevant envelope of the patient-applied HF current particularly
indicated if you wish to make a cut while controlling bleeding. This is just on the biggest advantages of
electrosurgery compared to traditional surgery: the operator can work under controlled bleeding
conditions or absent bleeding conditions and in an aseptic environment (the environment is undoubtedly
sterile because of the considerable heat developing in the tissue). The difference between this operation
mode and the pure cut (CUT) mode lies in the fact that the HF current slight modulation helps the
coagulation characteristics to prevail over the pure cut characteristics by increasing the lateral heat on the
wound. The whole operation procedure described hereabove is also applicable to this mode.
Any type of electrode can be used, according to the type of operation. It should be borne (in mind
that a large-surface ball electrode is particularly indicated for massive coagulation in relatively large
tissue areas.
COAG (monopolar coagulation):
It corresponds to 45% (medium modulation index) amplitude-modulated, HF simple harmonic
current. In HFS 100 it is indicated by a blue light.
45% amplitude – modulated HF current
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COAG BIPOLAR bipolar and micro coagulation:

It corresponds to 55% (high modulation index) amplitude-modulated, HF simple harmonic current.
In HFS 100 it is indicated by a blue light.
55% amplitude-modulated HF current

The last operation modes are described together, because they have very similar characteristics and
have been developed for very special applications, from micro-coagulation (highly accurate and delicate
capillary coagulation), to massive operations on larger tissue areas, with both the monopolar technique
(special handpiece + neutral electrode) and the bipolar technique (using insulated forceps).
The HF current envelopes supplied by the instrument in these operation modes are optimized for
any type of coagulation operation, because the high amplitude modulation index results in easily
adjustable lateral heat. However, for monopolar technique applications, the types of electrode used are
ball electrodes (for coagulation of large tissue areas like in tumor surgery applications) or pointed conical
electrodes (for micro-coagulation and to stop haemorrhagies at capillary level). Large face electrodes will
distribute HF current energy effectively over the tissue surface: this proves to be sufficient in most of the
cases to stop bleeding.
In the bipolar technique, the bleeding vessels are tied using the special insulated forceps complete
with a connecting cable or, in monopolar mode, you can clamp the vessel with a forceps (or a haemostat)
on which the active electrode should be placed to obtain an electric contact: coagulation will be obtained
in the point of contact with the blood vessel.
In general surgery, the range of applications of coagulation is very wide. The choice an electrode
type is also made according to the field of use. For special uses, thin needle cutting electrodes can also be
used, to obtain a very limited extension of the tissue coagulation field (e.g. cyclodiathermy for retinal
removal, depilation etc.).
Factors influencing coagulation:
1) HF current waveform;
2) HF output power (usually with settings close to maximum setting values);
3) activation time.
Coagulation of a larger tissue area can be controlled by both choosing an electrode (e.g. a ball
electrode) and by adjusting the HF power supplied by the instrument. Usually a limited power level,
coagulation is slower and covers a large tissue area.
By increasing HF output power, the coagulation effect is quicker and limited in space: the cellular
lay is dehydrated near the electrode and the applied HF current flow is gradually decreased due to the
progressive increase in the electric resistance offered by the tissue.
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ATTENTION
In coagulation technique, opposite to cutting techniques, the electrode or the forceps MUST BE
PLACED ON THE TISSUE BEFORE THE INSTRUMENT IS TURNED ON
The radio knife activation time is a critical parameter, because it has a direct influence on
coagulation performance and final quality: this is particulaly clear in highly sensitive tissue applications
(e.g. ophthalmological, dental, aesthetic surgery, dermatological, ENT applications). HFS 100 instrument
is particularly indicated for these kinds of operation, because it allows timed activation of HF current
to be controlled each time the foot control is pressed, with highly accurate (quartz-controlled)
timing which can be programmed from 0.01 to 0.99 seconds. These features make it virtually
impossible to destroy tissue parts close to and below the superficially treated ones. The average activation
times are between 0.1 and 0.5 seconds.
One of the main advantages offered by HFS 95 and HFS 100 coagulation modes is the possibility to
control the HF output power in a highly accurate and repeatable way up to very low levels, when the
highest delicacy and accuracy are needed. In these cases, the only effect is a cell protein denaturation (due
to an induced temperature lower than 100 °C). This causes tissue congultination which in turn makes a
haemostatic effect. A too high power level would be difficult to control and it would result in a more
aggressive action, with tissue burning and carbonization effects. It should be observed that these
operation modes, if properly used, at a relatively low power level, allow micro-coagulations (suitable
electrodes should be used) smaller than 0.2 mm in diameter, which is well beyond the minimum clinical
use threshold.
The above notes clearly show the importance of having a HF surgery instrument. The radio
knives HFS 95 and HFS 100 are brand-new products presented by LIARRE in the fields of minor
precision surgery and of in- and out-patient medium surgery. They are sophisticated instruments,
absolutely necessary whenever highest safety, precision and operation repeatability are needed.
These high-tech, aesthetically refined, highly compact, top quality instruments fully meet the
demands of both unpractised doctors and specialists who wish to obtain the best outcomes when using HF
surgical techniques. These instruments are easy to use thanks to a control keyboard (fully digital in the
HFS 100 model). All the main parameters influencing surgical technique can be entered with the highest
precision:
1) continuous adjustment of HF output power (displayed in model HFS 100, knob-controlled in
model HFS 95);
2) patient-applied HF current envelope selection in 4 different operation modes, (digital and LED-
indicated in model HFS 100);
3) instrument start (indicated by a sound and a visual signal) can be controlled in normal mode (each
time the foot control is pressed), or in the timed automatic mode (selectable working times from
0.01 to 0.99 seconds - in model HFS 100 only) which avoids tissue necrotization, given the short
operating times;
4) automatic stabilization of the supplied HF current with respect to the type of tissue to be
treated: to obtain the highest effectiveness and patient safety, avoiding sudden increases; in applied
HF current density after treatment of a tissue area where conductivity is not even (severely inflamed
area);
5) internal auto-check function: instrument operation is automatically interrupted after approximately
6 seconds of continuous operation (largely sufficient for any uninterrupted electrosurgery operation):
the foot control must be pressed again. The instrument is automatically disconnected (intermittent
sound signal in model HFS 95, intermittent sound signal and visual indication, with display flashing,
in model HFS 100), in case of internal overheating. The instrument is automatically resets after the
overheating problem is solved.
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6) thin active electrode handpiece, handy and reliable, can be sterilized in autoclave (135 °C)
together with its special cable and electrodes.
2.3 – Basic information and problems connected to HF surgery

Many doctors do not feel confident with electrosurgical techniques, and have many doubts on the
working principle of the instrument and on the interactions between HF current and biological tissues.
LIARRE wishes to provide explanations in handbook, based on its manufacturer's experience and
long-standing fruitful research cooperation with experienced electrosurgery specialists. A few specific
issues of dentistry will be dealt with. They are also easily adaptable to any other medical field. At the end
of this chapter you will find a an essential list of references for further information.
The average level of HF surgery danger, if the general rules mentioned so far are complied with, is
similar to the level of danger resulting from the use of micromotors, turbines, root canal instruments,
which are all more commonly used in dentistry.
The use of instruments like HFS 95 and HFS 100 will dramatically reduce the risk of patient
damage; however is up to the operator to learn the HF surgery technique and to become familiar with the
radio knife by practising on steaks and veal mandibles.
It should be observed that the experimental results which can be obtained on steaks (although
working conditions are different from those of the oral cavity) are meaningful because they show a few
basic characteristics of instrument and because they allow the doctor to become familiar with the
instrument, to appreciate its technical features and to acquire a precious knowledge of the interactions
between HF current and biological tissues.
To practise the monopolar technique, place neutral electrode plate on an insulating work surface
and place the meat on the plate before start working.
A direct comparison between the HF surgical technique and traditional knife shows the following
advantages offered by the former, which largely justify its use:
 NO PRESSURE MUST BE APPLIED ON THE TISSUE;
 ACCESSIBILITY TO THE ORAL CAVITY (ESPECIALLY IN REAR AREAS) IS CONSIDERABLY
IMPROVED. THANKS TO EXTREMELY HANDY HANDP1ECES;
 THE GINGIVA CAN BE EASILY MODELLED AND LEVELLED (PLASTIC OPERATIONS);
 THE ELECTRODE TIP HAS A LOW BACTERIAL LOAD AND WILL REMAIN STERILE DURING THE
OPERATION: THE WORKING AREA BACTERIAL LOAD IS THEREFORE DECREASED BY THE
ELECTRODE ITSELF;
 CONTROLLED OR ABSENT BLEEDING WORKING CONDITIONS.
WARNING
As already said, THE ONLY CONTRA-INDICATION FOR THE USE OF ELECTROSURGERIES IS REPRESENTED
BY CARDIAC STIMULATOR IMPLANT RECEIVERS.
Another frequently recurring issue in dentistry is the fear of producing bone damage with resulting
considerable postoperative pain. This may only happen if the doctor stops too long in the same tissue area
(near the bone) with an activated electrode. This will cause excessive; heat build-up in the bone, which
may lead to necrosis at worst and to postoperative pain at the best.
These problems can easily be avoided by using the HFS 100 instrument with preset timed mode
(maximum time 0.5 seconds): this activation time is more than sufficient for this kind of operation. If
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treatment of the same tissue area must be repeated, wait for 10 seconds before applying the electrode
again.
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RECOMMENDATIONS FOR THE USE OF THE ACTIVE ELECTRODE HANDPIECE:

1) Always use a support;
2) make short, regular movements;
3) always place the active electrode at right angles to the tissue surface;
4) do not apply pressure;
5) never stop in the same area.
2.4 – Clinical indications in DENTISTRY

 Clinical crown elongation (for aesthetic reasons or neck decay);
 subgingival suicus, for aesthetic and functional reasons in case of high quality denture fitting;
 dentin desensitization;
 root canal sterilization: the sterilization obtained by electrosurgery is effective and long lasting, as
is shown by a number of clinical research works. It is particularly indicated f gangrenous teeth;
 haemorrhage control by coagulation;
 frenotomy can be carried out quickly and with no haemorrhage;
 exposure of roots to be used as bridgework pillars;
 destruction of fistulous orifices;
 root canal instrument breaking;
 elimination of mucosal hypertrophia, in cavities, edentulous saddles, at gingival edges near fixed
and mobile dentures;
 gingivoplasty: the gingival remodelling performed with instruments HFS 95 and HFS 100 is
unrivalled. It offers the following advantages if compared to traditional knife remodelling: no
haemorrhage, perfect surgical field visibility, smaller-scale interventions, no postoperative pain, no
need of surgical pack, quick re-epithelization with very good aesthetic results;
 eighth tooth dysodontiasis: immediate pain relief is almost always obtained;
 paedodontics and orthodontics operations: retained teeth, band hypertrophia, gingival edge
reshaping;
 biopsies: the risk of cancerous cell scattering is avoided.Tissue removal can be performed at the
same time to submit small oral cavity lesions to bioptic examination;
 interventions on gingival pockets;
 apicectomies;
 creation of subgingival sulci for aesthetic and functional denture requirements.
ESSENTIAL LIST OF REFERENCES

Calciati R. ATLANTE Dl ELETTROCHIRURGIA DENTALE Mortara, C.I.E.G., 1975, V Edizione
Waxman, H.N. THE ELECTRONIC SCALPEL Worcester Med. News, 31: 28-29, May 1967
Oringer, M. J. ELECTROSURGERY IN DENTISTRY Philadelphia, W. B. Sanders Co., 1967
Schon F. L'ELETTROCHIRURGIA IN ODONTOIATRIA – Quintessenz - Verlag, Berlino
LE BASI DELLA TECNICA ELETTROCHIRURGICA
Malone W. F., ELECTROSURGERY IN RESTORATIVE DENTISTRY J. Pros. Dent., 20: 417-425, 1968
Manning J. L.
Calciati R., ELECTROSURGERY IN DENTISTRY Springfield, Charles C. Thomas, 1974
Malone W. F.
Calciati R. COMUNI CAUSE DI ERRORE NELLA Ergonomia Dent., 3: 153-158, 1970.
SPERIMENTAZIONE ELETTROCHIRURGICA.
PROPOSTE DI UNA METODOLOGIA DI RICERCA
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Chapter 3
Description of the control knobs and buttons, signals and connections of
HFS 95 and HFS 100
3.1 – Front panel HFS 95
Front panel HFS 95
(1) (g) (4) (2) (f)
(B) (C) (f) (γ) (δ) ()

CONTROL KNOBS:
(B): Knob selector of the operation mode (cut, cut mixed to coagulation, coagulation,
bipolar coagulation):
 the output (monopolar – connectors (γ), (δ) – or bipolar – connectors () – is automatically changed
accordino to the selected mode;
 the control operates also during the activation of the unit.
(C): Output power regulation potentiometer (1 = minimum; 10 = maximum).
CONNECTIONS:
(γ): Connection to the active electrode (handpiece): coaxial connector.
(δ): Connection to the neutral electrode (ground plate): three poles connector.
(): Connections to the bipolar electrodes (forceps): connectors  4 mm.
LED SIGNALS:
(1): Green led: the unit is switched on.
(2): Orange led: the unit is activated (output power on).
INDICATIONS:
(f): Indications and / or safety warning (see table og graphic symbols).
(g): Indication of the selected operation mode by means of the commutator (B):
 CUT (pure cut): non modulate output (output power: 100% of the nominal power – 100 W on 1000 ohm),
 CUT/COAG (cut mixed to coagulation): modulation at 30% (output power: 70% of the nominal power – 70
W on 1000 ohm),
 COAG (monopolar coagulation and micro coagulation): modulation at 45% (output power: 55% of the
nominal power – 55 W on 1000 ohm),
 COAG BIPOLAR (bipolar coagulation): modulation at 55% (output power: 45% of the nominal power – 45
W on 1000 ohm).
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3.2 – Front panel HFS 100

Front panel HFS 100
(h) (5) (3) (g) (4) (2) (f)
(H) (G) (D) (E) (F) (f) (γ) (δ) ()

CONTROL BUTTONS:
(D): Operation mode selection button (cut, cut mixed to coaglation, coagulation,
bipolar coagulation):
 You can select the operation mode by pressing repeatedly the button, clockwise, from top to bottom;
 output (monopolar – connectors (γ), (δ) – or bipolar – connectors () – is automatically changed according to
the selected mode;
 the control operates also during the activation of the unit;
 when the unit is switched on the operation mode COAG BIPOLAR is automatically selected.
(E): decrease power button,
(F): increase power button:
 you can increase or decrease of one step at a time the indication on the display (4) and consequently the
output power by pressing the button;
 by keeping the button pressed you will reduce or increase the indication on the display (4) and consequently
the output power until the button is released or until you reach the minimum or the maximum value;
 When the unit si switched on it will automatically display the la test selected operation mode.
(G): activation timer button:
 By pressing the button you switch on the timer. By pressing it again the timer is disactivated.
 When the unit is switched on the timer is not activated.
(H): Selectors of the activation time:
 The time is set by pressing the buttons + and – on top and below the figures of the selectors; the figures
indicate the set time in hundreds of second (from 01 to 99 hundreds of second);
 When the unit is switched on the timer is not activated.
CONNECTIONS:
(γ): Connection to the active electrode (handpiece): coaxial connector.
(δ): Connection to the neutral electrode (ground plate): three poles connector.
(): Connections to the bipolar electrodes (forceps): connectors  4 mm.
LED SIGNALS:
(2): Orange led: the unit is activated (output power on).
(3): Led indicatine the selected operation mod (blu for coagulation, yellow for cut and mixed modes):
 CUT (pure cut): non modulate output (output power: 100% of the nominal power – 100 W on 1000 ohm),
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 CUT/COAG (cut mixed to coagulation): modulation at 30% (output power: 70% of the nominal power – 70
W on 1000 ohm),
 COAG (monopolar coagulation and micro coagulation): modulation at 45% (output power: 55% of the
nominal power – 55 W on 1000 ohm),
 COAG BIPOLAR (bipolar coagulation): modulation at 55% (output power: 45% of the nominal power – 45
W on 1000 ohm).
(4): Display indicatine the output power:
 Relative indication from 01 (minimum level) to 99 (maximum level).
(5): Green led:
 The unit is switched on acceso: output power on.
INDICATIONS:
(f): Indications and / or safety warning (see table og graphic symbols).
(g): Selected operation mode indicated by the relevant led (3).
(h): Activation time set in the timer (indication of the selectors (H)).
3.3 – Back panel of HFS 95 and HFS 100
Bacl panel HFS 95 ad HFS 100
(a) (β)
(b) (d) (c) (α) (ε) (A)

CONTROLS:
(A): On/off switch (O = the unit is switched off ; I = the unit is switched on).
CONNECTIONS:
(α): Mains cable connection.
(β): Connectione to the foot switch (connector for the tub of the pneumatic pedal).
(ε): Fuse holder (to take it out press the hook on the left, towards the mains cable connector. In order
to do this you have to disconnect the mains cable).
INDICATIONS:
(a): Details of the machine:
 voltage (230 Vac – 50/60 Hz),
 max. absorbed power (192 VA),
 output signal frequency (485 kHz),
 max output power (100 W on a resistive nominal load of 1 kohm),
 features of the fuses (2 fusesi 3,15 A FAST, 250V~, 5 x 20 mm),
 IP 21: protection against liquid penetration,
 Serila number.
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(b): Manufacturer datas.

(c): CE mark and identification of the Notified Body (see table of the graphic symbols).
(d): graphic safety and indication symbols (see table of the graphic symbols).
3.4 – Sound signals of HFS 95 and HFS 100
Activation: continuous sound signal which lasts for the whole activation time (output power on). The
sound cahanges accordino to the selected operation mode (cut, cut/coag, coagulation, bipolar coag.).
Alarm indicating that the round plate is not correctly applied to the patient: intermittent sound
signal which stops when the pedal is released. The output power is stopped. The alarm is disactivaed if
you select the COAG BIPOLAR mode. Check the application of the neutral electrode to the patient.
Alarm indicating too high internal temperature: intermittent sound signal which DOES NOT depend
on the pressing of the foot pedal. The output power is stopped.
The signal stops only when the internal temperature is again below the limit: switch off the unit and wait
for it to cool down.
3.5 – Graphic symbols on the panels of HFS 95 and HFS 100
SYMBOL POSITION MEANING
Back panel CE mark and identification of the Notified Body
On/off switch (back panel)

No voltage (OFF, switched off)
On/off switch (back panel)

Voltage (ON, switched on)
Connector of the pedal (back

panel) Pedal commutator
Back panel Class II medical device
Back panel;
front panel, next to the output Attention
connectors
Back panel Type BF
Front panel; Applied part type BF
front panel, next to the output
connectors
Front panel;
front panel, next to the output Electrodes isolated from round at high frequency (“floating” output
connectors circuit)
Front panel;
front panel, next to the output Non ionising radiations
connectors
Front panel;
front panel, next to the output Dangerous voltage
connectors
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Front panel HFS 100, next to

the power controls Variability
Separate collection of electronic devices. The machine must be

Bottom of the machine
discharged by following the Directive 2002/96/CE and following
modifications
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CHAPTER 4
Use of the system
4.1 – Installation and use of the electrosurgeries HFS 95 and HFS 100
The installation of the high frequency electrosurgeries HFS 95 and HFS 100 is simple and quick
and there are only a few basic norms to be observed. The electrosurgery must be put is a convenient place
for the operator. The place must be dry, far from heat sources and well aerated. In order to grant a good
heat dissipation it is important not to put anything (such as cloths and materasses) between the machine
and the table and close to the air slots.
Connect the foot switch in its connector (see description of the back panel) on the back of the unit
and connect the cables of the active electrode (handpiece + electrode) and of the neutral electrode on their
connectors in the front panel. The neutral electrode,according to the application field (medical or
veterinary) is made of the cable and by a elecgtode for the connection to the patient. The neutral electrode
is different according to the application filed and to the customer's request. The neutral electrodes are the
following:
- square rubber ground plate ( a square of conductive rubber for the veterinary market)
- split single use ground plate (conductive plate with adhesive gel for medical use).
This kind of plate is is made by a unique body where there are n°2 conductors for the monitor of the
patient's connection to the neutral electrode.
- split reusable plate (square rubber ground plate made of conductive rubber with double conductor
for the monitor of the patient's connection).
The standard neutral electrode supplied with the unit is the single use split ground plate. This kind
of electrode is made by a split cable which must be connected to the electrosurgery by its 4 poles
connector and by the ground plate itself (also split) to be connected to the opposite end of the cable by the
forceps which is on the cable itself.
Make sure all the connectors are well tight.
Make sure the contact of the grund plate with the patient is perfect on its whole surface, in a wide
area of tissu, at a distance of at least 30 cm and in a position opposite to the operation point. The split
neutral electrodes are in conformity to the European norms about the manufacturing procedures of the
high frequency electrosurgeries.
This system allows to control constantly that the contact between the patient and the neutral
electrode (ground plate) which closes the power circuit, thus assuring a safe operation. If the contact
between the patient and the neutral electrode were bad one would risk, in extreme cases, to make a burn
on thye contact point of the active electrode. This system grants a high safety use, but it requires a very
accurate positioning of the ground plate in order to avoid to produce parassite currents which would cause
a alarm without a reason.
In almost all the cases of use, apart from operations on the back, the ideal application point of the
ground plate is the lower part of the back, just above the cluneals with the electrodes aligned to the spine.
This application point allows to operate on the head, harms and legs, torax without creating false alarms
because of parassite currents.
In case you have to operate on the back, the ideal application point is the abdomen, just abive the
navel.
If, for any reason, it is not possible to reach neither the back nor the abdomen, we suggest to put the
ground plate on a arm or on a leg not involved in the operation with the electrodes aligned to the limb
itself (see following picture).
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The limb with the ground plate must not be too far from the operation point.
The application point of the ground plate must be clean and shaved.
In case of alarm of the neutral electrode (when you press the foot switch there is no output power,
Arto stilizzato
Cavo di collegamento Modo di applicazione

all’elettrobisturi. della placca bipartita
monouso o
riutilizzabile
you hear an intermittent beep and , in the HFS100, the display blinks) try to change the position of the
neutral electrode. If the alarme continues after a few attempts, get in touch with the after sales service
LIARRE S.r.l.
For further information about the monitor circuit see Chapter 4 Paragraph 2.
We underline that, for safety reasons the unit does not activate if the cable of the neutral
electrode is not connected, moreover the monitor circuit of the neutral electrode cuts off immediately in
case it detects a bad contact between the ground plate and the patient. In order toachieve this, you must
use a split ground plate.
The connection to the mains (220-230 Vac / 50-60 Hz) must be made exclusively by the supplied
cable, making sure the system has the ground connection (necessary for functional reasons). Do not use
extensions.
ATTENTION
During installation and use,
MAKE SURE THAT THE ACTIVE ELECTRODE CABLE AND THE NEUTRAL
ELECTRODE CABLE ARE NOT TOO CLOSE OR INTERTWINED:
THEIR PATHS FROM THE APPLIANCE TO THE POINT OF APPLICATION MUST BE
STRAIGHT AND CONVENIENTLY SPACED.
This helps to avoid useless power losses which would make the working parameters less certain and
less easily controllable
When the instrument is switched on by the switch on the back panel a green light (ON) turns on in
model HFS 95; in model HFS 100 the display power tuns on.
The HFS 100 device will automatically start in the working mode COAG BIPOLAR, which is
shown by a blue light; the timer will be off.
Note that the operating mode COAG BIPOLAR automatically cuts the active electrode
(handpiece) connector and the neutral electrode connector, activating the bipolar output for the
forceps (black bushings with the writing BIPOLAR OUT).
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To use the monopolar technique, it is enough to select any of the other operation modes: the
instrument will automatically switch the HF output current to the active electrode and neutral
electrode connectors (MONO OUT), and will cut the forceps connectors.
This is a very useful feature because it allows the cables and the relevant connectors to be always
safely kept connected to the appliance, for fast switching between two surgical techniques (monopolar
and bipolar).
It should be reminded that also in the bipolar technique, the appliance will not be activated
until at least the neutral electrode connector is plugged in. Therefore, if you only plan to use the
forceps to carry out bipolar coagulation, the neutral electrode should be plugged in anyway, even
though you will not use it.
The selection of the operation mode (CUT, CUT/COAG, COAG - COAG BIPOLAR) is made by a
special knob in model HFS 95, and with the MODE push-button in model HFS 100.
The adjustment of the HF output power is done, in model HFS 95, with the HF.POWER knob,
whose scale ranges between 1 and 10. In the digital model HFS 100 two push-buttons are used (+ and -
HF.POWER) to control the increase and decrease in the power level, which varies between 0 and 99.
NOTE
Display reading of the power level in model HFS 100 is of the relative type only, providing an
approximate idea of the HF output power (expressed in watts) in the CUT operating mode.
The curve showing the deviation betwen the display reading and the actual RMS power supplied by the
appliance is shown in annex 1.
In model HFS 95, the HF output power is of the relative type with a 10-level graduated knob.
In all the instruments, when the foot control is pressed (HF activation), an orange led switches on
(ACTIVATED) and a sound signal is operated (tones change according to operation modes), to indicate
the presence of HF current at the selected electrodes.
Independently of the TIMER function, the supply of HF current is automatically suspended after
approximately 6 seconds of continuous operation. To reset, press the pedal once more.
WARNING
Do not test the radio knife by starting the appliance with an empty handpiece, without a
connected active electrode cable, against conductive parts or in direct contact with the neutral
electrode.
These working conditions, with an instrument preset for high HF output power would cause high open
circuit voltages or high pilot currents, possibly affecting the radio knife short- and long-term
performance.
If you wish to obtain timed activation using HFS 100, it is enough to press the TIMER ON button
(the TIMER function will be indicated by a green light turning on) and program times (from 0.01 to 0.99
seconds) with the SET TIME two-digit selector (time increase and decrease is controlled by keys + and -).
The displayed numbers are hundredths of second.
Under these conditions, every time the foot control is pressed, the appliance supply HF current to
the output circuit exclusively during the programmed time.
In case of internal overheating due to hard working conditions, an automatic control (auto-check
function) is provided in all models to stop the HF energy supply. Its operatior indicated by an intermittent
alarm sound signal (in model HFS 100 the displays also be flashing).
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This is an additional protection feature which is only operated under extreme working conditions,
i.e. in case of instrument improper use or malfunction which would affect the instrument reliability.
It is a temporary and fully automatic protection: wait a few minutes until the alarm signal stops and
normal operating conditions are restored.
WARNING
The electrodes, connectors and cables should be handled with special care since they are the parts
in contact with the patient. In particular make sure that:
1) the neutral electrode is safely applied as close as possible to the operation area;
2) contact with the neutral electrode is very good throughout the operation;
3) high frequency wires, especially the neutral electrode ones, do not form spirals and are positioned in
such a way as not to make contact to other wires or to the patient. You should use only the cables
supplied with the appliance;
4) the HF current path within the patient is as short as possible. Take into account any metal prostheses
in/on the patient. Do not allow the HF current to flow near low-vascularit body parts or near parts
with minor muscle mass.
WARNING
If the patient is connected to the radio knife and to a monitoring device (e.g. an E.C monitor) at the
same time, the following directions must be observed:
 the active electr should never be used near E.C.G. monitoring electrodes (minimum distance = 15
cm).
 Do not use needle electrodes or injection tubes; make sure no metal parts (like the monitoring
device connectors) make contact to the skin.
4.2 – Monitor circuit of the neutral electrode

In order to prevent the risks of burns due to the neutral electrode not perfect contact to the patient, a
monitor circuit has been projected for models HFS 95 and HFS 100.
The previously adopted safety measure, which requires the neutral electrode cable to be plugged in
the front panel connector to activate the unit, is still there for major safety.
Working principle and features of the monitor circuit:
basically, when the monitor circuit detects a bad connection between the neutral electrode and the
patient, it shuts off the HF output, preventing any possible risk of burns, and it makes an intermittent
acoustic alarm (on HFS 100 the display also flashes).
This monitor does not use any auxiliary dc or ac currecnt flowing in the patient body to perform this
function, it only measures the HF surgery currents returning from the patient body via the two half plates
to check their balance (i.e.: if they have the same amplitude and phase within a given percentage of
tolerance). If a substantial umbalance is detected, the montor stops the HF energy.
In other words, the monitor circuit is able to detect a bad connection of the neutral electrode
or its wiring by detecting a substantial difference between the HF surgery currents flowing in two
identical neutral electrodes circuits.
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This leads to several advantages if compared to other circuit tipologies:

 no active circuits are directly connected to the neutral electrode HF circuit;
 no need of a galvanically insulated power supply for those circuits;
 no need of auxiliary currents (dc or ac) flowing through the patient body;
 no reliabilty problems due to self induced interferences when the HF is activated.
The main consequence if this approach, from an operational point of view, is that the monitor
circuit can detect a faulty condition on neutral electrode connection only when the electrosurgical
unit is activated and the HF circuit is closed through the patient body.
For this reason, great care has been paid to teh following two parameters of the circuit:
 Trigger speed: the time between the faulty condition occuring and the energy shut-down is around 1
to 2 ms (thousands of a second). Depending on the degree of unbalance and output power, it may
range from a minimum of 400 µs (i.e. 0.4 thousands of second), at full output power 100%
unbalance (one half neutral electrode not connected), to a maximum of 20 ms when less than 2 mA
of total HF current (0.4 W on a 1000 Ω load) flows with a near.threshold unbalance between neutral
currecnts. As a general rule, the trigger speed increases at higher levels of power and/or higher
degrees of unbalance; in other words, the more hazardous situation leads to the maximum
trigger speed.
 Sensitivity: the degree of current unbalance that makes the monitor circuit trigger on. this figure has
been made as much as possible independent from output power: it has been fixed to 33% (i.e.: the
difference between the two neutral half electrode currents has to be at least one third of their sum to
trigger the circuit) and this is true regardless of the output power, provided that a minimum of 25
mA of total HF current flows in the neutral electrodes (which corresponds to a mere 0.625 W on a
1000 Ω load). Under this level, the amount of unbalance necessary to trigger the circuit increases
from 33% to 100% as the HF current decreases (3.1 mA of HF current flowing on a half plate are
more or less the minimum required to trigger the circuit: it corresponds to less than 10 mW on a
1000 Ω load).
This grants that the amount of energy released to the patient during the faulty condition
remains negligible in any situation, furthermore, a 33% of currents unbalance is a relatively large limit
that avoids false triggering of the circuit during normal operation.
Functionalities due to the presence of the monitor circuit:
here below we detail some functionalities due to the introduction of the monitor circuit:
 As described in this manual, in order to activate the appliance the neutral electrode cable must be
plugged to its connector on the front panel, whaterver the selected operation mode is (monopolar or
bipolar).
 A bipolar neutral electrode (ground plate ) is needed to allow the monitor circuit work properly; that
is: the ground plate must be composed by two identical halves electrically insulated each
other: the monitor will check if both halves are in contact with the patient body by comparing their
HF currents, as previously described.
 As a consequence, using a single surface ground which connects to both the neutral electrode
wires defeats the monitor circuit that will no longer detect any bad connection. This defeat
feature may be useful for laboratory tests on electrosurgical units, like power output measurements.
 For any reasons:
- Do not put the ground plate in contact with any conductive object which may shortcircuit
it;
- Do not out the ground plate too close to a large conductive surface or body;
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it may fool the monitor circuit that may see it as the patient body.
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 The monitor is enabled when any monopolar output mode is selected (pure cut, cut/coag., coag.); it
is intentionally disabled when COAG BIPOLAR mode is selected, since there is not any neutral
electrode on a bipolar output.
 As previously discussed, the monitor is able to detect a faulty condition only when the
electrosurgery unit is activated a minimum amount of HF current is flowing from the active
electrode through the patient body to the two halves of the neutral electrode; a faulty condition
is immediately detected and the output inhibited within less than two milliseconds: a too short time
to produce damages, even at the highest power setting.
 If a faulty condition is detected the alarm starts by an intermittent beep and the power display flashing
(the latter only on HFS 100). Releasing the activation foot-pedal clears the alarm indication and
sets the electrosurgery unit in a ready to operate condition: the user must check the neutral
electrode connection to the patient, cables and connectors in order to detect and remove the
bad contact before attempting to continue the operation.
 The monitor alarm indication described above is the same issued in case of overheating by the
temperature protection circuit; the difference being that overheating alarm holds while the
temperature stays over the protection threshold, whilst neutral electrode alarm stops at foot-pedal
release.
 Electrosurgery activation when the neutral electrode is disconnected may or may not trigger the
monitor circuit, depending on capacitive couplings of the two halves of neutral circuit with
surrounding objects.
 Electrosurgery activation when the neutral electrode is correctly applied to the patient body will not
trigger the monitor circuit.
4.3 – Special recommandations for use
Be very careful while you use a radio knife and follow the directions for use given below:
- the HF output power should be adjusted to the lowest possible value, compatibly with the
specific application;
NOTE: an insufficient output power, despite good instrument setting, may be caused by
insufficient contact of the neutral electrode or the connectors, by broken cables under the
insulation or by clogged electrodes. These causes of malfunction should be detected and
eliminated before the output power is brought to a higher value.
- After each patient positioning, the electrodes and cables should be checked.
4.4 – Maintenance after use
After using the radio knife, the following operations at least should be carried out. They should also
be carried out before use, especially if the instrument is not often used:
- make sure the outer casing is not visibly damaged;
- make sure all the instructions and symbols are readable;
- make sure the mains plug, the connectors, cables, active electrode handpiece insulated forceps -
if any - are not visibly damaged;
- make sure the neutral electrode is clean and in good condition.
4.5 – Discharge after use and environment’s protection
The product does not contain either piles or bacteries, but for its manufacturing it contains
some components which in some circumstances, if released in the environment, can
become potentially dangerous for people and for the environment itself.
Being an electronic device it has to be discharged with a separate collection.
It is up to the customer, if he/she thinks it is necessary, to apply to its dealer or distributor
to return the old device.
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We remind that the unauthorised discharge of the electric and electronic wastes will be fined according to
art. 13 comma 1 of D. Lgs. 25/07/2005 n° 151. Moreover it is fined by the local norms in force.
CHAPTER 5
Technical features of HF electrosurgeries HFS 95 and HFS 100
5.1 - Electrosurgeries HFS 95 and HFS 100
Classification: Medical devices classe IIb, patient applied parts type BF, conforming
to requisites of Directive 93/42/CEE, according to Harmonised
Norms EN 60601-1, EN 60601-2-2 ed EN 60601-1-2.
Electrical insulation: class II units (with functional earth connection).
Protection rating against liquids
and dust penetration: IP21 (according to EN 60529).
Mains supply: 230 Vac 50/60 Hz.
Mains absorbed power: 192 VA.
Mains fuses: 2 x 3.15 A fast 5x20 mm (line and neutral), reachable from the outside
on the back panel.
Output HF frequency: 485 kHz quartz controlled (± 100 ppm).
Case dimensions: 270 x 245 x 105 h mm
Weight: approx. 4.2 Kg
Control features:
 FLOATING output circuit (type BF).
 Monopolar and bipolar surgical techniques with separate outputs.
 Four operating modes: CUT (monopolar pure cut), CUT/COAG (monopolar cut with
coagulus effect), COAG (monopolar coagulus), COAG BIPOLAR (bipolar coagulus).
 Automatic output switching, according to selected operating mode.
 Activation audible and visual indication.
 HF frequency stabilization.
 Stabilization of HF output according to the type of tissue.
 Automatic interruption of HF output after 6 seconds of continuous operation.
 Neutral electrode monitor circuit for monopolar modes (audible and visual indication of
anomaly).
 Impossible activation when ground plate cable is not connected.
 Output power will be stopped if the inside temperature exceeds max value (audible and
visual indication of anomaly).
HFS 100 only:
 Activation timer programmable from 0.01 to 0.99 seconds. It can be excluded if necessary.
 Digital selection of operation modes with LED indication, and digital HF power control with
display indication.
Other features:
 External case made of painted steel.
 The handpiece, cable and electrodes can be sterilized in autoclave at 121 °C wrapped.
 Compactness and reliability: the most compact instruments on the market.
Max HF output power (measured on 1000  resistive load):
(output power tolerance: ±15%)
COAG
Operating Mode: CUT CUT/COAG COAG
BIPOLAR
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Max HF output power: 100 W 70 W 55 W 45 W

Modulation: none 30% 45% 55%
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Standard supplies:
 N° 1 mains cable.
 N° 2 spare fuses 250 Vac / 3.15 A FAST / 5 x 20 mm.
 N° 1 active electrode handpiece with cable and connector.
 N° 1 cable with connector for disposable double ground plate.
 N° 6 short electrodes (2 for cut, 2 for coagulus, 2 for biopsy).
 N° 1 disposable double ground plate.
 N° 1 pneumatic foot switch with joining tube (it can be screwed to the floor).
 N° 1 user’s manual.
Optional supplies, spare parts and consumables:
 Art. CONT0021: Electrode holder, autoclavable at 134°C.
 Art. MDP00105: Active electrode handpiece with cable and connector for HFS 50, HFS 95, HFS 100,
autoclavable at 121°C wrapped.
 Art. MDP00248: Cable with connector for disposable double plate for HFS 95, HFS 100.
 Art. MDP00297: Cable with connector for conductive rubber double plate for HFS 95, HFS 100.
 Art. ACCSTR09: Pneumatic foot switch with joining tube (it can be screwed to the floor).
 Art. 330: Bipolar forceps with cable and connectors for HFS 95, HFS 100, autoclavable at 134°C.
Short active electrodes, Long active electrodes, Neutral electrodes
autoclavable at 134°C autoclavable at 134°C (ground plates):
(general purpose): (gynecology):  Art. ACCELS04:
 Art. 446: thin wire (cut).  Art. 452: lance (cut). Disposable double ground
 Art. 447: thick wire (cut).  Art. 453: small ball (coagulus). plate.
 Art. 448: small ball (coagulus).  Art. 454: big ball (coagulus).  Art. ACCELS06:
 Art. 449: big ball (coagulus).  Art. 455: round loop (biopsy). Conductive rubber reusable
 Art. 450: round loop (biopsy). double ground plate,
 Art. 451: oval loop (biopsy). autoclavable at 121°C.
WARNING
Use only original supplies and spare parts, available through our costumer service.
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APPENDIX A
Graphic 1 (HFS 95, HFS 100): output power according to the load
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Graphic 2 (HFS 95, HFS 100): power setting in mode monopolar cut
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Graphic 3 (HFS 95, HFS 100): Power setting on a 1000 ohm load
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Graphic 4 (HFS 95, HFS 100): power setting on a 200 ohm load
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ANNEX 1
EMC TABLES
Included below are EMC tables for emissions and immunity compiled according to the results obtained by tests
performed, as indicated in EN 60601-1-2 article 6. These informations have to be reported by the manufacturer in
the documentation accompanying the product.
Emission aspects
Emission test Conformity Electromagnetic environment - guide
RF emissions Group 1 When not activated, electrosurgery units HFS 95 and HFS 100 use RF energy only
Cispr 11 for their internal work.
Therefore their RF emissions are very low and reasonably not a source of
interference for nearby electronic appliances.
When activated, they emit RF energy that is necessary to their functioning.
Therefore there is a potential risk of interference on nearby electronic appliances.
RF emissions Class A Electrosurgery units HFS 95 and HFS 100 are suitable to be operated in any
Cispr 11 building, except: domestic or residential buildigs and buildings that are directly
wired to a low voltage mains network that feeds also domestic or residential
buildings.
It is possible to use the units in any kind of building, included domestic and
residential ones and those directly connected to low voltage public mains network
that feeds also domestic or residential buildings, by taking cares during their
installation. In other word, by giving the guarantee of an increased distance of
installation with respect to potentially sensitive appliances.
Harmonic emissions Class A It is possible to use the units in any kind of building, included domestic and
IEC 61000-3-2 Conform residential ones and those directly connected to low voltage public mains network
that feeds also domestic or residential buildings.
Voltage floatings / flickers Conform
emissions
IEC 61000-3-3
Immunity aspects
Electrosurgeries HFS 95 and HFS 100 are designed to work in the electromagnetic environment described below. The
costumer or the user should check that the units will be used in such environment.
Immunity test Test level Conformity level Electromagnetic environment - guide
EN 60601-1-2
Electrostatic discharges 6kV in contact 6kV in contact The floors must be made by wood, calcestruzzo or
(ESD) 8kV in air 8kV in air ceramics. If the floors are covered by sintetic material,
EN 61000-4-2 relative humidity should be at least 30%.
Electrical fast transients /  2kV power  2kV power Quality of mains supply should be that of a typical
bursts supply lines supply lines commercial or clinical environment.
EN 61000-4-4
Surges  1kV differential  1kV differential Quality of mains supply should be that of a typical
EN 61000-4-5 mode mode commercial or clinical environment.
Voltage holes, short < 5% UT < 5% UT Quality of mains supply should be that of a typical
interruptions and voltage (>95% UT hole) (>95% UT hole) commercial or clinical environment.
variations on input lines for 0.5 cycles for 0.5 cycles If the user wants the unit continue to work even during
EN 61000-4-11 40% UT 40% UT mains supply blackouts, it is reccomended to feed the
(60% UT hole) (60% UT hole) unit through an uninterruptible power supply (UPS)
for 5 cycles for 5 cycles group.
70% UT 70% UT
(30% UT hole) (30% UT hole)
for 25 cycles for 25 cycles
< 5% UT < 5% UT
(>95% UT hole) (>95% UT hole)
for 5 seconds for 5 seconds
Magnetic fields at line 3 A/m 3 A/m Magnetic fields at line frequency should have levels
frequency typical of a commercial or clinical environment.
EN 61000-4-8
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RF immunity aspects
Electrosurgeries HFS 95 and HFS 100 are designed to work in the electromagnetic environment described below. The
costumer or the user should check that the units will be used in such environment.
Immunity test Test level Conformity level Electromagnetic environment - guide
EN 60601-1-2
Conducted RF 3 Veff from 150kHz 3 Veff from 150kHz Portable and mobile RF communication sets should not
EN 61000-4-6 to 80MHz to 80MHz be used close to any part of the unit, included cables,
except when the reccomended separation distances,
Radiated RF 3 Veff from 80MHz 3 Veff from 80MHz evaluated using the applicable formula at the
EN 61000-4-3 to 2,5GHz to 2,5GHz transmitter frequency, are met.
Reccomended separation distances:
d = 1,2 P from 150kHz to 80MHz
d = 1,2 P from 80MHz to 800MHz
d = 2,3 P from 800MHz to 2,5GHz
where P is the maximum nominal output power of the
transmitter, expressed in watt (W) according to the
manufacturer of the transmitter, and d is the
reccomended separation distance, expressed in meters
(m).
Field intensity of fixed RF transmitters, as ascertained by an electromagnetic investigation of the site, might be under the level
of conformity for each frequency range.
Interference may arise in the neighbours of apparatuses marked with the following symbol:
Reccomended separation distance between portable and mobile communication sets and HFS 95 and HFS 100
electrosurgery units.
Electrosurgeries HFS 95 and HFS 100 are designed to work in an electromagnetic environment where RF radiated
interferences are under control. The costumer or the user may contribute in preventing electromagnetic interferences by
assuring a minimal distance between mobile and portable RF transmitter units and the electrosurgery, as reccomended below,
according to the maximum output power of the RF communication apparatuses.
Maximum nominal output Separation distance at transmitter frequency (m)
power of the transmitter From 150kHz to 80MHz From 80MHz to 800MHz From 800MHz to 2GHz
(W) d = 1,2 
P d = 1,2 
P d = 2,3 
P
0,01 0,12 0,12 0,23
0,1 0,38 0,38 0,73
1 1,2 1,2 2,3
10 3,8 3,8 7,3
100 12 12 23
For transmitters with maximum nominal output power other than those reported above, the reccomended separation distance in
meters (m) may be evaluated by using the applicable formula at the transmitter frequency, where P is the maximum nominal
output power of the transmitter, expressed in watt (W) according to the manufacturer of the transmitter, and d is the
reccomended separation distance, expressed in meters (m).
Notes:
(1) At 80 MHz and 800 MHz the upper frequency range must be applied.
(2) The overstated guidelines could be not applcable in every possible situation. Electromagnetic propagation is influenced by
absorbtion and reflection due to structures, objects and people.
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LIARRE S.r.l.
Via G. di Vittorio, 5
40020 CASALFIUMANESE (BO)
Tel. +39 0542 667066 – Fax +39 0542 668000
e-mail: info@liarre.it – http://www.liarre.it
Cap. Soc. euro 10.800 i.v.
R.I. – C. F. 02387110378 – R.E.A. BO n. 278761
N. Mec.”M.” BO 001512 – Cod. Id. INTRA IT e P. IVA 00574751202
DICHIARAZIONE DI CONFORMITÀ
CONFORMITY DECLARATION
DECLARATION DE CONFORMITÉ
Nome del fabbricante: LIARRE S.r.l.
Manufacturer’s name:
Nom du fabricant:
Indirizzo del fabbricante: Via G. di Vittorio, n°5

Manufacturer’s address: 40020 Casalfiumanese (BO) – ITALIA
Adresse du fabricant:
Nome del prodotto: ELETTROBISTURI AD ALTA FREQUENZA

Product name: HIGH FREQUENCY ELECTROSURGERIES
Nom du produit: ELECTROBISTOURI A HAUTE FREQUENCE
Nome del modello: HFS 95

Model name: HFS 100
Nom du modèle:
DICHIARA – DECLARES – DECLARE
Che i prodotti suddetti sono stati progettati e costruiti in conformità alle prescrizioni della Direttiva 93/42/CEE recepita in Italia
con D.L. n°46 del 24/02/97, come certificato dall’Organismo Notificato CERMET n° 0476 nel certificato MED-9807.
That the above mentioned products are projected and manufactured in conformity to the Directive 93/42/CEE registered in Italy
by D.L. no. 46 dated 24/02/1997, as certified by Notified Body CERMET no. 0476 in the certificate MED-9807.
Que les produits ci-dessus ont été conçus et fabriqués en conformité aux prescriptions de la Directive 93/42/CEE enregistrée en
Italie par le D.L. n° 46 du 24/02/97, comme certifié par l’Organisme Notifié CERMET n° 0476 sur le certificat MED-9807.
I prodotti rispondono alle seguenti norme o direttive:

The products are in conformity to the following standards:
Les produits sont conformes aux normes ou directives suivantes:
- EN 60601-1, Apparecchi elettromedicali – Parte 1: Norme generali per la sicurezza.

Electromedical appliances – Part 1: General Safety Norms.
Appareils électromedicaux – Partie 1: Normes generales pour la sécurité.
- EN 60601-1-2, Apparecchi elettromedicali – Parte 1: Norme generali per la sicurezza – 2 – Norma
collaterale: Compatibilità elettromagnetica – Prescrizioni e prove.
Electromedical appliances – Part 1: General Safety Norms – 2 Collateral Norm:
Electromagnetic Compatibility – Prescriptions and tests.
Appareils électromedicaux – Partie 1: Normes generales pour la sécurité – 2 Norme
collaterale : Compatibilité électromagnetique – Prescriptions et tests.
- EN 60601-2-2, Apparecchi elettromedicali – Parte 2: Norme particolari per la sicurezza degli
apparecchi per elettrochirurgia ad alta frequenza.
Electromedical appliances – Part 2: Particular Norms for the safety of high
frequency electrosurgeries.
Appareils électromedicaux – Partie 2: Normes particulières pour la sécurité des
appareils pour électrochirurgie à haute fréquence.
- Directive 93/42/CEE, per i dispositivi medici, for medical devices, pour les dispositifs medicaux.
Page 39 of 41
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Il legale rappresentante – Legal representative – Le répresentant legal

Giuseppe Montanari Reggiani
Page 40 of 41
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VIA G. DI VITTORIO 5
40020 CASALFIUMANESE (BO)
TEL +39 0542/667066
FAX +39 0542/668000

E-mail info@liarre.it
Page 41 of 41

HFS95 100 Manuale E Rev08

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MUB.

HIGH FREQUENCY ELECTROSURGERIES

HFS 95 – HFS 100

Heigty Edition, May 2006

Information regarding this manual

Writing conventions used in this manual

The notes emphasize particular information in the text.

Goods under warranty are considered free LIARRE's warehouse (ex-works).

The customer is responsible for damages caused by improper packing.

DESTINATION FOR USE

HFS95 / HFS 100 are destined for use

1.2 – General information on HF (high-frequency) SURGERY

1.3 – Nature of the dangers of HF surgery

 BURNS CAUSED BY THE NEUTRAL ELECTRODE

1.3.2 – Electrocution Hazard

1.3.3 – Fires and explosions

1.3.4 – Electromagnetic Interferences

BECAUSE THEIR WORK MIGHT BE COMPROMISED BY THE ELECTROMAGNETIC INTERFERENCE

Simple harmonic current at HF Surgery output

Dissection effect due to the electric curent flowing at tissue level

2.2 – Operation modes

Unmodulated amplitude HF curent

30% HF amplitude-modulated HF current

45% amplitude – modulated HF current

COAG BIPOLAR bipolar and micro coagulation:

55% amplitude-modulated HF current

2.3 – Basic information and problems connected to HF surgery

RECOMMENDATIONS FOR THE USE OF THE ACTIVE ELECTRODE HANDPIECE:

2.4 – Clinical indications in DENTISTRY

ESSENTIAL LIST OF REFERENCES

(B) (C) (f) (γ) (δ) ()

3.2 – Front panel HFS 100

(H) (G) (D) (E) (F) (f) (γ) (δ) ()

(b) (d) (c) (α) (ε) (A)

(b): Manufacturer datas.

Back panel CE mark and identification of the Notified Body

On/off switch (back panel)

On/off switch (back panel)

Connector of the pedal (back

Back panel Class II medical device

Front panel HFS 100, next to

Separate collection of electronic devices. The machine must be

Cavo di collegamento Modo di applicazione

4.2 – Monitor circuit of the neutral electrode

This leads to several advantages if compared to other circuit tipologies:

Max HF output power: 100 W 70 W 55 W 45 W

Indirizzo del fabbricante: Via G. di Vittorio, n°5

Nome del prodotto: ELETTROBISTURI AD ALTA FREQUENZA

Nome del modello: HFS 95

I prodotti rispondono alle seguenti norme o direttive:

- EN 60601-1, Apparecchi elettromedicali – Parte 1: Norme generali per la sicurezza.

Il legale rappresentante – Legal representative – Le répresentant legal

FAX +39 0542/668000

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