Looking back over the innovative surgical developments of the last century, electrosurgery is kind of old hat. With minimally invasive surgery, laser surgery, and a slough of specialty procedures coming into play in just the past decade or so, electrosurgery, with its first introduction nearly 80 years ago, hardly seems like an emerging technological field. Nonetheless, there are some notable and important innovators that are continuing to develop and expand the current technology to make electrosurgical procedures safer for everyone involved.

Electrosurgical Generators

     The dawn of electrosurgery introduced the surgical community to an early electrosurgical unit (ESU) called a Bovie. Named for the man who invented it, the Bovie name soon came to be synonymous with electrosurgery units. Bovie ESUs are still being developed and marketed today by Aaron Medical Corporation.

     Aaron Medical offers a wide range of ESUs providing varying degrees of power output to meet the needs of any surgeon or procedure. Their current electrosurgical units, which include the A800, A900, A950, A1250, A2250, IDS-200, and the recently released IDS-300, all have both monopolar and bipolar capabilities, and are designed with redundant safety circuits to avoid shocking or burning the patient. In addition, most of the Aaron ESUs are equipped with the latest technologies, allowing them to use neutral electrode monitoring (NEM), which greatly reduces the risks associated with pad burns.

     To meet the special needs and problems that can arise as a result of the increased use of electrosurgery in laparoscopic procedures, Aaron's IDS-300 ESU offers a CutII mode that reduces the maximum peak-to-peak voltage, which helps reduce the risk of capacitative coupling. The IDS-300 also senses tissue impedance at an impressive speed of 5000 per second and adjusts internally to maintain a constant delivered energy.

     While Aaron Medical offers a number of ESUs with a large selection of power output options, Genard McCauley, ESU Product Manager at Aaron, offers this advice to facilities in the market for an electrosurgical generator. “Anyone looking to purchase new ESUs should take a hard look at the procedures that will be performed and purchase an ESU based on the clinical effect and safety features provided by the unit, not by the maximum power.”

     ConMed Electrosurgery's newest addition to the ESU market is The System™. A self contained and mobile unit, The System is essentially a totally integrated family of electrosurgical products that can address virtually any surgical need. With a number of advanced specialty modes, this ESU provides the accuracy, precision and power to accommodate individual specialties and techniques. The Laparoscopic Mode offers optimal safety by limiting output voltage through microprocessor controlled circuitry and minimizes the potentially harmful effects of capacitative coupling. The Fluids Mode provides immediate energy delivery for procedures performed in a fluid medium. Pulse Cut Mode provides precise energy bursts for critical dissection, while the Pulse Coag Mode delivers pulsing bursts of coagulation energy that provides hemostasis in both standard or spray modes. The System also offers multiple Bipolar Modes including a micro bipolar mode for fine and precise coagulation and macro bipolar for more energy intensive applications.

     DRE, Incorporated recently released a new electrosurgical generator as well, the DRE ASG-120. This unit feature both monopolar and bipolar functions with ten different blend settings plus cut, all with 120 watts maximum power output. The ASG-120 has two levels of coagulation: Coagulation and Fulguration, as well as Bipolar. In addition, the unit delivers consistent, repeatable power into varying load impedances with BovieFDFS (Fast Digital Feedback System), greatly reducing the need for power setting changes to obtain the desired surgical effect.

     Perhaps the newest ESU to hit the market is the Mega Power™ Electrosurgical Generator from Megadyne, which was introduced just this month at the AORN's 52nd Annual Congress. Drawing extensively from the requests and comments of surgeons and nurses alike, the Megadyne team developed the Mega Power to provide easy set up, intuitive use and the power to perform in any procedure. Ergonomically designed with a large display panel, preset power mode settings, and minimal adjustment required of the clinical staff, this unit incorporates sophisticated technology that provides simple and reliable use. Mike Hintze, Vice President of Marketing at Megadyne explains, “The simple elegance and intuitive nature of our design allows the nursing staff to focus on patient care, rather than focusing on the machinery.”

     While the Mega Power offers the standard modes typically offered by most electrosurgical generators, it also features Megadyne's proprietary advanced cutting effect (ACE) mode and their Constant Control Technology™. The ACE mode delivers a scalpel-like cutting effect for minimal thermal necrosis and reduced scarring, while constant control automatically monitors tissue impedance and adjusts power output to reduce tissue drag for a clean, accurate cut at the lowest possible settings.

Electrosurgical Instruments & Accessories

     Though the Mega Power electrosurgical generator has only just been released, Megadyne has been providing innovative electrosurgical products to the market for the past twenty years. Their E-Z Clean line of non-stick electrosurgical tips and electrodes come in a variety of sizes, shapes and configurations that can be wiped clean with a sterile sponge or washed clean with irrigation.

     The E-Z Clean product line includes Resposable Laparoscopic Electrodes and Reusable Stainless Steel Electrodes which incorporate the patented Indicator Shaft® technology. This safety feature provides a highly visible indication if the outer insulated layer of the electrode has been compromised, informing the surgeon that the electrode needs to be discarded and replaced to avoid injury to the patient. Also included in the E-Z Clean line are the Megafine Needle Line of extra sharp, precision needles and a variety of disposable laparoscopic electrodes.

     New to the E-Z Clean line this year is the Electrosurgical E-Z Pen™. The 12-time use E-Z Pen is lightweight and ergonomic, and features a failsafe, count-down, lock-out mechanism that prevents additional use once its lifespan has expired. “Because of the expense, hospitals and surgical centers currently use E-Z Clean and other coated tips in an average of 20 percent of surgical cases,” says Hintze. “The minimal reuse E-Z Pen is so cost effective that hospitals can us the E-Z Pen with E-Z Clean in 100 percent of cases for the same or lower cost.”

     In addition to this extensive line of products, Megadyne also completes the electrical circuit with their Mega Soft™ Patient Return Electrode Pads. These safe, reusable, and cost effective patient return electrodes incorporate an OR table pressure reduction pad, providing the patient with protection against stray current as well as pressure sores in long procedures. The Mega Soft pads also comes in a Dual Cord model to provide clinicians the option to attach two separate generators to a single patient return electrode.

     Another company that supplies tools for electrosurgery is Miltex, Inc, which offers insulated surgical instruments such as specula, dressing and tissue forceps, hooks, and laparoscopic instruments. They also provide a line of monopolar sterile disposable electrodes for OB/GYN, LEEP/LLETZ, and laparoscopic procedures and applications. The high-quality, German crafted instruments are thermally insulated with a superior, non-conductive coating that is smooth, durable, autoclavable, and exceeds high voltage testing requirements. These insulated surgical instruments are available in a wide variety of patterns and sizes, providing the flexibility to meet the unique needs of each patient or surgeon.

     Addressing the electrosurgical needs of Neuro and Plastic Surgeons, but also applicable to a variety of other surgical applications, is the SilverGlide® Bipolar Forceps form SilverGlide Surgical Technologies. These bipolar forceps have a proprietary composition on the tines that prevent tissue from sticking. Low-profile and ergonomically designed, the forceps provide better visibility of the tissue and a comfortable feel in the surgeons hand. The design and non-stick coating on the SilverGlide Forceps allows for optimal tissue manipulation, hemostasis and patient safety.

Smoke Evacuation

     One of the unfortunate, but all to prevalent, side product of electrosurgery is surgical smoke. Any time that an electrosurgical pencil ablates tissue, smoke plume is created. “Surgical smoke is a serious hazard for healthcare worker who are not properly dealing with the plume,” explains Kelly Steinkircher, Product Manager at Buffalo Filter. “Plume contains viruses, blood, blood fragments, dead and live cellular material, and large numbers of carcinogenic chemicals and gases.”

     To address the potential problem resulting from exposure to surgical smoke, a number electrosurgical device suppliers offer equipment for smoke evacuation. Aaron Medical markets a smoke evacuator, and Miltex's insulated specula feature an integrated smoke evacuation tubes. Megadyne offers its own smoke evacuator as well, the Mega Vac™.

     Designed to protect everyone in the OR from breathing in harmful surgical smoke, the Mega Vac provides quiet suction during the procedure, allowing the surgeon to easily capture the smoke without disrupting the surgery. Also available is the Mega Vac Plus, which is designed to accommodate smoke plume form both open and laparoscopic electrosurgical procedures.

     One company that has made the evacuation and filtration of electrosurgical smoke plume their primary focus is Buffalo Filter. With a product line that includes smoke evacuators, filters, tubing, surgical masks, and other accessories, Buffalo Filter systems are designed to be used with any electrosurgical unit or laser that creates smoke plume. These smoke evacuation systems are equipped with their proprietary Whisper™ Quiet Technology. This technology ensured that there is virtually no noise when the smoke evacuator is running at lower levels and that noise is minimized at higher levels. Buffalo Filter has also begun incorporating RFID (radio-frequency identification) technology into their systems to help track filter life and usage.

     Patented accessories also add to Buffalo Filter's user-friendly systems. The PenAdapt™, for instance, attaches directly to the electrosurgical pencil to capture smoke plume as it is generated at the surgical site, and there is no need for OR personnel to hold the tubing while the surgeon is working. Buffalo Filter's Remote Switch Activator is a small accessory that works between the smoke evacuator and the ESU to automatically activates the smoke evacuator when the ESU is being used. This ensures smoke evacuation when it’s needed, and avoids sapping filter life by leaving it running unnecessarily.

     With electrosurgery soon entering its second century of use, it is impressive to see how the technology has grown, and how safety features continue to develop, both for the patient and the surgeon. Naturally, as the safety increases, it makes sense to keep up with the emerging technologies. In closing, Greg Trudel, Vice President of Marketing for SilverGlide Surgical Technologies offers this advice. “Electrosurgery has been constantly evolving since the early 1920s. It is important to take advantage of the most modern technology available when outfitting a new OR. Not only will this allow the surgeon to provide the best possible outcomes today, but it will also provide a technological platform and advantage for the years to come.”