With such noteworthy advances in surgical technology over the past few decades as minimally invasive surgery, the use of lasers and now the growing potential of NOTES, certain surgical techniques, while still extremely useful, can appear a bit outdated. The basic technology behind electrosurgery, for instance, has seen very little change since it was first developed and harnessed over 80 years ago. But while the basic technology is still the same, there are still a number of medical device manufacturers and innovators that are dedicated to improving and building on electrosurgery’s firm foundation. Improvements and advancements in electrosurgical safety and specialized systems have emerged in the past few years that could very well give the aging technique of electrosurgery a modern boost. Here are some of the latest developments currently available to the field of electrosurgery.

Electrosurgical Generators & Equipment
MEGADYNE Medical Products, Inc. (Draper, UT) has long been a full solution electrosurgical provider. With products ranging from the electrosurgical generator to active electrodes to return electrodes, the company has established itself as an end-to-end electrosurgical provider featuring a complete circuit of electrosurgical care.

Included in MEGADYNE’s extensive offerings is the original, proprietary E-Z Clean® line of non-stick electrosurgical tips and electrodes. These non-stick electrodes feature a proprietary PTFE coating that reduces eschar build-up during surgical procedures, enabling surgeons to use lower power settings. Lower power settings mean less thermal necrosis to surrounding tissue and a further reduction in eschar build-up. The E-Z Clean Electrosurgical Tips are an ideal choice for safety-conscious surgeons and come in a variety of sizes, shapes and configurations that can be easily wiped clean with a damp sponge.

MEGADYNE is a full solution electrosurgical provider featuring a complete circuit of electrosurgical care.
In addition to the E-Z Clean Products, MEGADYNE offers a number of other flagship products. The Mega Power™ Electrosurgical Generator, for one, is designed specifically for simple elegance. It features large, easy to read displays and is safe, flexible and easy to operate. The generator is driven by the company’s proprietary Constant Control Technology™, which automatically monitors tissue impedance and adjusts power to reduce tissue damage and drag. The result is a smooth, clean, accurate cutting effect at the lowest possible settings. This maximizes patient safety and helps to enhance healing.

Another innovative MEGADYNE product is the MEGA Soft® Patient Return Electrode. These safe, reusable patient return electrodes are easy to use and provide cost savings for the hospital. They incorporate an OR table pressure reduction pad, providing added patient protection against pressure sores. Instead of small peel-and-stick disposable electrodes that make contact with only a limited area of the patient’s body, the reusable Mega Soft is a large pad extending the entire length and width of an adult patient’s torso, ensuring full and safe electrical patient contact to minimize resistance and eliminate heat build-up. Thus far, the Mega Soft technology has been used in over 20 million surgical procedures with zero pad-site burns.

Among MEGADYNE’s latest innovations is the Electrosurgical E-Z Pen™. Featuring the proprietary E-Z Clean technology, the 12-time use E-Z Pen has a built-in count down mechanism which displays the number of uses left and a “lock-out” failsafe function to prevent additional use once the lifespan has expired. Lightweight and ergonomically designed, the minimal reuse E-Z Pen is also cost effective, allowing hospitals can use E-Z Pen in every surgical case at a lower cost. In addition, because the E-Z clean coating decreases thermal necrosis, cleaning is easier and less frequent, saving the surgical team time.

Filling out their complete circuit of electrosurgical care, MEGADYNE offers full lines of disposable laparoscopic electrodes, resposable laparoscopic electrodes, reusable stainless steel laparoscopic electrodes and MEGAfine™ Needle electrodes. A variety of other accessories including cords, hand controls and smoke evacuation products are also available.

The AUTOCON II 400 ESU from Karl Storz Endoscopy America is capable of powering both bipolar and monopolar instruments.
Karl Storz Endoscopy America, Inc. (Culver City, CA) recently launched their advanced Bipolar Resectoscope as well as the AUTOCON® II 400 Electrosurgical Unit (ESU) for urology applications. Both of these innovative new products draw on Karl Storz’s many years of experience in developing resectoscopes and bipolar instrumentation capable of expanding surgeons’ capabilities.

The unique design of the new Bipolar Resectoscope provides advantages in urology applications and is compatible with existing Karl Storz telescopes and sheaths. It uses the same principles as monopolar units, but is equipped with an active electrode as well as a path for the current to return to the generator without requiring a neutral electrode/patient return pad. This current flow path has been redesigned to be isolated laterally and confined to the smallest space. This allows urologists to precisely control the energy at the tip of the resection loop, which results in a reduction of unintended tissue damage and other important benefits when the Bipolar Resectoscope is combined with the capabilities of the AUTOCON II 400.

The innovative AUTOCON II 400 ESU offers surgeons a single unit capable of powering both bipolar and monopolar instruments, while providing automatic output regulation and optimal hemostasis. It offers a specially designed bipolar C-Cut output mode that permits transurethral resection procedures in saline solution. Saline solution is physiologically compatible and reduces the likelihood of TUR syndrome during TURP, and bipolar operation reduces obturator nerve stimulation during bladder tumor resection procedures. The electrosurgical unit was designed for simplicity of operation and has been equipped to accommodate upgrades to functionality and features as they become available. This allows the unit to provide the capabilities required for today’s procedures while being compatible with developing techniques and instrumentation.

Bovie Medical’s ICON GI Electrosurgical Generator is specially designed for GI procedures.
Bovie Medical, Inc. (St. Petersburg, FL) offers a complete range of electrosurgical generators and a full line of disposable electrosurgical accessories designed to meet the needs of physicians’ offices, surgery centers and hospital ORs. Bovie’s line of generators and accessories allow for a wide variety of applications, though its most recent development, the newly introduced ICON GI™ electrosurgical generator, was specially tailored to meet the needs of GI physicians and staff.

Designed based on input from GI clinicians and applicable to a variety of gastroenterological procedures, the ICON GI generator features an intuitive touch-screen interface, physician preference database and common sense messaging. It is also equipped with all of the connectors necessary to integrate it into the GI suites of the future. It accepts all standard active accessories (monopolar and bipolar) and even features a pulsed output mode specifically developed for polypectomy and ERCP procedures.

The ICON GI generator also incorporates new innovative safety features for GI applications. First, there is a feature which alerts the staff in the event the unit is activated under open circuit conditions. This eliminated the risk of a snared polyp being guillotined should the staff be unaware of the improper set-up of the generator. In addition, the unit only allows split return electrodes to be used, which are safer than the solid version as the split electrodes allow for contact quality monitoring.

Gyrus ACMI’s PK Technology platform allows surgeons to perform numerous procedures with a variety of device for cutting, coagulating and sealing to minimize blood loss and shorten procedure times.
Gyrus ACMI (Southborough, MA) offers a comprehensive PK™ Technology platform that allows surgeons to perform a wide range of procedures with a variety of devices that cut, coagulate and seal to minimize blood loss and shorten procedure times. PK Technology provides unique, pulsed, low-voltage RF energy to resect rapidly at low temperatures virtually eliminating tissue charring. It combines the safety of saline with “seal-as-you-cut” tissue resection and vaporization for treatment of BPH with no risk of hyponatremia. Patients benefit from shorter than average catheterization times and can be treated on an outpatient basis. The PK working elements provide compatibility with Gyrus ACMI resectoscopes.

Encision Inc. (Boulder, CO) has developed innovative surgical technology called active electrode monitoring (AEM) for minimally invasive surgical procedures. The patented AEM® technology prevents stray current during laparoscopy due to instrument insulation failure and capacitive coupling.

Encision’s line of enTouch™ Surgical Instruments feature the AEM system which continuously monitors laparoscopic instruments during surgery to eliminate the risk of stray energy burns to patients. enTouch Surgical Instruments are ergonomically designed, lightweight, easy to assemble and equivalent in function and size to other conventional instruments.

Smoke Evacuation Systems
Just as the technology relating to electrosurgical safety and effectiveness has improved over the past few years, the systems and technologies for dealing with the byproducts of electrosurgery have seen steady advancements as well. Smoke evacuators and suction equipment that clear the air of harmful particulate continue to be developed and improved.

Buffalo Filter’s Porta PlumeSafe 604 smoke evacuator automatically tracks and records filter life.
Buffalo Filter (Buffalo, NY) offers a variety of smoke evacuation equipment to improve OR safety. Among their latest developments is the is LapEvac™, a patented solution for laparoscopic surgery that helps reduce many of the risks associated with poor vision and loss of distension due to smoke and efforts to clear smoke from the patient’s cavity. LapEvac is a disposable, battery powered smoke evacuator that creates a closed loop to filter and re-circulate gas into the peritoneal cavity. The small, sterile unit hooks up to two trocars and quietly runs throughout the surgical procedure. LapEvac keeps the surgeon’s view clear from smoke, minimizes the amount of CO2 gas needed to keep the patient’s cavity distended and also helps to reduce the amount of plume byproducts absorbed into patient’s system.

In addition to the LapEvac, Buffalo Filter also offers the innovative Porta PlumeSafe 604 smoke evacuator. Featuring a considerable reduction in noise level, this system uses RFID (radio frequency identification) to automatically track and record the filter life directly onto each filter’s individual microchip. Users no longer need to track the filter life as the system automatically senses the exact filter time remaining, as well as filter type and history. Porta PlumeSafe 604 is economically priced, making it an ideal choice for hospitals, surgery centers and physician offices.

Skytron (Grand Rapids, MI) offers a smoke evacuator that integrates easily with its equipment boom systems and other OR capital equipment. The built-in SkyVac Smoke Evacuation System is whisper quiet in operation and captures microorganisms and particulate matter at the rate of 99.9995 percent efficiency at 0.1 microns. Potentially harmful and infectious surgical smoke plume and odors are removed from the air, while greatly improving vision at the surgical site. SkyVac provides for automatic surgeon controlled on/off with auto sensor and provides up to 32 cfm suction at the surgical site. For additional ease of use, the SkyVac’s filters last up to 32 hours and are easily replaced without tools.

The Skytron SkyVac Smoke Evacuation System removes potentially harmful and infectious surgical smoke plume and odors from the air.
Another recent advancement in smoke evacuation technology is the E-Vac™ from New Leaf Medical, Inc. (Columbia Station, OH). The E-Vac device utilizes disposable electrosurgical suction technology to safely remove smoke plume from the OR environment. The patent pending accessory quickly attaches to the electrosurgical pencil and captures hazardous smoke, particles and fluids directly at their surgical source and before they are released into the O.R. environment. The device is easy to use, accommodates a variety of electrodes and requires no further modifications, electrode adapters or additional surgical assistance to operate. The device provides an inexpensive approach to OR safety by providing effective suction at the surgical site.