Electrosurgery

Safety Features

One of the greatest advancements in electrosurgery over the past two decades has been the advent of tissue impedance monitoring. This technology offers a detailed analysis of how much resistance a current encounters as it passes between the patient’s body and the return electrode. The implementation of this technology varies between makes and models, but some electrosurgical units are managed digitally for optimal current analysis. The hardware in the DRE ASG Series, for instance, measures tissue impedance 5000 times per second. In the occurrence of insufficient conductivity with the patient return electrode, the current is interrupted and the surgeon is alerted via audible and visual alerts.

Offering unparalleled patient safety, the Bovie FDFS™ (Fast Digital Feedback System) is implemented in some units as a means of offering superior control and consistency of electrosurgical cutting and coagulation. Other Bovie technologies implemented in some new units include Neutral Electrode Monitoring and Digital Error Detection, taking patient safety to new heights. All three of these systems are included in the full line of ASG Series electrosurgical units from DRE.

Ease of Use

With the advent of digital technology, electrosurgical usability has reached new heights. The first indication of this progress can be noted the moment you take the unit out of the box; analogue units required a complicated calibration process to be ready for usage, whereas the new digital technology implemented in units like the ASG Series from DRE eliminates the need for calibration. Once the unit is in use, the advancements abound:

• Digitally controlled cutting can be used in high-powered/high-impedance procedures and general applications alike. This innovative technology ensures greater precision and more efficient performance. Equipped with this technology, the ASG Series is able to operate at a lower power setting and produces little or no uncontrolled sparks.Â
• For greater control, some units feature a Surgeon’s Preset Center like those on the ASG Series that allow up to 10 surgeons to store their preferred power settings in the Cut, Coagulation, and Bipolar Modes.
• The ASG Series from DRE is equipped with 10 blend settings in 6% increments, combining cut and coagulation in a way that allows for greater flexibility and customization. A greater variety of available cut/coagulation permutations can substantially decrease operational transitions and surgery durations.

Improvements in coagulation technology allow Monopolar and Bipolar operation in every type of tissue and a variety of procedures.  Digitally controlled Monopolar Coagulation effects include Pinpoint, a rapid desiccation effect without carbonization and less sticking of the electrode; and Spray, a slight penetration of the tissue surface which is very efficient for treatments like diffuse bleeding or tissue devitalization. In Bipolar Coagulation the digital technology reduces active electrode sticking by minimizing tissue carbonization. It is important to find a unit that is equipped with all of these settings.

Electrosurgical units (ESUs) have greatly evolved in the 80 years since their introduction in the 1920’s. The past two decades, however, have seen the greatest revolutions in electrosurgical technology with improvements in isolated units (in place of ground references), discrete output technology, tissue impedance monitoring, enhanced coagulation and tissue response at the active electrode. If you’re not sure what each of these improvements means to your practice, or even what each of these improvements means at all, fear not: we here at Medical Equipment Update have composed the following series of posts to keep you abreast of the latest developments in electrosurgical technology and how they affect the generator your practice needs.

Applications

Just as we’ve seen new developments in electrosurgical technology over the past two decades, so too have we seen electrosurgery leave the traditional operating room environment and spread into the offices of dermatologists, plastic surgeons, gynecologists, ophthalmologists, urologists, otolaryngologists, dentists and family practitioners.Â

While it still remains a valuable tool in the hospital arena, the electrosurgical generator has become more accessible and more commonplace in smaller, more specialized practices. So being, the features and accessories available in this market have expanded greatly and today’s buyers of electrosurgical equipment face a whole host of options previously unavailable in the market for ESUs.

Monopolar and Bipolar Operation

Many new electrosurgical units will facilitate two types of operation: monopolar and bipolar. In monopolar operation, the primary electrode is applied at the surgical site with a cutting power ranging from 100 to 400 watts.  The energy leaves the body via a patient plate located somewhere else on the patient’s body. In contrast, bipolar operation requires only a fraction of the wattage (50-100) in order to accomplish the same caliber cut.Â

This discrepancy in power consumption can be attributed to the more focused nature of bipolar operation. With two electrodes – often the tips of a pair of forceps or scissors – the electrosurgical current is limited with greater control, confining the current to the immediate area surrounding the electrodes. This mode of operation eliminates the need for a patient plate and increases efficiency. Furthermore, it mitigates the potential for damage to sensitive tissue and patient burns.

Power Controls and Settings

Just as important as the delivery of an electric current is the proper maintenance of control over that current and the settings used to administer it. For instance, many older units have featured analog (dial) controls that inherently limit the precision of current delivery and leave a great deal of ambiguity regarding the unit’s operational settings.Â

Newer units have remedied this by featuring digital control panels accompanied by numeric displays of current administration settings; thus allowing discrete manipulation of power and blend levels. For instance, the ASG Electrosurgical Series from DRE features LCD wattage displays and easy-to-read digital controls.