Update on Electrosurgery
New products and features make procedures safer, easier
Judith Lee, Contributing Editor
- Electrosurgical injuries have increased, according to the Association of periOperative Registered Nurses (AORN). Each year some 40,000 patients are burned by faulty electrosurgical devices, and the burns may cost $50,000 a case to treat.
- When electrosurgery is used in laparoscopic procedures, nearly 70 percent of electrosurgical burns go undetected at the time of surgery, because 90 percent of the active electrode is outside the surgeon's field of view.
- A survey of members of the American College of Surgeons showed 18 percent experienced insulation failure or capacitive coupling during electrosurgery, and 54 percent of surgeons knew of a colleague who had experienced a stray electrical burn.
- In 1999, nearly $600 million was paid in claims regarding electrosurgical injuries.
Not surprisingly, manufacturers continue to focus on new products and product enhancements that make electrosurgery safer for the patient and easier for the surgeon. Some generators offer high-frequency current, which may reduce tissue trauma and enable more precise cutting. Other generators have built-in safety features that reduce or even cut off power to prevent stray current from injuring patients. Electrodes are being offered in micro-fine designs and with special coatings, and newer handpieces improve safety and precision. New testing devices enable surgery center staff to test equipment and replace it before injuries occur.
Following is an overview of new products and product enhancements to consider in electrosurgery equipment.
Update on generators
PEGASYS from Ethicon Endo-Surgery offers a unique, computer-controlled power supply and several built-in safety features:
- RF Leakage Canceling Circuitry senses open circuit activation. When detected, the generator immediately reduces output energy by 80 percent to minimize the risks associated with capacitive coupling (which can occur when RF current leaves its intended path and radiates through an insulator in order to complete the circuit).
- 3000TSR (Tissue Sensing and Response Technology) analyzes the clinical site including variables such as electrode size, material, technique, and tissue density. 3000TSR adjusts current, voltage and power 3,000 times per second depending on the clinical environment. This feature allows the PEGASYS generator to sense changes in tissue impedance 15 times faster than other generators, according to the company.
- PowerStep technology senses dramatic changes in tissue impedance. It provides instantaneous adjustment in current, voltage, and power. This is advantageous when passing between tissue types such as fat and muscle. It also minimizes "flash" and/or tissue damage when first encountering tissue.
Surgitron Dual Frequency 120 from Ellman International offers more power (up to 120 watts) in monopolar and bipolar modes, which allows for greater hemostasis and efficient performance in a fluid environment. It also allows for greater versatility. The multi-specialty unit contains a parameter memory, which recalls the last settings used for power and waveforms, and elevated button menus to prevent inadvertent power manipulation. A longer duty cycle allows for extended operation without interruption of energy. This simultaneous bipolar/hemostasis unit will operate in either mode, depending on the delivery system attached, without requiring manual selection of waveform. List price is $1,495.00.
The Aaron 900 high-frequency desiccator from Aaron Medical Industries offers coagulation, desiccation and fulguration, as well as a bipolar mode. The user-friendly unit forever removes the need to go through a tedious multi-step process to change from low to high power-simply rotate the power control knob or push the up/down buttons on the handpiece. If you prefer a foot control, just plug it in. There is no need for a separate handpiece, and you can still control the power setting from the handpiece while using the foot control. List price is $995.00.
Just introduced this year, the Aaron1250 high-frequency electrosurgical generator by Bovie, also from Aaron Medical Industries, is an excellent machine for Leep / LLETZ procedures or nearly any outpatient procedure requiring electrosurgery. This model features Cut (120 watts), Blend (90 watts), Coagulation (Coagulation 80 watts, Fulguration 40 watts) and Bipolar (30 watts) modes. The Aaron 1250 offers automatic safety features, such as self-test circuits, audible tones, discrete outputs, and isolated circuitry. List price is $2,400.00.
The most unique feature on the Aaron 2100 high-frequency electrosurgical generator by Bovie, is nine blend settings, which permit the surgeon to cut and coagulate simultaneously. With so many blend settings, the surgeon can precisely tailor the amount of cutting and coagulation to the type of tissue. The Aaron 2100 features Cut (200 watts), with Blend (200 watts adjustable in nine steps), Coagulation (force 140 watts, fulguration 80 watts), and Bipolar (80 watts) modes. Bovie has incorporated automatic safety features, including self-test circuits, audible tones, discrete outputs, and isolated circuitry. List price is $3,900.00.
The Malis CMC-III Bipolar System from Codman offers the improved microprocessor control of an exclusive generated waveform. The unit offers high power and micro bipolar cutting, with the ability to cut denser tissue as you would with monopolar current, but without the heating and current spread. The unique, patented waveform coagulates tissues gently, whether they are bathed in body fluids or irrigation fluid. Users may choose pneumatic or electric foot pedal capabilities, with individual or simultaneous connections. The Malis CMC-III Bipolar System provides precise fluid delivery, and minimizes disposables costs as compared to alternative technologies. List price is $14,195.
What's New in Needles and Electrodes
MegaDyne MicroFine Needles come in two sizes (2.5" or 2.75") and are among the sharpest needles currently available. Made of hardened stainless steel, they are specially coated to remain cleaner longer and promote faster, safer procedures. To avoid damaging surrounding tissue, modified insulation extends to the distal end of the needle.
These needles provide additional benefits:
- Precise electrosurgery with less thermal damage and lower power settings, reducing scarring and promoting faster recovery.
- The small extra sharp tip combined with the E-Z Clean coating produces less smoke for a clearer field of view.
A special manufacturing process produces Megadyne MicroFine tips at a cost savings of up to 60 percent, when compared to other micro tips.
Empire microIncision Needle Electrodes is an expanded line of ultra-fine needle electrodes from Ellman International, manufactured from proprietary surgical metal with a polished tapered tip. These electrodes enable surgeons to achieve precise dissection with hemostasis. Surgeon control and surgical outcomes are enhanced through the accurate, delicate and non-adherent application of the Empire Electrodes. The yellow coating of the Empire Electrode provides contrast to the surgical field for added safety and tip identification. The electrodes are provided sterile for single-use and packaged two per box.
Resposable laparoscopic instruments from MegaDyne provide excellent dissection and coagulation for a variety of applications, rendering surgical procedures cleaner, faster and safer. New E-Z Clean Resposable Laparoscopic Electrodes feature Disposable E-Z Clean MegaTIPs and Reusable Indicator Shafts.
Standard reusable laparoscopic electrodes will eventually wear out. When laparoscopic electrodes wear out, it usually occurs in the insulation of the electrode. When insulation breakdown occurs, it becomes dangerous to the patient, because stray current could escape from the electrode and burn adjacent tissues.
The MegaTIP and Indicator Shaft are a resposable system designed to minimize the possibility of stray current damage in laparoscopic procedures (which is estimated to occur in one or two cases per 1000).
The completely disposable MegaTIP comes with a patented, non-stick coating, which reduces eschar build-up on the electrode, and causes less smoke and thermal damage to surrounding tissues. The MegaTIP attaches to the reusable Indicator Shaft by simply holding the gray portion of the tip and rotating clockwise onto the shaft.
The Indicator Shaft is reusable, and thus, cost-effective. Its safety features include two layers of insulation, a black outer layer and a yellow indication layer underneath. Because the Indicator Shaft will see many re-sterilizations, eventually the black outer layer will break down, but the bright yellow indication layer will be very evident. This indicates that the user should discard the shaft and replace it.
Disposable MegaTIPs come in a variety of configurations, including Curved Blade, L-Hook, J-Hook, L-Wire and Modified versions. The MegaTIPs easily attach to Indicator Shafts. Rotating the tip or shaft clockwise until finger-tight ensures that a complete and safe electrical connection has been made, while a unique shaft-key guarantees that the tip is secure and will not twist or turn.
Codman offers three new bipolar forceps:
- RHOTON Non-Stick Mirror Finish Bipolar Forceps. The unique feature of this irrigating forceps is that the irrigation pipe is completely recessed into the right blade. This offers the surgeon increased visibility at the forceps tips. The forceps deliver the correct amount of irrigation, reducing tissue charring and sticking.
- Non-Stick Mirror Finish Bipolar Forceps. These forceps' highly polished working tips reduce pitting and the potential for tissue and coagulum buildup. They are offered in titanium or stainless steel, insulated or non-insulated, irrigating or non-irrigating.
- MALIS Non-Stick Mirror Finish Bipolar Forceps. The MALIS angle bayonet enhances visibility by keeping the surgeon's hand further from the line of sight. Insulated shafts protect the surrounding tissue when performing deep procedures. A variety of tip patterns are offered for bipolar coagulation and cutting technologies.
For neuro and spinal procedures, Codman also offers Codman MALIS Bipolar Cutting Loops, Bipolar Cutting Pen, and Bipolar Coagulating Ball.
Innovations in electrode handpieces from Ellman International make surgery safer and more efficient.
- HemoScalpel Handpiece is a patented blade/electrode handpiece that converts the standard scalpel blade into a hemostatic scalpel to minimize surgical time and reduce tissue trauma and blood loss. The locking chuck configuration firmly secures electrodes, providing unparalleled versatility and precision to any surgical procedure. The handpiece is made of lightweight materials and is perfectly balanced to prevent hand fatigue. HemoScalpel is a cost-effective product made durable for reuse and steam autoclave reprocessing.
- Fingerswitch Handpieces with Spin-Free Locking Chuck put an end to the frustration and danger of electrode rotation during the surgical procedure. This multi-specialty handpiece accommodates all Ellman electrodes and come in disposable and reusable models.
Erbe's side-firing (or lateral) probe for argon plasma coagulation (APC) makes GI procedures safer. Prior to this development, only a straight fire (or axial) probe was available. Since GI APC treatment is performed via a flexible endoscope within a relatively narrow hollow lumen, the physician must approach target tissue tangentially (or parallel). The side-firing probe ensures that the tissue is treated with a purely argon-enhanced plasma as opposed to lateral arcing that often is non-ionized plasma, or conventional "electrocautery."
These probes have also found a home in pulmonary intervention, treating airway lesions and bleeding in the pulmonary lab versus surgical intervention. A recent study showed tremendous cost-savings (OR time, anesthesia, etc.) and enhanced patient outcomes.
Safer Monopolar Cable for Minimal Invasion
Ellman's universal monopolar cable allows delivery of 4.0 MHz radiofrequency energy from Ellman's Surgitron Dual Frequency Unit via laparoscopic/endoscopic instruments to the surgical field. Standard instruments have enhanced precision with the delivery of this focused, high-frequency energy. Tissue adherence and charring is reduced or eliminated. Surgeons can target and treat pathology while sparing healthy tissue. Of particular interest to surgeons performing endoscopic procedures including GYN/GS surgeons performing minimally invasive laparoscopic procedures. It is reusable and autoclavable.
Check for Insulation Defects
The long, thin metal probes used in electrosurgery are covered in insulation, allowing electricity to flow only at the tip. If the insulation breaks down, the probe can burn the patient's tissue, and the burns can go unnoticed for weeks.
The InsulScan from Mobile Instrument Service