Outpatient Surgery Magazine

Watch Your Step - May 2014 - Subscribe to Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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Stephen M. Cohen, MD, MBA, FACS, FASCRS THINKING OF BUYING … 1 0 8 O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E | M AY 2 0 1 4 Cutting and Sealing Devices Energy and effectiveness drive this surgical essential. H ow a surgeon chooses to cut, ligate and seal blood vessels can be, without exaggeration, a life-or-death decision. • The method matters. The first decision is the type of surgical energy: monopolar, bipolar, harmonic, thermal fusion or plasma. Balance the speed at which a device can stop bleeding with its potential for collateral damage. While bipolar energy produces less thermal spread, it's more time-consuming and can't cover a large surface area. Monopolar technolo- gy is quite fast, but the heat it generates can have a charring effect on tis- sue. Harmonic technology doesn't generate the same amount of heat as the 2 electrosurgery devices, but it can still harm tissue. Newer technolo- gies combine bipolar and harmonic energies, employ direct thermal ener- gy and pressure, or electrically excite inert gas into a plasma state to cut and coagulate. Adaptive feedback in several products precisely controls energy delivery and sends warning signals to head off thermal injury. • Instruments on hand. Surgeons need technology that works without requiring any additional steps to ensure hemostasis. Why should they have to use a vessel sealer in addition to a suture ligation? Larger jaw sizes have been developed to accommodate larger vessels, and the fatigued hands of laparoscopic surgeons benefit from grips that fit their hands and don't require crushing pressure to work. Not every blood vessel can be grasped on end, so the ability to articulate or rotate the working channel can make a big difference in reach and how quickly you can bring bleeding under control. • Plug and play. If you're coordinating a product trial, the first thing you should find out is how many parts are necessary to make it work. Many new devices have a significant capital expense secondary to the non-sterile unit that runs it, and many come with proprietary energy OSE_1405_part3_Layout 1 5/8/14 2:29 PM Page 108

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