um, the range of possibilities between "cut" and "coag," is one of the
areas that manufacturers are targeting in an attempt to give surgeons
more options and to improve patient safety.
Manufacturers are now equipping monopolar devices with a "blend"
option that's neither pure cut, nor pure coag. That's both a conven-
ience and a safety factor, since traditionally, the coag mode has created
a greater potential for unrecognized thermal spread and burn injuries,
compared with the cut mode, which delivers current continuously, but
at a lower voltage. Where typically we've had 2 buttons on the hand-
piece — a yellow one for "cut" and a blue one for "coag" — what
they're doing now is providing a 3
rd
button that automatically finds the
optimal blend of current, whether it's 80% cut with a 20% coag rate, or
60/40, or a different ratio. They're providing a button you can push for
that middle of the road without really having to think about it. That's a
smart feature and one that holds promise in terms of minimizing ther-
mal damage.
Some of the other promising developments in electrosurgery involve
approaches that aren't technically electrosurgery, but that use the
same concept. One, for example, uses small, parallel ceramic plates
and a closed feedback loop between the energy source and the hand-
piece. The heat generated by the plates is applied to tissue, and by
changing the heat parameters it's able to seal and cut with no blade.
Since the energy is contained in the system, there's no possibility of
traditional electrosurgical risks like capacitive coupling (inadvertently
generating a current via another conductor) or direct coupling (which
happens when an activated electrode touches another metal instru-
ment). The idea is to improve safety by completely bypassing the risks
of electrosurgery, and it's definitely a promising approach.
Other manufacturers using similar technology are actually kind of
throwbacks to the days when argon was regularly used in electro-
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