Outpatient Surgery Magazine - Subscribers

What's the Harm? - December 2015 - 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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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- 1 2 0 O U T P A T 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 | D E C E M B E R 2 0 1 5

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