surgery. Their devices work by energizing argon as it passes through a
low direct-current voltage, creating plasma in the process. The plas-
ma's effect on tissue depends on a series of variables, including how
close the ionized gas is to the tissue, and which handpiece is used. My
experience has been that the devices work well. Of course, the key
with any device is to become familiar with all the different nuances
and variables. It's challenging to master one, let alone more than one,
which is why most skillful surgeons end up settling on one type of
technology.
Monitoring monopolar
One of the most significant advancements in safety is neither terribly
new, nor as widely adopted as you might expect, probably, at least in
part, because to use it, you also have to use the company's proprietary
instrumentation. So while intellectually it makes a lot of sense, it may
represent a significant expenditure.
It's called active electrode monitoring (AEM) and it's designed to
detect in any reusable instrument any type of leak or stray charge.
That's primarily a concern with monopolar devices, since risks like
direct coupling, capacitive coupling, open-air activation and insulation
failures are predominantly monopolar pitfalls. Ongoing improvements
in conventional laparoscopic surgery have been moving the needle
more toward bipolar devices, but the advent of robotic surgery has
brought monopolar energy back to the forefront, because it's a main-
stay of the robotics platform. Surgeons who were previously using
ultrasonic devices or advanced bipolar devices are having to go back
and learn how to use monopolar.
Monopolar energy has to make a complete circuit from the radiofre-
quency generator, to the instrument, through the patient, to the
grounding pad, and then ultimately back to the generator. AEM works
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