One of the most widely used devices in the operating room, the electrosurgical unit (ESU) employs electrical current to cut and coagulate, desiccate, or fulgurate tissue. Electrosurgery is performed using the ESU, a power generator, and an electrode that is in contact with the tissue. The electrode can be either monopolar (conducting the electrical current from the generator and through the tissue with a grounding electrode to receive the current and return it back to the generator) or bipolar (using forceps that allow for current passage between the active tip and the neural tip of the forceps). The traditional ESU has a manually adjustable power level and can switch between the cut and coagulation modes with the press of a button.
Bipolar electrodes enhance precision
The newest advancements in the electrosurgical field have introduced extremely sensitive tissue density sensing and an automatic adjustment of the power output. While the technology has been on the market for a few years now for the monopolar electrodes, the bipolar forceps are now also available with this advanced feature. Bipolar electrodes are routinely used for very delicate procedures where precision and minimal damage to adjacent tissue are of utmost importance, such as neurosurgery, plastic surgery, vascular, and minimally-invasive cases.
Another improvement in the field of electrosurgery is more control of the power output in wet areas such as urology, gynecology, and arthroscopy. This not only decreases the necessary level of energy but also allows for an uninterrupted and constant delivery of electrical current.
The dangers of capacitive coupling
With laparoscopic and minimally invasive procedures becoming the standard in surgical procedures, capacitive coupling has been a dangerous problem. Capacitive coupling refers to damaging the adjacent tissue by displacing monopolar current from the intended area. This can be especially harmful when occurring out of the field of view, leaving the surgeon and the operating team unaware of the incident. The newest ESU generators can be programmed to minimize the risk of capacitive coupling by lowering the output voltage.
Thanks to the recent improvements in the electrosurgical field, electrical current is becoming a much safer means of cutting tissue and achieving hemostasis.