The evolutionary state of electrosurgery: where are we now?

Purpose of review The purpose of this review is to discuss the evolutionary changes that have taken place in the area of electrosurgery. The distinct differences between devices along with disadvantages and ways of minimizing hazards will be analyzed. Recent findings Since the first surgical application of electricity in the 1880s, the use of radiofrequency current in surgery has grown. Although monopolar and bipolar energy form the backbone of electrosurgery, various modifications have been made to both the electrosurgical generators and the hand instruments. Much of the driving force behind these modifications has been the goal of minimizing possible complications while improving surgical efficiency. Recently, the ability to obtain vessel sealing has dramatically impacted clinical practice in open, laparoscopic, and vaginal surgery. Summary Current evidence demonstrates the effectiveness and safety of electrosurgical devices in gynecologic surgery. Technology has evolved to allow vessel sealing capability through various instruments. Critical to the successful use of these advanced electrosurgical devices is a thorough understanding of their individual differences and nuances in order to obtain the desired tissue effects. Further studies are needed to determine the most appropriate applications and surgical procedures for these devices.

[1]  Nader N Massarweh,et al.  Electrosurgery: history, principles, and current and future uses. , 2006, Journal of the American College of Surgeons.

[2]  G. Vilos,et al.  Electrophysical properties of electrosurgery and capacitive induced current. , 2001, American journal of surgery.

[3]  L. Malis.  Electrosurgery. Technical note. , 1996, Journal of neurosurgery.

[4]  J. Humphrey,et al.  Histological evidence for the role of mechanical stress in modulating thermal denaturation of collagen , 2005, Biomechanics and modeling in mechanobiology.

[5]  T. G. Frank,et al.  Real-time thermography during energized vessel sealing and dissection , 2003, Surgical Endoscopy And Other Interventional Techniques.

[6]  D. Albala,et al.  PlasmaKinetic bipolar vessel sealing: burst pressures and thermal spread in an animal model. , 2005, Journal of endourology.

[7]  N. Kirchhof,et al.  Vessel sealing using a pulsed bipolar system and open forceps. , 2003, The Journal of the American Association of Gynecologic Laparoscopists.

[8]  M. Munro.  Mechanisms of thermal injury to the lower genital tract with radiofrequency resectoscopic surgery. , 2006, Journal of minimally invasive gynecology.

[9]  John J Meehan,et al.  The robotic Gyrus PK: a new articulating thermal sealing device and a preliminary series report. , 2008, Journal of laparoendoscopic & advanced surgical techniques. Part A.

[10]  S. Habib,et al.  Dissection techniques in laparoscopic surgery: a review. , 1996, Journal of the Royal College of Surgeons of Edinburgh.

[11]  I. Cooke,et al.  Complications of laparoscopic pelvic surgery: recognition, management and prevention. , 1997, Human reproduction update.

[12]  P. Wicker.  Electrosurgery--Part I. The history of diathermy. , 1990, NATNews.

[13]  R. Tucker,et al.  Laparoscopic electrosurgical complications and their prevention. , 1995, AORN journal.

[14]  L. Rombauts,et al.  Ignorance of electrosurgery among obstetricians and gynaecologists , 2004, BJOG: an International Journal of Obstetrics and Gynaecology.

[15]  J D Humphrey,et al.  Denaturation of collagen via heating: an irreversible rate process. , 2002, Annual review of biomedical engineering.

[16]  H. Clavé,et al.  Painless vaginal hysterectomy with thermal hemostasis (results of a series of 152 cases) , 2005, Gynecological Surgery.

[17]  Ketan R. Bulsara,et al.  History of bipolar coagulation , 2006, Neurosurgical Review.

[18]  K. Harold,et al.  Comparison of ultrasonic energy, bipolar thermal energy, and vascular clips for the hemostasis of small-, medium-, and large-sized arteries , 2003, Surgical Endoscopy And Other Interventional Techniques.

[19]  A. Brill.  Bipolar electrosurgery: convention and innovation. , 2008, Clinical obstetrics and gynecology.

[20]  Van Way CW,et al.  Electrosurgery 201: basic electrical principles. , 2000, Current surgery.

[21]  B. Matthews,et al.  Initial results with an electrothermal bipolar vessel sealer , 2001, Surgical Endoscopy.

[22]  M. Menger,et al.  Efficacy and quality of vessel sealing: comparison of a reusable with a disposable device and effects of clamp surface geometry and structure. , 2006, Surgical endoscopy.

[23]  B. Heniford,et al.  A comparison of laparoscopic bipolar vessel sealing devices in the hemostasis of small-, medium-, and large-sized arteries. , 2003, Journal of laparoendoscopic & advanced surgical techniques. Part A.

[24]  R C Odell,et al.  Electrosurgery: principles and safety issues. , 1995, Clinical obstetrics and gynecology.

[25]  G. Neufeld.  Principles and hazards of electrosurgery including laparoscopy. , 1978, Surgery, gynecology & obstetrics.