Collective review

Electrosurgery: History, Principles, and Current and Future Uses

Evolution of a tool

Many credit the man for whom the “Bovie” was named with being the father of elecrosurgical devices. But the physical scientific advancements behind these instruments had been known for some time before William T Bovie. Surgeons had used cautery and electricity in medicine well before the early 1920s, when Bovie developed the modern-day instrument and helped bring it to the forefront of the profession. Today there are increasing numbers of applications for electrosurgery in the operating room,

Biophysics

Electrosurgery has been described as high-frequency electrical current passed through tissue to create a desired clinical effect.⁵ As the current is delivered, it passes through and heats the tissues. This differs from electrocautery, in which electrical current heats an instrument and a clinical effect is realized when the heated tool is applied to the tissues. Central to the understanding of electrosurgery is an understanding of electrical circuits and Ohm’s Law. Circuit is an uninterrupted

Types of electrosurgical instruments

Electrosurgical technology offers essentially two types of devices for energy delivery: monopolar and bipolar. The monopolar instrument, the Bovie being the most common example, delivers current through an active electrode, which then travels through the patient and back to the generator through a conductive adhesive grounding pad applied to the patient before beginning the procedure. Bipolar instruments resemble surgical forceps, with both the active electrode and the return electrode

Current uses

Electrosurgical instruments are undoubtedly some of the most useful and most-often used tools at the surgeon’s disposal. But there are potential applications for which these instruments are not commonly used. For example, there is a pervasive dogma in surgery that skin is to be opened using the traditional scalpel, and deeper tissues may then be opened using the electrosurgical tool. The theory behind this proposition is that use of the Bovie causes worse cosmesis at closure and predisposes

Complications

Although the use of electricity in surgery is highly useful and effective, it is not without possible complication. From the 1970s through the 1990s, the reported incidence of electrosurgical injuries has remained at roughly 2 to 5 per 1,000.20, 21, 22 Regardless, the exact incidence of electrosurgical complications is difficult to pinpoint and, in many cases, is operator dependent. But these types of injuries do constitute a significant amount of morbidity associated with surgery.

Proper use and safety

Although electrosurgical instruments are commonly used, they are powerful and potentially dangerous, and most surgeons and residents do not receive any formal training in their proper use.

The following are some suggestions to avoid injury to the patient and to the surgeon and operating team. First, the simplest means of avoiding injury is to always use the lowest possible generator setting that will achieve the desired surgical effect and to never exceed the power settings recommended by the

Future directions

Electrosurgery is a continuously evolving field, with active research into new applications. Today’s electrosurgical generators use closed-loop control loops to adjust the voltage and current to keep the output power constant as the active monopolar electrode moves through tissues of varying impedance. These “adaptive” generators are a significant improvement over those used in traditional electrosurgery (Fig. 11).

Because the ability to incorporate more sophisticated computer chip technology

Acknowledgment

We thank Valleylab Corporation for providing the illustrations.