Mastering Electrosurgery: The Bovie Technique

Table of Contents

1. Introduction to the ESU (Electro Surgical Unit)
2. The History of the ESU: From WT Bovie to Modern Technology
3. Understanding the Anatomy of Electricity
4. Electro Surgery: Definition and Application
5. The ESU Circuit: Generator, Active Electrode, and Grounding Pad
6. Mono Polar Cauterization: How It Works
7. Bipolar Cauterization: A Different Approach
8. Different Devices Utilizing Mono Polar and Bipolar Cauterization
9. Understanding Cords and Generators
10. Safety Measures and Potential Risks in Electro Surgery
11. The Impact of Plume in the Operating Room

The ESU: An Essential Machine in the Surgical Room

Introduction to the ESU (Electro Surgical Unit)

In the surgical room, there is one machine that stands out as a vital tool for surgeons and surgical techs alike - the ESU (Electro Surgical Unit), also known as the Bovie. This machine plays a crucial role in using mono polar and bipolar cauterization techniques during surgery. In this article, we will explore the ESU in-depth, covering its history, anatomy of electricity, application in electro surgery, and much more.

The History of the ESU: From WT Bovie to Modern Technology

To understand the roots of the ESU, we take a step back in time to the 1920s when physicist WT Bovie invented the spark gap generator. This invention quickly evolved into the electro surgical generator, which, after several iterations and upgrades, became the ESU we use today. It is fascinating to think that a machine named after its inventor, DT Bovie, would become a staple in the surgical world for years to come.

Understanding the Anatomy of Electricity

While delving into the history of the ESU is intriguing, our focus is on the practical aspect of its operation. We won't dive too deeply into the complexities of atoms, electrons, and matter, as that would require an entire book. Instead, let's define electro surgery as the application of electric current to cauterize or coagulate tissue at the surgical site. The current flows from a generator to an active electrode, delivering the electric current to the surgical site through the patient's tissue. It then channels back to the generator via a dispersive inactive electrode (grounding pad).

Electro Surgery: Definition and Application

Now that we comprehend the basics of electro surgery, it is worth highlighting its application in the surgical field. Electro surgery is a technique used to cauterize or coagulate tissue, providing precise control and minimizing bleeding during surgical procedures. This essential process ensures a safer and more efficient surgical experience for both patients and medical professionals involved.

The ESU Circuit: Generator, Active Electrode, and Grounding Pad

Let's take a closer look at the ESU circuit and understand the roles of its key components. At the core, we have the generator, which serves as the power source. The active electrode, also known as the Bovie, is the tool used on the surgical field to cut and coagulate tissue. It is directly plugged into the generator, providing the necessary electric current. On the other side of the circuit, we have the grounding pad, or Bovie pad as it is commonly referred to. This pad, with its special adhesive, is applied to the patient's fleshy areas, allowing the electric current to complete its circuit back to the generator.

Mono Polar Cauterization: How It Works

Mono polar cautery is one technique employed with the ESU, and it involves the flow of electric current from the generator through the patient's tissue and back to the generator. By controlling the amperage of the electric current, surgeons can precisely cut and coagulate tissue. The ESU offers different settings, including cut and coagulation (Co AG), which determine the amperage flowing through the active electrode. Surgeons can adjust these settings to tailor the cauterization process to their specific needs.

Bipolar Cauterization: A Different Approach

In addition to mono polar cautery, the ESU provides another method called bipolar cautery. Unlike mono polar cautery, bipolar cautery is performed between the prongs of a forceps-like instrument. The top prong serves as the active electrode, and the bottom prong acts as the dispersive electrode. This technique eliminates the need for a separate grounding pad, as the forceps itself completes the circuit. Bipolar cautery is commonly used for precise coagulation of tissue, minimizing thermal spread and promoting faster healing.

Different Devices Utilizing Mono Polar and Bipolar Cauterization

Various surgical instruments and devices employ both mono polar and bipolar cautery techniques. One such device is the robotic spatula, specifically designed for robotic surgery. This mono polar spatula allows surgeons to dissect and coagulate tissue during robotic procedures, often used in robotic colectomies. Other instruments, such as mono polar scissors and bipolar forceps, provide surgeons with further options to perform cautery procedures based on their preference and the surgical requirements.

Understanding Cords and Generators

To effectively utilize the ESU, it is important to comprehend the role of cords and generators. Different devices may require specific cords, while some share universal compatibility. Hospitals often use generators with mono polar and bipolar hookups, ensuring flexibility and compatibility with a range of surgical instruments. The ligature machine, specifically designed for ligature procedures, combines mono polar and bipolar capabilities along with separate hookups for ligature supplies.

Safety Measures and Potential Risks in Electro Surgery

Safety is paramount when utilizing the ESU due to potential risks associated with electrical burns. Proper application of the grounding pad is crucial in preventing electrical burns. However, if there are any breaches in gloves or open skin, the risk of electrical burns increases. Surgeons and surgical assistants must exercise caution and ensure their hands are adequately protected during surgical procedures. Additionally, plume, the smoke generated during cauterization, should be addressed to prevent inhaling hazardous fumes.

The Impact of Plume in the Operating Room

The generation of plume during surgical procedures is a pressing concern. The smoke emanating from cauterized tissue can pose risks similar to smoking daily. Surgical teams must utilize suction devices to remove plume, ensuring a safer environment for everyone present in the operating room. Addressing the issue of plume is crucial not only for the immediate well-being of the surgical team but also for long-term respiratory health.

Highlights:

• The ESU (Electro Surgical Unit), also known as the Bovie, is a vital machine in the surgical room.
• It utilizes mono polar and bipolar cauterization techniques during surgery.
• Mono polar cautery involves the flow of electric current from the generator through the patient's tissue and back.
• Bipolar cautery is performed between the prongs of a forceps-like instrument, eliminating the need for a separate grounding pad.
• Various devices and instruments utilize mono polar and bipolar cautery, offering flexibility in surgical procedures.
• Understanding cords and generators is essential for effective ESU usage.
• Safety measures must be taken to prevent electrical burns, and attention should be given to the hazards of plume generation in the operating room.

FAQs:

Q: What is the difference between mono polar and bipolar cautery? A: Mono polar cautery involves the flow of electric current from the generator, through the patient's tissue, and back to the generator. Bipolar cautery, on the other hand, is performed between the prongs of a forceps-like instrument, eliminating the need for a separate grounding pad.

Q: How does the grounding pad work in electro surgery? A: The grounding pad, also called the dispersive electrode or Bovie pad, is applied to the patient's fleshy areas. It provides the path for the electric current to complete its circuit back to the generator, preventing electrical burns and ensuring safety during surgical procedures.

Q: Is plume generation a significant concern in the operating room? A: Yes, plume generation during cauterization procedures can pose health risks similar to daily smoking. Surgical teams should utilize suction devices to remove plume and minimize exposure to the potentially hazardous smoke.

Q: Why is understanding cords and generators important in electro surgery? A: Different surgical instruments and devices may require specific cords and generators. Understanding their compatibility ensures efficient and safe usage of the ESU in various surgical procedures.

Q: What precautions should surgical professionals take to prevent electrical burns during electro surgery? A: Surgical professionals should ensure proper application of the grounding pad and avoid breaches in gloves or open skin to minimize the risk of electrical burns. Proper hand protection is crucial during surgical procedures involving the ESU.