© by BiPAD, Inc.

BiPAD’s Electrocautery Primer

“Electrocautery is arguably the single most-used surgical technique, yet it is perhaps the least understood and least appreciated by surgeons.”

(Lee Ponsky MD, Assistant Professor, Case Western Reserve University, Cleveland, Ohio; Surena F. Matin MD, Associate Professor, University of Texas M. D. Anderson Cancer Center, Houston, TexasComplications of Urologic Surgery (Fourth Edition), Prevention and Management, 2010, Pages 333–342)

 

What is ELECTROCAUTERY?:

In the old days, before electricity, bleeding was stopped by applying a scalding hot prong to an incision. All tissues touched by the red-hot prong were cooked. This resulted in a lot of pain, high infection rates, complications caused by inadvertent damage to nerves and other blood vessels and long healing times. And of course it only could be used in large open incisions, it could not support microsurgery, for example. A better way was needed if surgery was to advance.

 

“Monopolar electrocautery was developed first. In 1920 William T. Bovie, an eccentric inventor with a doctorate in plant physiology, developed an innovative electrosurgical unit that Harvey Cushing, the founder of modern neurosurgery, introduced to clinical practice.”

(https://www.ncbi.nlm.nih.gov/pubmed/8644002)

For an excellent history of William T. Bovie's invention of electrocautery, see CLICK HERE.

The BiPolar forceps electrocautery was developed by James Greenwood, M.D., was chief of the neurosurgical service at Houston Methodist Hospital from the 1930s until 1980 and by the Leonard and Jerry Malis brothers, the former the Chair of Neurosurgery at Mount Sinai hospital and the latter a physiologist. (https://www.researchgate.net/publication/7237959_History_of_bipolar_coagulation). 

 

For a good summary of the history of electrocautery, please see: https://www.slideshare.net/MANJUNATHSETHURAMANI/basics-of-electrosuregery 

 

and 

https://www.researchgate.net/profile/Shahid_Nimjee/publication/7237959_History_of_bipolar_coagulation/links/552fe3dc0cf2f2a588ab01f0/History-of-bipolar-coagulation.pdf

 

Two types of ELECTROCAUTERY and how they are different:

 

  1. MONOPOLAR ELECTROCAUTERY: The difference between the two is that in MONOPOLAR the patient is grounded and the surgical instrument is a probe that delivers electricity that arcs, like a lightning bolt, from the instrument to the patient.  Bleeding is controlled, but the surrounding tissues are cooked to death. This is commonly called Bovie Electrocautery and is used mostly to cut tissues. MONOPOLAR Electrocautery is used to cut tissues like muscle and ligaments because it coagulates as it cuts. Cutting with a scalpel, by contrast, leaves all opened vessels bleeding.

  2. BIPOLAR ELECTROCAUTERY: In contrast, in BiPOLAR ELECTROCAUTERY, the electricity jumps from one side of the electrocautery instrument to the other, it does not arc to the patient. The electricity stays between the two poles of the instrument and only the tissues between the poles of the instrument is cooked. This is the best instrument for controlling bleeding during surgery in that it causes the least damage to surrounding tissues.

 

Advantages of BiPOLAR electrocautery:

"With the current strong enough to produce coagulation," wrote Greenwood in 1940, "there is some damage to surrounding tissues since the current must spread by eventually passing to the common or body electrode.”

 

 

How are MONOPOLAR and BIPOLAR ELECTROCAUTERY INSTRUMENTS USED used?:

  1. MONOPOLAR ELECTROCAUTERY is mostly used primarily for cutting (dissecting) in a process called electrosurgery. Monopolar can be used for electrocautery, that is, to achieve hemostasis, but it is not ideal for this purpose because it creates too much damage to normal tissue surrounding the vessel that is hemorrhaging.  

  2. BiPOLAR ELECTROCAUTERY is used to stop bleeding

    1. Surgical dissection causes bleeding, the best tool for stopping this hemorrhage is BiPOLAR electrocautery.

    2. When Surgery is OPEN SURGERY, all surgeons of every specialty use BiPOLAR forceps electrocautery.

    3. When surgery is ENDOSCOPIC, all surgeons use BiPOLAR LAPAROSCOPIC/ENDOSCOPIC ELECTROCAUTERY.

 

HOW IS ELECTROCAUTERY ACTIVATED BY THE SURGEON?

  1. Initially, all forms of electrocautery, monopolar and bipolar were activated with a foot switch.

  2. In the 1960’s, a hand switch was developed for monopolar electrocautery. By the 1970’s, no one used a foot pedal, and today most surgeons don’t even know that the monopolar electrocautery instrument was ever activated by a foot pedal even though all of the generates still have a connection for a foot pedal.

  3. Laparoscopic Bipolar Electrocautery was initially activated by foot pedal as well; it has been activated by a hand switch since the 1980’s. And like monopolar electrocautery, no surgeons use a foot pedal, and most do not know that this tool was ever activated by the foot pedal. 

  4. BiPolar Forceps Electrocautery is the only form of electrocautery still activated by a foot pedal.

 

Why isn’t there a hand switch for bipolar forceps electrocautery? Why have others failed to achieve wide-spread adoption?

  1. Kirwin patented a device in 1993 that inserted onto the forceps prongs connector. This failed because:

    1. Requires a special cable.

    2. Requires a special generator.

    3. The device was too big and interfered with use in microsurgery

    4. The actuation arm was awkward and did not allow the surgeon to grasp the forceps in the usual manner

    5. Was not customized for different forceps.

  2. ConMed sells a forceps with a built-in proximity switch. This has not succeeded because: 

    1. Activates whenever the tips are opposed. Therefore prevents the use of forceps for micro-dissection and carrying items to and from the operative field. Dangerous. 

    2. Replaces the cadre of bipolar forceps specific for different types of surgery. For example, plastic surgeons, hand surgeons, and ophthalmic surgeons are more likely to use jeweler's forceps. Neurosurgeon and most other surgeons are more likely to employ bayonet forceps. 

    3. Requires a special cable which is sold separately from the forceps. 

    4. Requires a special electrocautery generator.

    5. We did not find evidence of sales of these devices in the purchasing history of 89  randomly sampled hospitals.

 

 

Why 90% of surgeons who see BiPAD want to use BiPAD:

Our invention, BiPAD (an acronym for BIPolar Activation Device),  applies to ALMOST ALL OPEN SURGERIES which use BIPOLAR FORCEPS ELECTROCAUTERY:

 

  1. Works with any forceps.

  2. Works with any generator.

  3. BiPAD resembles and replaces the current sterile cord.

  4. The BiPAD sterile cord can replace the current hand-switched cord at about the same price.

  5. BiPAD allows for adding or removing the switch component as needed during surgery

  6. BiPAD can work with a foot pedal, allowing the surgeon to use either or both, BiPAD hand switch or BiPAD pedal.

  7. BiPAD has an ergonomically designed actuator arm allows the surgeon the hold the forceps in the normal manner.

  8. BiPAD can accommodate different actuator arms for different situations.

 

 

Why is BiPAD critically important?:

  1. Surgeons can inadvertently injure a patient when distractedly searching for a foot pedal, particularly during microsurgery.

  2. Time is wasted, and blood is lost in the time in takes to search for the foot pedal dozens and dozens of times per surgery. We estimate that 760,000 units of blood loos will be saved by the use of BiPAD per year.

  3. The foot pedal impedes the frequent use of the bipolar forceps in some situations, and BiPAD makes bipolar forceps more facile. More surgeons will use bipolar forceps more frequently once BiPAD is commercially available.

  4. Monopolar forceps causes most of the cases of operating room fires. Bipolar has never been implicated as a cause of operating room fire.

  5. BiPOLAR electrocautery produces less char; less char has been shown to result in lower infection rates and faster healing.

  6. BiPAD does not interfere with the usual grasp and use of the bipolar forceps. 

  7. BiPAD is adaptable: 

    1. The hand switch portion can be removed and replaced as needed during surgery.

    2. BiPAD allows for the use of the foot pedal if needed and the hand switch in tandem

    3. Any surgery that can be done with a bipolar forceps using a conventional cord can be done with the BiPAD cord