Tools of the Trade: Electrosurgical Devices

In electrosurgery, medical devices that use alternating high-frequency electrical currents apply heat to tissue in order to cut and coagulate with minimal blood loss. Surgeons manipulate the depth and rate of heat production to tissue to produce the desired surgical effects. This is accomplished by altering the type and use of the electrode, the time of application to the tissue, as well as power and waveform settings of the electrosurgical generator. With the use of these tools and the manipulation of voltage, surgeons can quickly and cleanly produce a variety of surgical effects on tissue as demanded by a given procedure. The high-frequency alternating electrical currents used in electrosurgery have been termed radio frequency, or RF, energy.

Electrosurgery allows for minimally invasive surgical solutions which would have previously required much more intensive procedures. Electrosurgical devices, such as those developed and manufactured here at NextPhase, offer many advantages over alternatives, including more versatile use, lower cost, minimization of blood loss, and faster and more efficient surgical effectiveness. One study that compared scalpel incisions to electrosurgical ones found “no significant differences […] regarding infection rates or scar appearance,” but “lower reported postoperative wound pain from patients with electrosurgical incisions.”

Electrosurgery’s uses are as varied as treating cutaneous lesions in dermatology; sterilizing root canals in dentistry; closing incisions in eye surgery; producing artery grafts and increasing precision in cardiothoracic surgery; and enabling laparoscopic procedures in gynecological and gastrointestinal surgeries, among many others. Due to its flexibility and unique advantages, electrosurgery has become common across all areas of medical practice and continues to be adopted for novel uses, with researchers noting that “many of today’s surgical procedures and techniques owe their existence and success to radio frequency.”

Monopolar Versus Bipolar Instruments

 Monopolar Versus Bipolar Instruments

Electrosurgical instruments can be roughly divided into two categories: monopolar and bipolar. These describe the path of the electrical current during surgery. In monopolar electrosurgery, the active electrode - the electrosurgical “blade” - is applied to patient tissue. The electrical current passes through the patient to a dispersal pad which is connected to the electrosurgical generator, where it is safely dissipated. This is the most commonly used form of electrosurgery, but it does present risks of burns due to equipment or operator malfunction. It may also be dangerous for patients with certain pacemakers or prosthetic devices.

Bipolar electrosurgery eliminates the need for a dispersal pad. The electrosurgical instrument itself has an active electrode and a return electrode. These are usually the tips of a pair of forceps or scissors. Importantly, only the tissue between the instrument is affected by this circuit. This means that bipolar electrosurgery presents a decreased risk of burns. However, a bipolar configuration may limit the ability of tools to cut or coagulate when compared to monopolar electrosurgery, limiting its uses.

Major Categories of Electrosurgical Medical Devices

Numerous classes of electrosurgical devices and instruments exist, each of which provides different capabilities to the surgeon, and comes with a variety of specialized use cases depending on the fields and procedures for which each is designed.

Electrosurgical generators combine with handpieces to form what is referred to as an electrosurgical unit. These generators deliver the electrical energy which passes through tissue to perform surgery. They can offer monopolar and bipolar configurations, and give operators the ability to adjust power levels and modes to suit the surgery at hand. Generators vary in their power levels, safety and quality control measure, usage modes, vessel sealing capabilities, and other characteristics which suit different use cases. Argon gas systems are used in fields like gastrointestinal surgery, resulting in less chance of bleeding, reduced smoke production, and more efficient cutting and coagulation.

The electrosurgical instruments which surgeons use during surgery include electrosurgical pencils, forceps, scissors, electrodes, laparoscopic tools, coagulation and irrigation devices, tissue sealers and dividers, and more. These instruments differ in their materials, design, and function to suit uses across different surgeries and medical fields. Smoke dispersion units are required due to the production of smoke inherent to electrosurgery. These units may stand alone, or may attach to electrosurgical instruments to remove smoke and fluids as a surgeon operates. Surgical smoke is dangerous to inhale, as it has been linked to numerous health conditions and can contain live viruses. Efficient and quick smoke extraction was even more important during the height of the COVID-19 pandemic, with the removal of aerosols emerging as a top priority.

Electrosurgical device design requires careful consideration of safety features, versatility across different operations and medical fields, and convenience to users. Electrosurgical medical devices must stand up to the high demands of surgical procedures, minimize the risk of burns or other malfunction, and meet exacting regulatory standards. Designers and manufacturers continue to push technology forward to envision tools which make existing surgeries easier for surgeons and patients alike, and which open up new surgical opportunities for minimally invasive or previously impossible procedures. Transcatheter electrosurgery, where an electrified guidewire is used to perform delicate, cutting-edge cardiac operations, is one such example. Robotic-assisted surgery is another exciting advancement, in which specialized electrosurgical tools, including generators and instruments, are designed with unique capabilities to provide compatibility with robotic sealing devices and platforms. Such tools are commonly used in “robotic cholecystectomy and inguinal hernia repair,” and offer greater rotation than the human wrist for “fine dissection in restricted spaces and precise planes.”

Similarly, advances in vessel-sealing technology are proving useful for achieving hemostasis (stopping blood flow from a wound) while minimizing thermal damage, leading to new possibilities in endoscopic surger. Automation is driving the production of safer, more standardized coatings for electrosurgical instruments. These advances are revolutionizing device design and manufacturing, improving surgical accuracy and outcomes, and delivering tools which offer increased performance and greater safety for surgeons and patients alike.

A Bright Future for Electrosurgery

The global electrosurgical device market is expected to grow substantially in the coming years, with projections reaching $8.8 billion by 2025. With increased demand for minimally invasive procedures, along with new solutions enabling easier electrosurgery with reduced operating time and better patient outcomes, the future of electrosurgery appears promising.