While the average person on the street may not even know what electrosugery is, it happens to be used in 80 percent or more of all surgical procedures today. The invention is credited to Dr. William T. Bovie, who along with Neurosurgeon, Harvey W. Cushing M.D., invented the first electrosurgical unit. The first use of an electrosurgical generator in an operating room occurred on Oct. 1, 1926 at Peter Bent Brigham Hospital in Boston, enabling a surgeon to remove a portion of a tumor that could not be taken out using traditional methods, and with almost no bleeding. While so many other significant advancements have happened in general electronic technology since the 1920’s, until recently, the advancements of electrosurgery have been few and far between.
However, over the decades, innovations in use and technology have radically improved. Megadyne, an electrosurgical products company, is celebrating 30 years of electrosurgical innovation this year. In retrospect, the company took a look back at several major milestones and technological advances in the electrosurgical arena. Needless to say, electrosugery has come a long way since 1926, with the following most recent notable milestones:
- 1970’s: the improvement from ground reference to isolated units
The original electrosurgery systems were ground referenced, meaning that the “ground” was an inherent part of the circuit. Next came isolated units. This innovation made it possible for all contemporary electrosurgical systems to use isolated circuits, which meant the “ground” is excluded.
- 1980’s: the improvement to discrete outputs
This innovation provided the ability to produce specific power settings. Prior to this, settings were determined by knobs that could be turned or adjusted so that they were “close” to the desired power setting, but was never exact. With digital outputs coming onto the scene, this provided the ability to choose an exact number and obtain that exact power setting.
- 1980’s: the improvement of tissue impedance monitoring at the patient plate/REM™
The invention of Contact Quality Monitoring (CQM) System, often referred to as REM™, is a (split surface) dispersive pad system developed in the early 1980’s to help reduce failures in the return electrode and subsequent patient injury.
- 1986: The World’s first PTFE coated non-stick electrosurgical tips
Megadyne was founded in 1985 with the the E-Z Clean® line of non-stick, eschar-resistant electrodes, developed by Dr. G. Marsden Blanch, an ENT surgeon. They featured a proprietary polytetrafluoethylene (PTFE) coating that reduced eschar buildup during surgical procedures, enabling surgeons to use lower power settings. Surgeons liked this technology as it reduced eschar buildup, so they did not need to stop and wipe the blade clean during procedures, increasing efficiency.
- 1987: the introduction of argon gas enhanced coagulation
A major advance in electrosurgical technology, argon enhancement has enabled a new element of precision and control in electrosurgical applications. The clinical benefits demonstrated by argon-enhanced coagulation include quick and efficient coagulation, a thinner, more flexible eschar, less charring, and less tissue damage.
- 1990’s: Introduction of tissue response at the active electrode
The 1990’s brought the capability of measuring the resistance of tissue when it is exposed to the electrode. This provided consistency in power delivered to tissue. This improvement also provided the ability for the generator to adjust power settings on the fly to achieve constant power regardless of the tissue impedance.
- 1991: E-Z Clean® Laparoscopic Electrodes
Many manufacturers looked to provide added safety and efficiency to their offerings. With this product, reintroduction during surgery was minimized and lower power settings were an option for safer delivery of electrosurgery.
- 1998: Vessel Sealing Technology
Introduced by ValleyLab (now Medtronic Minimally Invasive Therapies), the ligasure vessel sealing system is an electrosurgical device that seals blood vessels. Core to this technology is the use of bipolar electrosurgery that relies on tissue response generators.
- 1999: Mega 2000® Patient Return Electrode
The Mega Soft Patient Return Electrode provided an alternative to the traditional “sticky pad” and offered a new level of safety and comfort than ever before. The pad is set on the operating room table, eliminating the small disposable that can damage the patient’s skin, providing a safe and easy-to-use return electrode combined with an effective O.R. table pressure reduction pad.
- 2000: Indicator Shaft®
The patented, inner yellow, insulation shaft alerts clinicians to nicks or holes in the outer insulation, indicating it is time to discard and replace the electrode. This was yet another big leap in electrosurgical safety for both surgical staff and patients alike and was developed by Megadyne.
- 2005: Mega Power® Electrosurgical Generator
In 2005, the Mega Power, an electrosurgical generator that delivered an intuitive design and user-friendly interface with the power to provide consistent and efficient surgical performance regardless of tissue type. Many other electrosurgery companies also developed similar technologies.
- 2010: ACE Blade® Scalpel Replacement
The ACE Blade replaced the need for a scalpel and a separate electrosurgical tool in 2010. Combined with its proprietary ACE Mode, the Mega Power Generator could be safely used from skin to skin: incision, dissection and coagulation, all in one device.
- 2015: Zip Pen® Smoke Evacuation
This technology addressed many of the obstacles surgeons had to using existing smoke evacuation tools. Today, electrosurgery is standard practice in operating rooms throughout the world. The Association of Operation Room Nurses (AORN) recommends the use of a smoke evacuation system to protect operating room staff from inhaling the smoke generated during electrosurgery procedures.
Sources:
1. http://old.repertoiremag.com/Article.asp?Id=1458
2. http://www.servicemed.eu/index.php?option=com_content&view=article&id=255%3Aargon-enhanced-electrosurgery&catid=67%3Aelectrosurgery&Itemid=284&lang=en
3. https://en.wikipedia.org/wiki/Electrosurgery
4. Fundamentals of Electrosurgery Part I: Principles of Radiofrequency Energy for Surgery, Malcolm G. Munro
5. http://cdn2.hubspot.net/hub/123147/file-16763634-pdf/docs/bovie_medical_corporation–_understanding_electrosurgery.pdf
6. http://www.rigelmedical.com/downloads/rigel_medical_electrosurgical_guidance_booklet_v1.pdf
7. https://books.google.com/books?id=fLPwAwAAQBAJ&pg=PA234&lpg=PA234&dq=when+was+REM+Contact+Quality+monitoring+System+introduced?&source=bl&ots=wY6Z7HHM2t&sig=3DYMpYCzWE-Sw4-hs_bzpC9yuKM&hl=en&sa=X&ved=0ahUKEwit8Z6HquHJAhWDbB4KHaiaD1UQ6AEIMzAD#v=onepage&q=when%20was%20REM%20Contact%20Quality%20monitoring%20System%20introduced%3F&f=false
8. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3407433/
9. Source: HealthTap, https://www.healthtap.com/user_questions/159544-when-was-the-first-ligasure-model-launched
*REM™ is a registered trademark of Medtronic. E-Z Clean®, Mega 2000®, Indicator Shaft®, Mega Power®, ACE Blade®, and Zip Pen® are registered trademarks of Megadyne Medical, Inc.
