( continued from page 19 )
Monopolar vs . Bipolar
The “ Bovie ” is a monopolar electrosurgical device . In this configuration , the electrical current exits the tip of the electrode , rapidly dissipates and travels through the patient ’ s body to the return electrode ( Figure 2 ). In contrast , bipolar electrosurgical devices include both the active and return electrodes within the device , often shaped like forceps ( Figure 3 ). Because the current only travels through a short distance ( the tissue placed between the two electrodes ), a much lower voltage is needed . 4 This configuration achieves simultaneous cutting and hemostasis with minimal thermal spread . Bipolar cautery is used for fusion of intimal layers of vascular structures . 1 In the field of microsurgery , bipolar cautery is especially helpful for the careful dissection of blood vessels without damaging surrounding structures . 4
Safety
While electrosurgery offers precision , it quickly becomes dangerous if appropriate protocols are not observed . Complications may include thermoelectric burns , fire and smoke inhalation . When electrosurgery is used the patient becomes part of a circuit . The current goes through the patient and exits via an adhesive electrode patch . If the electrode ( ground ) is not adhered properly , the electricity will flow down the path of least resistance , possibly resulting in a burn . 1 Electricity may also pass through a hole in the surgical gloves , towel clamps , electrocardiogram leads , stands , intravenous poles , or the bed . 1 If the Bovie ’ s current passes through an object which is flammable , fire may result . There are an estimated 550- 650 incidences of fire in operating rooms annually . 15
Furthermore , there are an estimated two to five electrosurgical injuries per 100,000 surgeries . 1 Of the more than 30 million surgeries performed in the U . S . annually , 80 % use an electrosurgical device . There are between 480 and 1,600 such injuries each year in this country . 14 , 16 Caution should be used in patients with cochlear implants , cardiac pacemakers and implantable cardiac defibrillators . 17 A magnet can be used to signal to the pacer to operate at reset rate and ignore other electrical signals . Of note , the surgical team should avoid circuit travelling through prosthetic conductive devices ( e . g . place grounding pad contralateral to knee or hip prosthesis ). 1
Conclusion
The Bovie device revolutionized surgery by enabling precise tissue dissection and hemostasis . Through high-frequency current and low voltage , electrosurgery provides versatility for tailored cutting and coagulation . Monopolar and bipolar electrosurgery configurations offer different applications . The Bovie represents a true milestone in the evolution of surgical tools .
William T . Bovie , we salute you .
References
1
Massarweh NN , Cosgriff N , Slakey DP . Electrosurgery : history , principles , and current and future uses . J Am Coll Surg . 2006 ; 202 ( 3 ): 520-530 .
2
Alsanad SM , Asim , A . A . H ., Gazzaffi , I . M . A ., & Qureshi , N . A . History of Cautery : The Impact of Ancient Cultures . Journal of Advances in Medicine and Medical Research . 2018 ; 25 ( 9 ): 1-17 .
3
DeLeon MF , Yeo CJ , Maxwell PJt . The evolution of cauterization : from the hot iron to the Bovie . Am Surg . 2011 ; 77 ( 12 ): 1574-1575 .
4
Barrett SL , Vella JM , Dellon AL . Historical development of bipolar coagulation . Microsurgery . 2010 ; 30 ( 8 ): 667-669 .
5
El-Sedfy A , Chamberlain RS . Surgeons and Their Tools : A History of Surgical Instruments and Their Innovators-Part II : The Surgeon ’ s Wand-Evolution from Knife to Scalpel to Electrocautery . The American Surgeon . 2014 ; 80 ( 12 ): 1196-1200 .
6
Kirkup J . From flint to stainless steel : observations on surgical instrument composition . Ann R Coll Surg Engl . 1993 ; 75 ( 5 ): 365-374 .
7
Kirkup J . The history and evolution of surgical instruments . VI . The surgical blade : from finger nail to ultrasound . Ann R Coll Surg Engl . 1995 ; 77 ( 5 ): 380-388 .
8
Brill JB HE , Sise MJ , Ignacio RC . The history of the scalpel : From Flint to zirconium-coated steel . Bulletin of the American College of Surgeons Web site . https :// bulletin . facs . org / 2018 / 02 / the-history-of-the-scalpel-fromflint-to-zirconium-coated-steel /. Published 2018 . Updated January 31 , 2018 . Accessed .
9
Carter PL . The life and legacy of William T . Bovie . Am J Surg . 2013 ; 205 ( 5 ): 488-491 .
10
O ’ Connor JL , Bloom DA . William T . Bovie and electrosurgery . Surgery . 1996 ; 119 ( 4 ): 390-396 .
11
Marrero K , Fingeret A . The Innovator of Electrosurgery . J Craniofac Surg . 2019 ; 30 ( 7 ): 1936-1937 .
12
Cushing H , Bovie WT , Surgical Publishing Company of Chicago . Electro-surgery as an aid to the removal of intracranial tumors . Chicago : Surgical Pub Co . Chicago ; 1928 .
13
Karaki W , Lopez CA , Rahul , Borca-Tasciuc DA , De S . Waveform-Dependent Electrosurgical Effects on Soft Hydrated Tissues . J Biomech Eng . 2019 ; 141 ( 5 ): 0510031-05100314 .
14
McCauley G . Understanding electrosurgery . Bovie Med Corp . 2010 ; 4:4-15 .
15
Fisher M . Prevention of Surgical Fires : A Certification Course for Healthcare Providers . AANA J . 2015 ; 83 ( 4 ): 271-274 .
16
Sankaranarayanan G , Resapu RR , Jones DB , Schwaitzberg S , De S . Common uses and cited complications of energy in surgery . Surg Endosc . 2013 ; 27 ( 9 ): 3056-3072 .
17
Baigrie D , Qafiti FN , Buicko JL . Electrosurgery . In : StatPearls . Treasure Island ( FL ) 2022 .
18
Cordero I . Electrosurgical units - how they work and how to use them safely . Community Eye Health . 2015 ; 28 ( 89 ): 15-16 .
19
Bree K , Barnhill S , Rundell W . The Dangers of Electrosurgical Smoke to Operating Room Personnel : A Review . Workplace Health Saf . 2017 ; 65 ( 11 ): 517-526 .
Camille Walton is a third-year student at the University of Louisville School of Medicine .
Dr . Barrow is a third-year integrated plastic surgery resident at Duke University Medical Center and graduate of the University of Louisville School of Medicine . ( non-member )
Dr . Kasdan is an emeritus clinical professor of plastic surgery and resides in Louisville , Kentucky . ( non-member )
Dr . Wilhelmi is the director and chief of the Division of Plastic and Reconstructive Surgery at the University of Louisville .
20 LOUISVILLE MEDICINE