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Electrosurgery has become a cornerstone of modern surgical practice. From general surgery and gynecology to dermatology and urology, electrosurgical units (ESUs) are indispensable tools for cutting, coagulating, desiccating, or fulgurating tissue with precision and efficiency. But with various types, modes, features, and safety requirements, healthcare professionals may be confused with the ESU selection. This guide equips healthcare professionals with the strategic considerations essential for making an informed, optimal ESU selection.
An electrosurgical unit is a medical device that uses high-frequency electrical currents to achieve surgical effects. ESUs deliver electrical energy through a hand-held instrument (such as a pencil or loop) to the target tissue. The two primary functions of the ESU are cutting and coagulation.
✅Cutting: Use a continuous waveform of high-frequency current to rapidly vaporize cells, allowing you to slice through tissue smoothly.
✅Coagulation: Use an intermittent waveform of high-frequency current to denature proteins and dry tissue, allowing it to stop bleeding.
Classified by working principle, the electrosurgical unit can be divided into the monopolar electrosurgical unit and the bipolar electrosurgical unit.
In a monopolar electrosurgical system, the electrical current flows from the active electrode (held by the surgeon) into the patient’s body, then exits the body via a return electrode (dispersive pad) placed on the patient’s skin. The current travels through a relatively large area of tissue between the two points.
In a bipolar electrosurgical system, the current flows between two tips of a single instrument (like bipolar forceps). The current stays confined to the tissue between the two electrodes, and no return electrode is needed.
Patient and staff safety is paramount. An ESU must provide robust safety mechanisms to minimize risks associated with electrosurgery, such as unintended burns, electromagnetic interference (EMI), and fire hazards.
It continuously monitors the contact quality of the patient return electrode during energy delivery. If contact degrades significantly, it instantly interrupts power, drastically reducing the risk of pad site burns.
The active current path is confined within the generator circuit and only flows through the patient between the active electrode and the return electrode. It minimizes electrical shock risk and reinforces the capacity of resisting interference.
3) Alarm Systems: Clear, audible, and visual alarms for malfunctions, open circuits, poor pad contact, or settings outside recommended parameters are vital.
A “one-size-fits-all” approach rarely works in surgery. The ESU must align with the procedures performed across your hospital.
Often require robust cutting and coagulation capabilities.
Often require smoke evacuation, compatibility with laparoscopic instruments, and vessel sealing.
Often require monopolar loop electrodes, vessel sealing, and smoke evacuation.
Often require very fine control.
5) Neurosurgery & Cardiac: Often require high precision, minimal thermal damage, and vessel sealing.
Often require high precision, minimal thermal damage, and vessel sealing.
Often require capability of working in fluid, vessel sealing, and fine control.
Different tissues and surgical techniques require different power outputs. While high power may be suitable for large muscle dissection, more delicate tissues require lower energy levels to prevent collateral damage.
Continuous high-frequency current vaporizes cellular water for rapid, precise tissue division with minimal inherent hemostasis.
Intermittent, lower-power current denatures proteins to coagulate tissue or seal small vessels, generating more heat spread than cutting.
Combine tissue cutting with moderate hemostasis during the incision.
Use high-voltage arcs to the tissue surface for diffuse hemostasis over broad and raw surfaces with minimal contact.
Use electric current to coagulate blood vessels through a bipolar instrument, usually a forceps with two tips acting as both the active and return electrodes.
The efficient ergonomics and intuitive user interface can greatly enhance efficiency and reduce errors in high-pressure environments.
1) Touchscreen or digital display: Facilitate quick access to modes and settings.
2) Foot pedals/switches: Allow hands-free control during procedures.
3) Programmable memory presets: Store settings for frequently performed surgeries.
4) Form factor and mounting: Portable type, tower integration, or tabletop type.
The technical support is a critical, but often overlooked, step when selecting an electrosurgical unit. Even the best device can become a liability without responsive and reliable support. Here are some items that the buyer shall take into account:
In summary, this guide underscores that selecting the optimal electrosurgical unit (ESU) requires a strategic assessment focused on core priorities. Core priorities include safety features (REM, circuitry isolation and alarm systems), clinical needs, power and modes, ergonomics and user interface, and technical support. By carefully evaluating these factors, healthcare professionals can make an informed decision to procure the ESU that best enhances surgical precision, efficiency, and patient outcomes.