The Art and Science of Monopolar Electrosurgery

Abstract

The most polished application of an energy source is an art form with the stroke of the monopolar electrode, not unlike that of the most renowned artist. Yes, our canvas is perhaps more dynamic as are our outcomes. For the artist confined to the constraints of a canvas, the beauty of the end result is in the eye of the beholder. For the surgical artist, the only real-time beholder may only be the surgeon but subsequent quality measures (observed by by-standing “beholders”) might include less pain, less bleeding, early discharge, shorter operating times, uneventful recovery, and likely lower costs, or alternatively, the need for transfusion, morbidity, and perhaps even mortality. The traditional artist employs a variety of mechanical strokes and paints to initiate visual change on the canvas. In a similar fashion, the electrosurgical artist also employs varying techniques and tools to initiate visual change on a tissue canvas. The traditional artists and the electrosurgical artist anticipate the effect of minor modifications of technique. It is a tribute to the ease of use of basic monopolar electrosurgery that application has been so successful with a very limited understanding of the underlying biophysics by the end-using surgeon. Indeed, surgical application has been accomplished traditionally by intuitive learning (“see one, do one, teach one”). However, a basic understanding is a prerequisite to an improved art form. Furthermore, technical challenges with increasingly complex biophysical contortions of instrumentation mandate a better understanding of elementary biophysics (as outlined in the two previous chapters).