Use Of Electrosurgery Research Articles

There can be no doubt that the use of electrosurgery adds a complex piece of surgical equipment to a technic already dependent upon meticulous attention to detail for its success. The surgeon, of course, does not have to be acquainted with all of the laws of electrical physics to employ such an apparatus successfully. However, a thorough acquaintance with its performance obtained upon experimental living structures is necessary before one should attempt its use during a complicated surgical procedure. Even with such a preparation, the advantages and limitations of its use are indicated more clearly by practice. That some surgeons may find it of more value than others to gain the same result is a fact which depends entirely upon the individual's surgical technic. It should be emphasized again, therefore, that electrosurgery cannot be said to have superceded the basic principles of osteoplastic cranial operations and tumor removal. It has been our experience that one is likely to hurry the procedures of coagulating vessels or incising brain tissue. As has been pointed out, the use of a strong current to coagulate a vessel may cause it to explode and to defeat the object for which it is intended. It is certain that the electrodes are of no service whatever in a bloody field which does not allow one to see the bleeding or oozing point. It is of course understood that an electrosurgical apparatus should not be used during the administration of a general anesthetic. The possibility of an explosion is too factual to be dimissed. Consequently the operations in which the electrodes are used are performed under local anesthesia. The disadvantages of a general anesthetic such as ether in intracranial operations are well known, so that the necessity of a local anesthetic in itself is of value. However, it must be recognized that many individuals are not suitable patients for the use of local anesthesia. In such circumstances we have taken the precaution to remove the ether bottle from the room, and have placed a wet cloth between the patient's face and the operative field while the unit is in use. We have satisfied ourselves that there are not untoward or disturbing complications due to the use of this apparatus in intracranial surgery. As a matter of fact the immediate postoperative convalescence in all the cases in which it has been used has been smooth and uneventful. We have never had to re-elevate a flap in this group of cases because of secondary hemorrhage. Neither do we believe that any greater amount of postoperative edema follows its use. In conclusion, we believe that : 1. 1. Electrosurgery is a distinct addition to the neurological surgeon's armamentarium. It does not however completely supercede the well established principles of osteoplastie craniocerebral surgery. 2. 2. At present, it may be employed to its greatest extent in the removal of meningiomas; in particular, to the relatively inaccessible meningiomas. 3. 3. The improvement of the use of electrosurgery in the surgical treatment of gliomas offers the possibility for its greatest contribution to the surgery of the nervous system.

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