Argon plasma coagulation minimizes risk of injury

Lack of electrical current means no accidental burns

One of the most frightening aspects of injuries caused by stray electrosurgical current is that almost 70% of these injuries are undetected during surgery and 25% of patients with undetected burns during surgery die, even after aggressive treatment once the injury is discovered.1 The threat of injury to patients is causing same-day surgery managers to look at a new product that does not use electric current to cauterize tissue.

Safety is the key benefit of the PlasmaJet, says Denis F. Branson, MD, a plastic surgeon in Fayetteville, NY. "Because electrical current is not used to cauterize, there is no danger of current traveling through jewelry or a pacemaker," he points out. "There is no need for a grounding pad, either."

The PlasmaJet uses a high-energy jet of pure argon plasma to coagulate, says Pia Johansson, RN, MBA, clinical service manager for PlasmaJet manufacturer PlasmaSurgical in Alva, FL. "Electrodes heat the plasma, which is then directed at the incision site to coagulate the blood," Johansson says. "No electrical current passes to the patient, just the heated plasma," she explains.

Other benefits of neutral plasma coagulation include no direct contact of the handpiece with the tissue, so there is no danger of tissue adhering to the handpiece, and a very low gas flow that minimizes the risk of embolism and overpressure, Johansson points out. "The heated plasma also coagulates the tissues in successive layers, as opposed to top layer only, that produces a more effective barrier to further bleeding," she adds.

Branson has found that the neutral plasma coagulation effectively seals lymphatic vessels and prevents fluid buildup in the incision site. "This means that my breast reduction patients have less need for drains, and that means less patient education and quicker recovery," he adds.

Another unanticipated benefit of neutral plasma coagulation discovered by Branson is less pain after surgery. "Because this process does not cause any damage to nerves as electrosurgical cauteries can cause, patients report less postoperative pain," he says. "This means patients return to normal activities sooner."

Other procedures in which he has used neutral plasma coagulation with the same results include breast augmentation, abdominoplasty, and post-bariatric abdominal contouring, says Branson. The benefits of neutral plasma coagulation seen in plastic surgery procedures will be seen in general and laparoscopic surgery as well, Johansson says.

There is a short learning curve to use the PlasmaJet, but no special courses are needed, says Branson. "It does require a slight change in technique because you do keep the handpiece further away from the bleeding vessel, and you do have to learn to judge what settings work best for your patient and your technique," he says.

There also is a different look to the tissue as it coagulates as compared to electrosurgical cautery, Branson says. "While the tissue may appear black, the argon plasma is not injuring the tissue," he explains.

The price for the PlasmaJet console ranges from $30,000-$35,000, says Johansson. The disposable handpieces are $295 each, but the price may vary according to volume ordered, she says.

The price is reasonable for the patient safety benefits as well as the patient comfort, says Branson. While the overall costs are not significantly different from electrosurgical equipment, the handpieces are higher than electrocautery handpieces, he says. The trade-off for the slightly higher costs is the reduced need for drains, lower levels of postoperative pain, and increased level of patient safety, he adds.

"Overall, I can be more effective because the risk and concern about injury to adjacent tissues and organs is reduced," he says. "Not only do I have more control over the coagulation process, but I know that my patient is going to recover more quickly."

Reference

  1. Werner C. Guarding against an unseen killer: Stray electrosurgical burns. Healthcare Purchasing News 2002; 26:28.

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