Surgeons have cool tools

Surely no one can be pissed at me for pointing out that surgeons have some of the coolest tools, so I think I’ll describe a few of them that I’ve seen used a great deal in general surgery.

The one most frequently in use is referred to simply as “the Bovie” and it is used for electrocautery. Named for William Bovie it was first used by the famous surgeon Harvey Williams Cushing almost a century ago. The patient in the OR is laying on a large conductive pad that grounds them, and the Bovie device, which resembles a little plastic pencil with a flat, rounded metal tip, generates an electrical current which is transmitted directly to tissues to cut like a scalpel.

I can’t find a nice video of one in action, but it really is an interesting little device. By generating an alternating current at the tip it rapidly generates a great deal of heat in a very tightly-controlled location. Further, because you aren’t grounded, you can use it in close proximity to your fingers, or touch it to metallic surgical instruments to transmit the current to through the instrument to tissues without burning yourself. The effect of the device is dramatic. On one setting, the cut, a continuous waveform is generated that allows you to cut through tissue like a scalpel. The second setting, coagulation, turns the current on and off rapidly for a slower heat which coagulates while it cuts. The advantage of a Bovie over a scalpel is that a cut can be made that is clean and doesn’t bleed excessively thus maintaining hemostasis. One can also grasp a small vessel with a hemostat (or clamp) and touch the Bovie to the hemostat to rapidly coagulate the vessel to prevent bleeding.

More below…

The problem with the Bovie, and one of the first things you have to get used to in the OR, is the smell. After all, you are burning tissue, and it can be a little disturbing at first, but as with most things in medical school, you just get used to it after a little while.

Also cool are the surgeon’s staplers. I’m not kidding, they’re really neat. Depending on what kind of connection you want to make they have a stapler for the job. For instance, a gastrointestinal anastomosis stapler (GIA).

Here’s an image I nabbed from a product brochure:
i-05c6f5a32ec5c3ef125c2f2c8aaceeda-GIA stapler.jpg

These staplers put down two lines of staples, then automatically cut in between them. They can be used in open or laparoscopic procedures, and are an immense time saver. Consider, you want to cut the jejunum in half to remove a diseased portion of bowel. Well, you simply load the stapler, place it across the segment you want to cut, and it will automatically seal both sides and cut between, preventing spillage of the contents.

Here’s a video (I apologize for the wacky music), the stapler says “ethicon” in it, and is fired in the first step to separate two pieces of bowel.

Alternatively, you want to create a new hole (aka anastomosis) between two hollow organs, say the stomach and jejunum. You cut a small hole in each, place the stapler so the top half is in one hole/organ, the bottom half is in the other organ, and fire. The two are now joined by a row of staples with a new hole in between. You then sew off the holes you made for access, and you’ve effectively re-routed the plumbing in under 5 minutes. In the video above the second time they use the stapler it’s for this purpose, notice they also cut some holes with a Bovie current being sent down the laparoscopic tools.


10 responses to “Surgeons have cool tools”

  1. Well I’m glad to see my friend hasn’t spent all those years jabbing pig corpses at Ethicon for naught.

  2. I watched my wife deliver both of our boys by C-sect. And the doc used the hot knife both times. Kinda smelled like steak. 😉 But it was really kewl to watch. And it worked wonders as the boss was chock-full-o fribroids both times… something you don’t really want to get the scalpel around when the blood is running so well.

  3. Man. The human body is weird. I’m not sure I could ever get used to seeing that sort of thing. I guess that’s why I’m not a surgeon. 😉

  4. Don’t forget about the Morcellator. Have you done your OB clerkship yet? Morcellation for less-invasive hysterectomies and fibroid removal is amazing. It’s basically a laparoscopic blender.

  5. It is also useful for any quick bits of soldering you have to do if your patient turns out to be a cyborg.

  6. If you are impressed now … just wait until you see Robotics, Stereotactic Surgery and others. Welcome, and I hope you will keep up with your enthusiasm.

  7. Dont forget the disturbingly bacony smell.

  8. Christine

    I’ve seen those staplers used to create an anastamosis and was goggle-eyed behind my face shield! I’ve also seen the Morcellator that Thomas Robey mentions and it’s a really weird thing. The tools are super fun. My goal is to get my hands on a Bovie before my rotation ends.

  9. I think you are full of it christine….i am going to school for surgical technology and techs are not allowed to bovie. the only people in the OR allowed to do so is the surgeon and maybe the PA if you have one in the OR. So i dont know what you are talking about?

  10. I am a 65-year-old semi-retired Certified Medical Transcriptionist. I have been transcribing for about 15 years and have transcribed literally hundreds of these types of ops. Out of curiosity, I “googled” under images, GIA stapler and found this site. The video of the laparoscopic Roux en Y gastric bypass was so awesome! Thanks so much for posting it here. I am so amazed and impressed with the accuracy and delicacy of maneuvering that is done with those instruments. Even though I often mumble and complain when surgeons dictate from the Recovery Room with somebody in the background yelling “Open your eyes Mr. Smith,” I have the highest respect for the talent and skill that surgeons need to do their job.

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