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.