The scalpel has traditionally been used by surgeons for skin incisions and fine dissection because of its precision, but one of its biggest drawbacks has always been that scalpel incisions result in bleeding that obscures the surgical field. The first electrosurgical generator, developed by William T. Bovie in 1914, directed high frequency electrical current through a metal probe to increase temperature in the patientâ€™s tissue directly adjacent to the probe. Today, according to Bovie Medical, this core technology platform is used in more than 17.5 million electrosurgical procedures in the United States annually.
(For more on the RF devices market, see “Radiofrequency-Ablation Technologies Worldwide Market, 2009-2019”, report #A145-RF.]
The fundamental design of the electrosurgical generator and its accompanying handpiece has not changed dramatically through the years: continuous RF energy is delivered to the tissue via electrical arcing from a high-temperature, uninsulated metal probe. By adjusting the amplitude and waveform of the RF energy the function of the electrosurgical device can be changed from cutting to coagulation. But this technology, too, had its limitations: its lack of precision and deep thermal injury profile made it impractical for routine use. Hence, surgeons stayed with traditional scalpels to make skin incisions, and then switched to the electrosurgical device for subcutaneous dissection and bleeding control.
[inset: Halt Medical 2000GI Electrosurgical System.]
The use of electrosurgical plasma, induced with pulsed radiofrequency (RF) energy, has emerged as a method for precision dissection with simultaneous hemostasis and an improved thermal injury profile. It combines the advantages of the scalpelâ€™s cutting precision with conventional electrosurgeryâ€™s coagulation capability, while minimizing collateral thermal damage. This technology, first described as PEAKÂ® technology, utilizes very short bursts of RF energy to induce a plasma-mediated discharge along the edge of a very thin (12Î¼m), flat, 99.5 percent insulated electrode. This conductive plasma allows RF energy to cross at much lower levels, leading to lower operative temperatures and less thermal damage. This technology has been commercially developed as the PEAK PlasmaBladeâ„¢ from PEAK Surgical, Inc (Palo Alto, CA), and is currently used in general, plastic, ENT, orthopedic and OB/GYN surgeries.
Companies with products on the market and/or in development include:
Advanced Cardiac Therapeutics, AngioDynamics, Ardian, Arthrex, ArthroCare, Asthmatx, Atricure, Bard EP, BÃ‚RRX Medical, Inc., Baylis Medical (Kimberly-Clark), Biosense Webster (JNJ), Biosense Webster (JNJ), Biotronik, Boston Scientific, Bovie Medical, BSD Medical, BTL Industries, Inc., Cardima Inc., Celon AG, ConMed, Cook Medical, CoRepair, Covidien, Endosense, EndyMed Ltd., EP Limited, Erbe Elektromedizin GmbH, Estech , Halt Medical, Hansen Medical, Gyrus ACMI (Olympus), Hologic, Integra Radionics, Mederi Therapeutics, Inc., Medtronic, nContact Surgical, Inc., OrthoDynamix LLC, PEAK Surgical, Salient Surgical Technologies, Smith & Nephew, St. Jude Medical, Stereotaxis, Stryker Interventional Spine, Valleylab (Covidien), VNUS Medical Technologies (Covidien), Voyage Medical.