Heat has been used in the treatment of wounds since ancient times. Hippocrates, around 400 BC, describes the use of cautery irons to stop bleeding and remove tumors, and is well-known for his aphorism that “fire will succeed where other methods fail.” This largely remained the state of the art for almost two thousand years.
Discovery of Electricity
The discovery of electricity provided a new mode of the application of energy to a surgical site, with early attempts going back to 1600, though usually with mixed results. It wasn’t until after the invention of the vacuum tube that the first practical, reproducible electrosurgical generator was developed by William Bovie and Harvey Cushing and used to successfully remove a large tumor from a patient’s head on Oct. 1, 1926. The development of solid-state electronics, and other technical innovations led to its widespread use in operating rooms throughout the world, and even today the word “Bovie” is often used synonymously with Electrosurgery.
Electrosurgery
Even though the mode of surgical energy delivery has changed over the centuries, Hippocrates is still right; the effect is still primarily about heat. In Electrosurgery, electrical current flows through tissue, heating it, and providing the operative effect. At low to moderate power levels, the heating dries out tissue creating desiccation or coagulation and is useful in hemostasis. At higher power, the tissue dries so rapidly that fragments are carried away with the water vapor, creating a cutting action. Often, this cutting is accompanied by the formation of eschar, or burnt tissue. Because of the flow of electrical current over the patient’s body, a return pad in needed to complete the circuit. However, as the current flows away from the operative site, nearby healthy tissue is also affected. Poor contact at the return pad can cause burns there as well.
The Next Step Forward: J-Plasma
J-Plasma represents the next step forward in the evolution of Electrosurgery. It is formed by passing an inert gas, such as helium, over a sharp conductive point that is held at high frequency and high voltage, producing a luminous plasma discharge beam. It also produces a localized heating effect, but only a brief pulse of current flows into the tissue, and then, an instant later, the current flows back out, creating what is referred to as a displacement current. There is no net flow of current around the patient’s body, and no return pad is needed. This also results in a highly localized effect, minimizing collateral damage to surrounding healthy tissue. The back-and-forth flow of displacement current occurs about a half million times a second. In addition to the flow of electrical current (electrons), the J-Plasma beam operates in a concert of ion bombardment (positively charged helium atoms), localized ultraviolet light, and a small amount of ozone, which may assist in wound healing, although we need to verify this in a clinical setting.
Independent Controls: Plasma Beam and Flow Rate of the Inert Gas
J-Plasma also has two independent controls of electrical power into the plasma beam which provides heating, and the flow rate of the inert gas, which provides a cooling effect. By adjusting the ratio of these two independent controls, the J-Plasma beam can be tuned over a wide range of effect, from a gentle beam that might be used in dermatology, to a powerful beam that can remove diseased tissue, for example, by ablating tissue layer by layer.
Retractable Blade
In a recent innovation, a retractable blade has been added to the J-Plasma hand piece. When the blade is retracted, it serves as the sharp conductive point. When it is extended, it can be used as a standard surgical scalpel, or it can be energized by the J-Plasma beam, providing exceptionally easy cutting action, but virtually no eschar formation.
Given the widespread acceptance of Electrosurgery and the evolutionary leap forward J-Plasma represents over Electrosurgery, even Hippocrates might agree that J-Plasma can succeed where fire might fail.
Feel free to reach out or leave a comment below.
Additional J-Plasma Resources:
- What is Cold Plasma?
- Advancements in J-Plasma Surgical Tools
- J-Plasma: An Advanced Cold Plasma Surgical Tool
- Understanding J-Plasma: What is Plasma?
- How is J-Plasma Different from Laser
Image courtesy of Master isolated images / FreeDigitalPhotos.net
