An electrosurgery unit places the power of electrical cutting and coagulation at a surgeon's fingertips, but it's often your nurses who have their hands all over ESUs — assembling and plugging them in, adjusting the alarms and changing their settings at the surgeons' requests. So it's important when making a purchasing decision to balance your doctors' personal preferences and brand loyalties with such nurse-centric issues as safety, support and supplies.

Beyond ease of use
In general, it's a fairly standard piece of equipment. Most generators offer comparable options in terms of delivering monopolar and bipolar energy through variable settings for different applications and types of tissue, just as most pencils or handpieces are designed to easily switch between cutting and coagulating modes. An electrosurgery unit can be effectively purchased after brochure research, visual inspection or exhibit-hall-style trials in your OR using cuts of meat.

At the same time, it's advisable to gauge the level of service with which the company stands behind its products and to obtain a solid service contract. Will the manufacturer and their sales representatives offer occasional educational in-services for your OR staff as well as for your surgeons? Without that backup, repair and maintenance can easily cost you what you saved in the initial purchase price, many times over.

Even outside of the OR you've got staff who play an important role in the care and handling of this equipment. Like any electrical equipment, an electrosurgery unit demands a once-over from your biomedical engineers to ensure that its safety features are effective before it is put into service, and that it's set up for regular maintenance. And your central sterile staff are not only reprocessing its reusable components in line with manufacturers' directions but also, ideally, inspecting them for damage and defects to their insulation. As a result, you may want to include input from these personnel in your purchasing decision and include these personnel in any training the company offers.

Capability and compatibility
Buying an electrosurgery unit is in some ways similar to buying a car. You've got your Cadillacs and your Pintos. In addition to the standard features — such as front panel power settings as well as cut, coagulate and blend functions — some have a lot of bells and whistles. But do you need all of them? It's important to look at the features in terms of what your surgeons use now, and what you know you need.

An important starting point for this assessment is knowing for what applications the requested electrosurgery unit is intended to be used. Some units are adaptable with special accessories for particular procedures — wands for arthroscopic shoulder surgery, for instance, or thermal ablation probes for GYN procedures — and this niche marketing may mean that some surgical facilities may need a basic electrosurgical generator for traditional cutting and coagulating, plus another unit for specialty uses.

Since these accessories are designed for use with a particular manufacturer's generator, you need to verify whether the attachments and disposables you have are readily compatible with the unit you're considering. Electrosurgery pencils and electrode pads of one make may work with any basic generator, but some makers don't support the use of other supplies or equipment with their devices, even if they're able to connect to multiple models. Check with your vendors, and if one makes claims of interchangeable parts, get a statement from them in writing.

This is an issue of critical importance in the area of safety features, which, as electrosurgery technology has advanced, have become standard. Most units offer comparable options to prevent injuries or fires, including alarms to notify users of stray or interrupted electrical current and faults in the circuit, and monitoring and automatic response to decrease or shut down current. So it's important that electrode pads from one manufacturer are recognized if used with a generator from another manufacturer, for example, in order to ensure that safety features are activated.

Factoring in
Disposable accessories such as electrosurgery pencils and electrode pads also influence the operational costs of an electrosurgery unit. When you're budgeting, account not just for the equipment purchase price, but also for the ongoing expense of these supplies, often bought through contracts directly with the vendor or with a group purchasing organization. During cost comparisons and negotiations, don't neglect the price of the continuing expenses in favor of reducing the initial capital expense.

On the usability front, one thing I try to strive for is standardization. If you have generators in 3 rooms and need a fourth, you may want to consider buying another of the same type in the name of safety, efficiency and ease of use. There's an argument to be made that your surgical team and facility are less likely to suffer mistakes or errors if the equipment operates identically from room to room.

It will benefit your supply budget, too, since you won't have to stock different types of disposables for the same procedures. Plus, it may also keep the size of your OR equipment consistent. If your electrosurgery unit is on a cart or a tower, you don't want to replace a relatively small device with one that has a much bigger footprint.

Make sure the ESU you choose is easy to clean according to the manufacturer's directions. The generator may stay in the OR at all times, but it needs to be disinfected, given its close proximity to the surgical site and the probability that aerosolized or dripping fluids will land on it.

Electrosurgery Product Roundup

Bovie Medical Corporation
Icon GP Electrosurgical Generator
(800) 537-2790
www.boviemed.com
List price: $12,500
FYI: Designed in conjunction with OR clinicians, the Icon GP provides a safe, user-friendly unit that can meet all operating room procedure demands. A wide variety of output modes enables tailored settings for many surgical applications. The intuitive touchscreen interface allows for easy setup and quick settings adjustments. And Bovie's neural electrode monitoring technology helps prevent pad burns.

ConMed Electrosurgery
System 5000 ESU
(800) 448-6506
www.conmed.com
List price: not disclosed
FYI: The System 5000 electrosurgical unit's flexible settings let surgeons attain the desired clinical effect in most surgical conditions. Settings include general mode for open procedures; fluids mode for urology, arthroscopy and other fluid environments; and laparoscopic mode, which limits output voltage to minimize the potential hazards of capacitive coupling and insulation breakdown. Pulse cut and pulse coag offer precision handling, and automatic return monitoring provides advance warning of a compromised electrical circuit.

Covidien
ForceTriad Energy Platform
(303) 530-2300
www.forcetriad.com
List price: $36,000
FYI: A full-featured radiofrequency energy system, the ForceTriad Energy Platform enables surgeons to precisely manage energies and desired tissue effects. Delivering both enhanced monopolar and bipolar energies with the next generation of LigaSure tissue fusion technology in one integrated unit, it features consistent power delivery, easy-to-use touchscreen setup and automatic instrument recognition.

Ellman International
Surgitron Dual RF 4.0MHz Energy Source
(800) 835-5355
www.ellman.com
List price: $18,445
FYI: Providing precision and versatility, the Surgitron Dual RF cuts and coagulates soft tissue at a radiofrequency approximately 8 times higher than traditional electrosurgical generators while minimizing thermal tissue damage along the incision path. Its dual frequency design enables operation at 4.0MHz in monopolar mode and 1.7MHz in bipolar mode.

Elliquence
Surgi-Max Plus
(516) 277-9000
www.elliquence.com
List price: $25,000 (flexible purchasing options available)
FYI: Elliquence's radiowave technology utilizes a proprietary blend of high-frequency (4.0MHz), low-temperature waveforms for a cell-specific tissue effect that affords unparalleled surgical precision while sparing healthy tissue. This low-temperature emission results in non-adherent bipolar performance, which minimizes tissue trauma and eliminates the need for frequent cleaning and instrument irrigation.

Erbe USA
VIO / APC 2 System
(800) 778-3723
www.erbe-usa.com
List price: not disclosed
FYI: The VIO / APC 2 System offers precise dosing of power output, high safety standards and maximum control using self adjusting cut and coag modes. The system is equipped with Precise APC, which adjusts the argon plasma automatically regardless of impedance, and can even be upgraded to include BiClamp thermal vessel fusion technology and ErbeJet 2 waterjet technology to create an all-in-one workstation.

Megadyne Medical Products
Mega Power Electrosurgical Generator
(800) 747-6110
www.megadyne.com
List price: $10,700
FYI: Advanced on the inside and simple on the outside, the Mega Power Electrosurgical Generator provides surgeons with the power they need and surgical teams with an easy-to-set-up system. The proprietary Advanced Cutting Effect (ACE) mode delivers scalpel-like cutting for minimal thermal necrosis and reduced scarring, and Constant Control Technology monitors tissue impedance and adjusts power output to reduce tissue damage and drag.

Olympus
PK Technology SuperPulse Generator
(888) 524-7266
www.pkturp.com
List price: $27,830
FYI: A simple-to-operate, yet powerful and intelligent bipolar energy generator automatically detects electrodes and cabling, guides users through the setup process and offers default cut and coag settings. Software algorithms use an informational feedback loop to optimize electrode energy and minimize thermal spread while providing consistent and precise tissue resection and vaporization, for less charring and complications from deep tissue desiccation.

Peak Surgical
Pulsar Generator
(888) 792-PEAK
www.peaksurgical.com
List price: $34,900
FYI: The cornerstone of the Peak Surgery System, the Pulsar Generator supplies unrivaled waveforms for pulsed-plasma-mediated surgery and powers Peak's PlasmaBlade ($310 to $362), a disposable cutting device that offers the exacting control of a scalpel and the bleeding control of traditional electrosurgery without extensive collateral tissue damage. Simple and easy to use, the system is plug-and-play, with the PlasmaBlade communicating with the Pulsar Generator to program settings, monitor connectivity and adjust power.