30-30 Cut/coag – Is Electrosurgical Monopolar Energy Technology Underused?

Paul N Montero, MD, Matthew Fox, MD, Thomas Robinson, MD, Gregory V Stiegmann, MD. University of Colorado School of Medicine

 

Objective: Our hypothesis is that monopolar electrosurgery technology is underused, and that the "standard" setting of Coag 30 remains the most commonly used generator setting. Despite advances in monopolar elecrosurgical energy devices, surgeons routinely use generator settings they are most familiar with or that they used in training.

Methods: Monopolar energy activation data were downloaded from electrosurgery generators at an academic hospital. The following information was collected: number of monopolar activations, generator mode, generator power setting, and type of case performed. Data included an activation histogram detailing the generator modes used for monopolar activations and an event log surveying the generator power setting and mode for a subset of activations.

Results: Seven generators were interrogated from operating rooms where general surgery, vascular, cardiovascular, orthopedic, and otolaryngology cases took place. Of 113,867 monopolar activations, Coag mode was more commonly used in comparison to Cut mode (91.2% versus 8.8%; p<0.0001). For Coag activations, the Fulguration setting was used more commonly than the Spray setting (97.2% versus 2.8%, p<0.0001). For Cut activations, Pure mode was used more frequently than the Blend mode (80.7% versus 19.3%; p<0.0001). Of 1152 activations analyzed for power setting, Coag mode was used 97.9% of the time with a wattage range of 20 to 60 (Table 1).

Conclusions: Coag 30 is the most commonly used setting for surgeons. Cut mode is infrequently used. This suggests that innovative technology in electrosurgical monopolar devices is underused and perhaps poorly understood by surgeons. Further education on these complex instruments may benefit surgeons and surgical trainees.

Table 1. Monopolar Activations, Modes and Power Settings from Event Log Data (*p<0.0001 versus all others)
Coag Power  Setting (Watts) Activations % Cut Power Setting (Watts) Activations %
  20 178 15.8   30 9 37.5
30 401* 35.5   35 3 12.5
35 160 14.2   40 10 41.7
40 229 20.3   50 2 8.3
60 160 14.2        

 


Session Number: Poster – Poster Presentations
Program Number: P413
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