The plasma scalpel: A new thermal knife

Abstract

A new thermal knife, the plasma scalpel, capable of simultaneous division of tissue and coagulation of blood vessels, is described. A high temperature argon gas plasma (unrelated to blood plasma) is created by passing the gas through a direct current arc, ionizing the gas and elevating its temperature to 3000 degrees C. A small plasma cutting jet is formed by a nozzle at the tip of the handpiece. Liver resections and muscle transections performed in a canine model, and full thickness burn excisions in a pig skin model showed effective division of tissue and significantly less blood loss when compared to the steel scalpel. Wound healing studies of histologic comparisons and wound breaking strength were performed for steel, plasma, laser, and electrosurgical scalped incisions in the skin of mice and rats. All thermal knife wounds showed localized tissue damage at the edges of the incision, but the events of healing began at the same time. Compared to the steel scalpel, there was a three to six day delay in the onset of healing, but healing occurred in the normal fashion and all thermal knife wounds reached the same healed breaking strength as the steel scalpel wounds. Clinically, the plasma scalped has been used for 138 procedures in 96 patients. The majority of cases have been transection of muscle, hepatic resection or debridement, or soft tissue debridement. Muscle transection data for the plasma scalped compared to the electrosurgical scalpel has shown virtually no blood loss with a shorter time to hemostasis for the plasma scalpel. The plasma scalpel has proved to be an effective thermal knife, capable of simultaneous division and coagulation. Further development work and proof of its efficacy in the clinical setting are necessary to establish the plasma scalpel and adequately demonstrate its proper role in surgery.

Comparative Healing of Rat Fascia Following Incision with Three Surgical Instruments

“…Accordingly, these limitations have led to improvements in electrosurgical device design including low-stick electrode coatings, ultrasonic blades, sealing technology, and feedback controlled RF generators [6][7][8][9]13]. Some of these innovations have demonstrated incremental improvement in reducing thermal damage during dissection while preserving bleeding control; however, the use of continuous RF energy and a large uninsulated electrode has remained unchanged despite many generations of traditional electrosurgical technology.…”

“…Central to their design is the use of continuous-waveform radiofrequency (RF) energy, delivered via an uninsulated metal electrode, to cut tissue by thermal ablation, thus producing a simultaneous hemostatic effect [3,4]. While prized for hemostatic control and dissection capability, conventional electrosurgical devices are associated with significant thermal damage to incised tissues, low surgical precision with the potential for injury to adjacent structures (eg, bowel, nerves, blood vessels), and delayed wound healing [5][6][7][8][9][10][11][12][13].…”

Skeletal Cell Differentiation Is Enhanced by Atmospheric Dielectric Barrier Discharge Plasma Treatment

“…Medical use of plasma technology is most commonly associated with thermal plasmas, such as the plasma knife used in surgery to cut and simultaneously cauterize vessels as a result of the high temperature generated by plasma [1]. Advancements in atmospheric pressure plasma systems led to the development of a novel NT dielectric barrier discharge plasma with a discharge sufficiently uniform and cold to safely apply to living cells and tissues [2]–[6].…”

Comparative Healing of Surgical Incisions Created by the PEAK PlasmaBlade, Conventional Electrosurgery, and a Scalpel

“…4 -12 Consequently, a number of new electrosurgical technologies have been introduced, such as insulated cutting electrodes, ultrasonic blades, and feedback-controlled radiofrequency generators. [5][6][7][8][9]12 Some of these developments have demonstrated incremental improvements in reducing the thermal damage while preserving hemostatic ability. However, substantial room for improvement remains in electrosurgical technology that can approach the surgical precision and favorable wound-healing characteristics of the scalpel while also providing hemostasis.…”