The utility of electrocautery for suture passage through bone: A biomechanical study

Abstract

Electrosurgical devices are routinely employed during surgery. The use of a Bovie Electrosurgical Unit (ESU) to facilitate the passage of a suture needle through bone has not been studied in the literature. This study aimed to identify force reduction with the application of Bovie ESU to the suture needle through the bone. Peak and the average axial force required for a suture needle to penetrate cadaveric proximal humeri were measured using a custom setup. Twenty-four trials were conducted without electricity, and 72 trials were conducted with a Bovie ESU applying current. Needle size and Bovie ESU power settings were varied. t Tests and analysis of variance were used with p ≤ 0.05 denoting statistical significance. The application of electricity reduced the peak and average axial force needed for a needle to pierce bone, regardless of the Bovie ESU power setting (p < 0.001). The average peak force with the Bovie ESU was 65.7 N, compared with 126.0 N without (p < 0.001), a 47.9% reduction. The average axial force with the Bovie ESU was 38.2 N compared with 81.8 N without (p < 0.001), a 53.3% reduction. There was no significant difference in peak or average axial forces between power settings. At 30 and 90 W of power, larger needle size was associated with significantly lower peak (p = 0.001 and p < 0.001, respectively) and axial (p = 0.002 and p = 0.004, respectively) force. The Bovie ESU reduces the axial force required to pass a suture needle through bone. The use of this technique may allow for the avoidance of drilling for soft tissue repair.*A resident brought this technique back with him to our institution.

Use of Electrocautery to Facilitate Suture Passage Through the Greater Trochanter of the Femur: A Biomechanical Study

“…This power setting was chosen based on the findings of previous studies and is a commonly used setting. 6 , 11 For the control group, needle penetration testing was performed similar to the study group except without any electrical current applied to the needle.…”

“…The experimental setup and test protocol were similar to previously described in the literature for consistency. 6 , 11 A custom-designed testing apparatus was designed and used to stabilize the specimens and standardize the testing procedure for conducting needle penetration ( Figure 1 ) and failure mode testing ( Figure 2a ). An electrocautery grounding pad was placed onto the adjacent intact skin and soft tissues of the distal femurs to provide a closed loop for the electrocautery device.…”

“…One technique for repairing a hip abductor tendon to the bone is by simply passing suture needles directly through bone using the mechanical advantage from a needle driver. 4 , 6 Bone tunnels created by needle are more efficient, more cost effective, and provide an equivalent outcome in comparison to techniques that require implants or specialized tools. 4 , 5 However, passing suture needles directly through the greater trochanter often is difficult or impossible depending on the bone quality and cortical thickness.…”

“…Previous biomechanical studies using this technique have identified a 36% – 48% average reduction in peak axial force to pass a suture needle through bone. 6 , 11 This technique, in theory, has multiple benefits including improved safety and efficiency, reduced surgical equipment use, creation of smaller bone conduits, decreased cost, and decreased potential for bone injury. Though there are a few studies to support its safety and efficacy in the shoulder, 6 , 11 there are no studies that evaluate its use in the greater trochanter (such as during abductor, capsular, or short external rotator repair about the hip).…”

“… 6 , 11 This technique, in theory, has multiple benefits including improved safety and efficiency, reduced surgical equipment use, creation of smaller bone conduits, decreased cost, and decreased potential for bone injury. Though there are a few studies to support its safety and efficacy in the shoulder, 6 , 11 there are no studies that evaluate its use in the greater trochanter (such as during abductor, capsular, or short external rotator repair about the hip). The specific aims of this cadaveric biomechanical study were to evaluate (1) the axial force reduction of suture passage with the use of electrocautery when applied to the greater trochanter of the femur, (2) the temperature change caused while using electrocautery for suture passage, and (3) the failure loads and failure modes of this technique.…”