Abstract
Objective
Intraoperative fires are a well-described and devastating complication of oropharyngeal and airway surgery. We utilized a physical model to study the fire risk for an electrosurgical device (Bovie) as compared to a bipolar radio-frequency ablation wand (Coblator)
Methods
A 6.0 endotracheal tube was inserted into the cranial end of a degutted whole raw chicken through which 100% oxygen was piped at 10 L/min. Three tonsil sponges were placed inside the cavity. An electrosurgical device (15 watts, coagulate mode) and bipolar radiofrequency ablation wand (9, 7 and 3 in ablate mode; 5 and 3 in coagulate mode) were activated in the central cavity of the chicken through its caudal opening. All experimental conditions were tested for 4 minutes, or until a positive result was achieved. All trials were repeated in another chicken to ensure accuracy.
Results
Ignition of the tonsil sponges and endotracheal tube was obtained with a sustained fire in the cavity of the chicken when using the electrosurgical device for between 45 and 80 seconds. Under all 5 experimental conditions, no ignition or sustained fire could be produced using the radiofrequency plasma ablation wand. After 20 sustained minutes of continuous plasma ablation in the chicken cavity without ignition, the electrosurgical device was able to ignite a fire within 45 seconds in the same cavity.
Conclusions
While electrosurgical devices present a significant risk of fire during open cavity surgery in oxygen-enriched environments, that risk appears to be eliminated with bipolar radiofrequency plasma ablation. Compelling video and photographic evidence will be provided.
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