One example of this is the various GI staplers used in bowel surgeries, which simultaneously cut and staple all in one go.Įven more basic than cutting, though, are various forms of blunt dissection. Other specific cutting applications are served by even more specialized cutting instruments. simultaneous tissue ablation and cauterization. There are also laser scalpels used in more specialized applications, which have the same sort of advantages as electrocautery and ultrasound instruments, viz. Going this way, you very quickly get through the fat layer and expose the peritoneum (membrane layers lining the abdominal cavity) with no significant bleeding, and then you use the Bovie to open up the peritoneum as well. When you get a bit of bleeding, you can see those focal bleeding vessels and cauterize them directly with the Bovie tip, or you can grab a little arterial bleeder with forceps or a hemostat at the bleeding site or proximal to it, and then touch the Bovie tip to the metal instrument and actuate it, and sizzle off the bleeder that way. You then set the scalpel aside and take up the Bovie, using it to basically sizzle your way through those fat layers, by distracting the tissue to the sides and then making a stroke with the instrument, and then repeating this process. In a typical open general surgery procedure, the scalpel is used just to make a skin-deep incision exposing the subcutaneous fat. The “unipolar” kind is basically your classic Bovie electrocautery instrument ( so classic, that it’s called a “Bovie” whether or not it’s actually manufactured by the Bovie Medical corporation, which also makes bipolar instruments and other stuff). Electrocautery includes both “unipolar” and “bipolar” variants. To achieve this, you need ways of cutting that produce concomitant coagulation, and there are two primary kinds of instruments for this: electrocautery, and ultrasonic ablation/coagulation instruments. The bloodless field is one of the great advances of modern surgery. So if surgeons relied on sharp dissection to separate tissues, there’d be a lot more bleeding, which would be directly harmful to the patient in the case of significant blood loss, but also an immediate disadvantage because blood obscures the surgical field. When you really need to cut, you need a good cutting tool, but a sharp cutter is also indiscriminate… for instance, it goes through blood vessels, and not just the areterial “bleeders” that you can suture off or cauterize, but also through the microvasculature that invests all tissues. In most types of surgery, the scalpel is used for making the skin incision, and that’s pretty much “it”.Ī super-sharp cutting instrument like a scalpel is good at one thing – cutting – which has both an upside of utility and a downside of potential harms. While the average person may imagine surgeons in the operating room just going to town with scalpels the whole time, that’s not actually how it goes :-). Interestingly enough, most surgery does not rely a whole lot on the scalpel. ![]() Wanbasion Black Stainless Steel Knife Set, Sharp Kitchen Knife ReplyĪ steel scalpel is every bit sharp enough For most circumstances you probably don’t truly need the fine edge of obsidian compared to the added cost. For comparison, I can get a 10 pack of disposable sterile stainless steel scalpels on Amazon for $8.99. A single obsidian scalpel will cost $83 (not counting bulk discounts of course), likely because they have to be hand made given how brittle obsidian is. The price difference is also significant. Lateral pressure is not well tolerated at all and so they are more prone to breaking compared to their steel cousins, and are potentially dangerous for that reason. Some physicians are a fan, however they are not FDA approved and obsidian can also be very brittle. In fact, it is suggested that because obsidian scalpels are so perfectly smooth (it is only 30 angstroms thick as well), they may reduce inflammation and the wounds they generate may heal faster. The obsidian is impossibly smooth while the stainless steel might as well be a brick covered in sandpaper. On that image, you can clearly see the difference on electron microscopy between obsidian and stainless steel. ![]() Obsidian has been used as a tool for thousands of years, valued for its ability to be extremely sharp and smooth, even at a microscopic level. TL DR: While sharper and with arguably better results, obsidian scalpels are also more brittle (potentially more dangerous) and significantly more expensive than stainless steel scalpels, which are adequate for most surgery.
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