Department of Gynaecological Surgery, Faculty of Health and Medical Sciences, University of Surrey, Guildford, England.
J Minim Invasive Gynecol. 2013 May-Jun;20(3):271-8. doi: 10.1016/j.jmig.2013.03.001.
The history of energy sources used in surgery is inextricably linked to the history of electricity. Milestones include identification of safe electrical waveforms that can be used in the human body, patient isolation to prevent alternate-site burns, bipolar energy sources to negate capacitance injuries, laser energy, and the combination vessel sealing devices commonly used today. Engineering efforts to eliminate many of the hazards of electrosurgery are critical to how we practice modern gynecologic surgery. The introduction of bipolar instruments, increasing the safety of monopolar electrosurgery by not using hybrid trocars, and introduction of active shielding of the instruments from stray radiofrequency energy using intelligent secondary conductors have led to the re-emergence of electrosurgery as the universal surgical energy source. The low ongoing costs and the presence of electrosurgical generators in all hospitals readily enables electrosurgery to be the mainstay. Expensive lasers are confined to specialized centers, where they continue to be used, but for a long while filled a gap created by complications of electrosurgery. Sophisticated power sources continue to be introduced and include the ultrasonic scalpel, plasma surgery, and various devices for sealing vessels, all of which have advantages and disadvantages that are recognized as they begin to be subjected to scientific validation in randomized trials.
手术中使用能源的历史与电流的历史密不可分。其中的里程碑包括确定可用于人体的安全电波形、隔离患者以防止异位烧伤、使用双极能源消除容性损伤、激光能量，以及当今常用的组合血管密封装置。消除电外科许多危险的工程努力对于我们进行现代妇科手术至关重要。引入双极仪器、不使用混合套管来提高单极电外科的安全性，以及使用智能二次导体对仪器进行杂散射频能量的主动屏蔽，都导致电外科重新成为通用的手术能源。持续较低的成本和所有医院都配备电外科发生器，使得电外科很容易成为主要手段。昂贵的激光器仅限于专门的中心，在那里它们继续被使用，但在很长一段时间里，它们填补了电外科并发症造成的空白。复杂的电源继续被引入，包括超声刀、等离子手术和各种血管密封设备，所有这些设备都有各自的优缺点，随着它们开始在随机试验中进行科学验证，这些优缺点也被认识到。
