Bipolar Transurethral Resection - Letters to the editor: readers comment on prostrate article, redesign - Letter to the Editor

AORN Journal, Oct, 2003 by Karl Hausner

The article "Bipolar Transurethral Resection of the Prostate: A New Approach by Paula Bishop, RN (vol 77, May 2003) drew my attention. The author stated

   ... until recently, the use of
   monopolar current was the only
   method available for electrosurgery
   in urology procedures. The bipolar
   TURP [transurethra] resection of
   the prostate], however, uses bipolar
   electrosurgery, which does not travel
   through the body and creates less
   risk of electrical shock.

Thirty years ago, when bipolar technology was introduced to the surgical armamentarium, E. Roos developed and patented a bipolar snare for TURP; thus, the technology is not new, except that the majority of urologists were not ready to change.

The author, in plain and easy-to-understand language, describes the anatomy and physiology of the prostate. In addition, symptoms of benign prostatic hyperplasia and a test protocol are reviewed, along with the nonsurgical and surgical treatment.

The monopolar surgical approach and technology are well defined in the article so that individuals with limited knowledge of physics wi]l fully understand it. What should be mentioned, however, is the importance of a grounding pad or dispersive electrode and its placement on the thigh and not underneath the patient. The author briefly explains principles of bipolar technology and its advantage that the current flow is strictly limited between the two poles of the bipolar snare.

The author also states

   In contrast to monopolar energy
   delivery, the bipolar technique
   requires an electrolytic medium to
   conduct the electrical energy from
   the active to the return electrode.

This is partially incorrect because there is not a designated active and return electrode. Both electrodes are alternately active with the frequency of the high frequency current.

Another statement says

   The nurse determines whether the
   patient has any metal implants or a
   pacemaker. This is important to
   know, but because bipolar energy is
   being used, there is no concern with
   electrical current traveling through
   the body.

This is partially true, but in case the bipolar cable would rest on the patient's chest, with a pacemaker implanted, it could still receive interferences, and precautions must be considered.

The author failed to alert surgical personnel that a special bipolar generator, designed for such interventions is required, with regard to waveform, pick-to-pick voltage, and output impedance. Otherwise, this article is very informative, but the above-mentioned amendments should be published to make sure no false considerations are being made.

KARL HAUSNER

PRESIDENT

ELMED, INC

ADDISON, ILL