Anything you always wanted to know about hot and cold surgery tools


This rabbit’s fur was set on fire after applying an energy-based device in the presence of a surgical field still wet from an alcoholic disinfectant

Happy 2021! We just published our fourth chapter of the Cutting Edge. Dr Bart van Goethem and others discuss electro-, cryo-, and laser surgery.

In electrosurgery or diathermy, heat is generated in the patient’s tissue due to an electric current, with the aim of using this heat for hemostasis or for making incisions. Electric current is the flow of free charge carriers – electrons and ions – from a positive electrode (the source) to a negative electrode or ground.

Electrosurgery requires an electrosurgical generator that changes the standard 50 or 60 Hz, low frequency electrical current into a useable high frequency 200 kHz to 5 MHz current. Since the neuromuscular system becomes refractory to electrical stimulation beyond a frequency of 100 kHz, there is minimal stimulation when using these high frequencies. The spectrum mentioned falls within the electromagnetic spectrum of low radiofrequency bands (AM broadcast signals 550-1550 kHz). Some units go as high as 3-4 megahertz (MHz) and occur in the range between AM and FM radio broadcasting. These are referred to as radio wave radiosurgery units (Figure 1).

Figure 1. Most electrosurgical units operate in the low radiofrequency bandwidth (AM broadcast). Radio wave radio surgical units operate in the high radiofrequency bandwidth (FM broadcast).

When heat is applied to a biological system, the effect is temperature-related and also dependent on application time. Between 38-60°C, tissues will warm and weld without obvious visual signs. At 60-65°C irreversible damage resulting from coagulation necrosis and protein denaturation is visible as blanching. At 65-90°C protein denaturation resulting in white/greyish discoloration occurs. At 90-100°C tissues dry and show puckering. Above 100°C solid tissue vaporization results in steam and smoke, and temperatures of 350-450°C result in immediate carbonization and char formation.

The use of electrosurgical equipment has some inherent risks. Most operating room fires are caused by the use of electrosurgical equipment. Regular checks of insulation and grounding pads should therefore be performed. Smoke generated by these devices contains many carcinogenic compounds. A smoke evacuation system is therefore highly recommended.

Click on the Cutting Edge chapter for more info!!

Chapter 3 of the Cutting edge is now ‘live’

Various types of surgical scissors

Just before the new year, we have published the third chapter of ‘the Cutting Edge.’ This chapter describes the various and most common instruments you need as a surgeon. Please go to the menu and click the ‘Cutting Edge’ tab.

What kind of grip do you use when you hold your instruments? The ‘pencil grip‘ is used for short or sharply curved incisions. In this grip, the hand’s muscles and the upper arm are used to direct the scalpel, allowing small and accurate movements. As the scalpel is held almost vertical and mainly uses the blade’s tip, it is only in partial contact with the wound edges. This facilitates the making of curves and improves the accuracy of the incision.

The Pencil grip

The ‘fingertip grip’ or ‘palm grip‘ is used for long, slightly curved, or straight incisions. The scalpel is held more horizontally so that the blade is in contact with the tissue over a longer distance (using the blade’s belly). This grip stabilizes the scalpel and reduces the effect of the variable blade pressure on the incision’s depth.

The palm grip

In this grip, the scalpel is predominantly guided by the arm muscles. There is less radial deviation, which makes the grip less tense. The incision should be made with a fluid movement without removing the blade from the wound. This avoids the ragged edge of several subsequent incisions. When cutting through the skin, the free hand may pull the skin tight to control better the scalpel pressure and, hence, the incision’s depth.

New VetSurg Podcast is published

In this episode, we have an extra-long interview with Dr. Peter Lotsikas from Skylos Sports Medicine. We discuss his latest publication about the combination of total hip replacement and amputation in dogs. Peter has a fascinating story about his surgery background and the article. He explains that THR has become very advanced and that dogs with amputation do really well with a THR if needed. We end the podcast with a neighboring article from the same journal, where a new technique for stenotic nares is described, call DOR. Want to know what it stands for? Listen to the podcast 🙂

For more info about Peter:

The Cutting Edge Chapter 2 will be online soon!

Dr. Bart van Goethem in the OR

It is happening at last! I have just finalized the copy for the Cutting Edge. Basic Surgery for the Veterinary Surgeon, 3rd edition. So what does this mean? I will send the whole thing to a graphic designer to make it beautiful, and as soon as that is done, it will be freely downloadable online on this website as a pdf. Did I say FREE? Yes, completely free. Better even is that I will publish the chapters here right on the website too. Please check our Cutting Edge page, where I will be adding chapters every week. I can’t wait to hear what you think of the project!

The Cutting Edge: Acknowledgement

The third edition of ‘The Cutting Edge, Basic Veterinary Surgery Techniques’ has been prepared by various veterinary lecturers at the Utrecht University Faculty of Veterinary Medicine, the University of Ghent, and the Royal Veterinary College of the London University. Its goal is to teach students the essential art of surgery without having a specific species in mind. This edition is designed for an open-access web-based platform. Students worldwide will be able to use the information for their benefit while improving their surgical knowledge and skills. 

The ‘Cutting Edge 3’ provides veterinary students and new graduates tools to grasp the principles of surgery, along with a discussion of the limitations and complications of surgical procedures. It should not be regarded as a complete reading text for all surgical problems and techniques but merely a basis for the inexperienced surgeon. Other textbooks will be able to provide more advanced techniques. 

Previously published work by Dr. Wim Klein, Dr. Marianne Tryfonidou, Dr. Rien van de Velden, Dr. Peter Stolk, Prof Herman Hazewinkel, Prof Astrid Rijkenhuizen, Dr. Ruud Keg, and Prof Ludo Hellebrekers is updated and expanded. We value their expertise and thank them for their previous work. Mr. Joop Fama is thanked for supplying many of the photographic materials used in this book. The ‘Cutting Edge 3’ is an improvement of the Cutting Edge 2 (2006) and is translated initially from the first edition ‘Leren Opereren’ (2005).

We want to acknowledge the help of Dr. Jos Ensink, Dr. Wim Back, Dr. Herman Jonker, and Dr. Stefan Cokelaere for their support of the equine and production animal sections.

Parts of this publication were previously published on Vetvisuals (www.vetvisuals.com), and we would like to thank André Romijn, from Roman House Publishers Ltd and Kathryn Jenner for their support.

 Jolle Kirpensteijn & Gert ter Haar

Chief Editors

jollenl@gmail.com & gterhaar@anicura.com

Dr. Gert ter Haar is from the Netherlands and studied veterinary medicine at the Faculty of Veterinary Medicine in Utrecht. He graduated in February 1997 with differentiation in Small Animal Medicine and Surgery. After having worked for a few months in private practice, Gert accepted a Clinical Rotating Internship position at the Department of Clinical Sciences of Companion Animals at the Utrecht University, followed by a Residency in Small Animal Surgery from September 1998 – September 2001 in the same Department. In September 2001, he became Assistant Professor in Veterinary Surgery at the university where he trained, dealing mainly with Ear-, Nose- and Throat (ENT) and upper airway diseases. In July 2002, he passed the surgical specialist certifying examination held in Vienna and became a Diplomate of the European College of Veterinary Surgeons. He then became Head of the Department of ENT at the University of Utrecht in February 2003. Also, in 2003 he became the secretary of the International Veterinary Ear, Nose and Throat Association (IVENTA), a specialist association affiliated with the World Small Animal Veterinary Association (WSAVA). His research on hearing in dogs led to his Ph.D. thesis, a 220-page book entitled “Age-related hearing loss in dogs.” in 2009. On the same day, he became President of the IVENTA and the representative of the IVENTA to the WSAVA. He gave over 200 national and international lectures on ENT medicine & surgery, hearing research in dogs, and soft tissue/reconstructive surgery in dogs and cats. He joined the Royal Veterinary College’s surgical team in London, the United Kingdom, in September 2011, where he is working as a senior lecturer in soft tissue surgery and head of the ENT department and ENT, Audiology and Brachycephaly clinics. In 2017, Gert started working in private practice for Anicura in Utrecht, The Netherlands. His current research involves a hearing loss in dogs and cats and brachycephalic obstructive airway syndrome.

Dr. Jolle Kirpensteijn graduated from the Utrecht University Faculty of Veterinary Medicine, Holland in 1988 and finished an internship in small animal medicine and surgery at the University of Georgia in the United States of America in 1989. After his internship, he completed his residency training in small animal surgery and a master’s degree at Kansas State University, USA. The residency was followed by a fellowship in surgical oncology at the Colorado State University Comparative Oncology Unit, USA. In 1993, Jolle returned to Europe to accept a surgical oncology position and soft tissue surgery at Utrecht University. In February of 2005, he was appointed Professor in Surgery at the University of Copenhagen and in August 2008 Professor in Soft Tissue Surgery at Utrecht University. Jolle is a Diplomate of the American and European College of Veterinary Surgeons. Jolle received the title Founding Fellow in Surgical Oncology (2012) and Minimally Invasive Surgery (Small Animal Soft Tissue) (2017) of the American College of Veterinary Surgeons (ACVS). In September 2013, Jolle accepted the Chief Professional Relation Officer position at Hills Pet Nutrition in the USA. Here, he played an integral role as the interface between the company and the profession at large. In 2018, he was promoted to the Chief Professional Veterinary Officer position in the US, where he leads all professional activities in the United States. Jolle has published over 100 peer-reviewed articles, given more than 250 lectures worldwide, and has received the prestigious BSAVA Simon Award in 2007, Hills Voorjaarsdagen Excellence in Healthcare Award in 2009, WSAVA President’s Award, and honorary membership to the Netherlands Association of Companion Animal Medicine (NACAM) in 2017. His main clinical and research interests are professional social media and digital innovations, surgical oncology, and endoscopic & reconstructive surgery. Check out his podcasts at purrpodcast.net and globalveterinarysurgery.net