Spotlight ON TECHNOLOGY & TECHNIQUE

By Leslie Goldberg, Associate Editor

Radiosurgery: A Technology Well Suited for Oculoplastics

Ellman’s patented Dual Frequency Surgitron 4.0 MHz allows surgeons to deliver precise dissection and improved hemostasis effectively and cost-efficiently through the use of radiosurgery technology. The ultrahigh frequency of the 4.0 MHz output minimizes lateral heat production which helps decrease tissue damage, reduce postoperative discomfort, minimize scar tissue formation and enhance healing.

Physician Feedback

Stuart R. Seiff, M.D., of Pacific Eye Associates, San Francisco, and chief of the department of ophthalmology at San Francisco General Hospital, has been using the Ellman (Oceanside, N.Y.) radiosurgical units almost as long as he has been in practice and has been using the newer dual-frequency unit for the last 2 years.

"By and large for ophthalmologists and oculoplastic surgeons, the original Ellman was an economical device for office cutting and coagulation," says Dr. Seiff.

Dr. Seiff says that the larger, newer unit has several advantages over the original monopolar device. "With this dual-frequency device, you can run bipolar and monopolar units at the same time. The monopolar phase is not the most effective for coagulation, although it is a wonderful cutting instrument. The bipolar coagulation unit works great. It eliminates the problem of the original unit not being as good a coagulator."

Additionally, the unit cuts tissue well and limits the bleeding compared to a scalpel blade, says Dr. Seiff. "The bipolar attachment for the new unit is very good at coagulating bleeding tissue. With the new unit, you can have both frequencies set up and change hand pieces back and forth; you use a hand-control for the cutting portion of the unit and the foot pedal for the bipolar part of the unit. That’s a big advantage."

The Ellman Technology

"The Ellman high-frequency radiosurgical technology is superior to using standard cautery," says Dr. Seiff. "It does not tend to distribute heat to the tissues beyond what you are cutting or coagulating. There is not as much collateral tissue damage. This translates to less swelling and decreased necrosis around the treatment site. It is probably comparable to using a laser."

It also has advantages over a laser, explains Dr. Seiff. "It is not necessary to perform all of the laser precautions in terms of shielding eyes and sealing doors. It is a lot easier."

Dr. Seiff has never used a laser or the Ellman devices for skin incisions. "Any time you have heat transfer into the adjacent tissue on the edges of your skin incision, it creates a risk of the wound coming apart because the tissue that the suture is sitting in may necrose and then the suture isn’t holding anything," explains Dr. Seiff.

He uses the Ellman to make the conjunctival incisions for his transconjunctival lower blepharoplasties because the healing time of the mucosa is so fast that he is not relying on the suture to hold the wound together in those areas. "These incisions are more vascular and you have the advantage of a hemostatic wound with either a laser or the Ellman unit," says Dr. Seiff.

"I use the Empire tip with the device for my conjunctival incisions for blepharoplasty," says Dr. Seiff. "I find that this gives me a finer incision than with a laser and is a little more controlled cutting. On the other hand, I may have a little more bleeding with the Ellman, but I use the bipolar feature to control that — it minimizes bleeding as an issue."

Other Uses for the Ellman

"I use the endoscopic attachment for my endoscopic brow lifts," says Dr. Seiff. "I take it to the OR with me. I have a suitcase I can wheel around with. The Ellman unit with the endoscopic attachment provides one of the best ways to weaken the depressors of the eyebrows, which are muscles that cause frowning and drop the eyebrows. This relaxation of the depressors gives a kind of long-lasting Botox effect.

"When you are performing this procedure endoscopically, one of the problems is that smoke accumulates under the flap and you are unable to see. This endoscopic attachment allows you to have a long-handled coagulation instrument and suction that will pull the smoke out."

When Dr. Seiff first used this instrument, he had a problem with the blades. "The blades would rotate under the flap and turn," explains Dr. Seiff. "The company modified the original design and gave it a groove with a screw fitting so that it can’t rotate. This has been a real advance in being able to work under the flap. There is nothing else out there that works as efficiently."

Ellman equipment in use with the advanced alloy electrode for blepharoplasty.

Features

• Dual frequency combining two optimal frequencies for maximum surgical benefits
• Digital operation for accurate parameter selection and viewing
• Solid-state circuitry for dependable, consistent energy emission
• Five distinct waveforms providing procedure-specific tissue treatment options
• 120-watt output; the maximum power needed for all surgical environments
• Visual and audio safety indicators
• Parameter recall that allows rapid set-up for subsequent procedures. OM

For more information on Ellman’s Surgitron Dual Frequency unit, please visit their Web site at www.ellman.com.