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this system is monopolar and delivers electrically charged plasma, Dr. Cooper notes that a grounding pad must be attached to the patient. But not all plasma systems work this way. Other options include a bipolar system that delivers an electrically neutral plasma beam for open or laparoscopic surgery, which Ms. Dennis says she used at her previous facility. While this model also requires a console and a single-use handheld device, it instead works by passing low-voltage electricity between 2 internal electrodes to ionize argon. This creates electrically neutral plasma, says Ms. Dennis, which is then emitted as a beam from the tip of the handheld tool. When this beam contacts tissue, it first transfers its heat quickly to cut and/or seal tissue, depending on the handpiece and setting the sur- geon selects. Additionally, the physical force of the plasma beam actu- ally pushes aside blood and other fluids to provide a clear and clean surface for cutting or coagulation, says Ms. Dennis. Compared to Dr. Cooper's scalpel, the plasma in these bipolar devices generates a higher temperature, but they do not pass an electric current through the patient. This means you don't use a grounding pad, and it improves patient safety, says Ms. Dennis. "You don't have a risk of insu- lation failure, direct coupling or capacitive coupling," she says. How low can you go? Though every system has a unique, patented way of creating plasma and applying its energy to tissue, they all minimize lateral thermal spread, which can improve wound healing and reduce infection. "The two main purposes of any electrosurgical device are to cut or coagu- late tissue," says Dr. Cooper. "With the plasma — and especially with the cut function — the major difference is that it does this at a lower temperature." 1 3 8 O U T P A T I E N T S U R G E R Y M A G A Z I N E O N L I N E | S E P T E M B E R 2 0 1 5