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Because Dr. Cooper's scalpel uses pulses of plasma, it cleanly cuts through tissue at a low temperature, reducing tissue necrosis and scarring when compared to other electrosurgery. Some research sug- gests that while traditional electrosurgery instruments can cause ther- mal injury depths of up to 1.5 mm, a plasma scalpel can create values of only 250 µm. "It lets you cut sensitive tissue without a heat burn injury, which is better for the patient," says Dr. Cooper. In Dr. Cooper's specialty, the plasma is essential when working on patients with pacemakers or defibrillators, since the leads on these devices melt and cause complications when traditional electrosurgery is used. While electrosurgery reaches temperatures of 250°C to 350°C, Dr. Cooper says his plasma scalpel tends to hover between 40°C and 170°C, depending on if it's cutting or coagulating. "In these surgeries, we use cautery tools to dissect between sensitive leads," he says. "That's where the plasma has been so useful for me." Ms. Dennis notes that while the plasma in her device produces high- er temperatures, its swift transfer of kinetic energy and physical force leaves less than 0.5 mm of lateral thermal spread to tissue. She says that surface temperatures of tissue that's been coagulated with the plasma beam are around 100°C, letting the device precisely vaporize tissue with minimal collateral damage. Plus, Ms. Dennis says, the device uses circulating coolant to keep the handpiece and tip at room temperature. "It has a high temperature initially, but it gets cool extremely fast," she says. This gentle cutting and coagulating action makes plasma a useful adjunct technology across specialties, says Ms. Dennis. She notes that her facility has used plasma coagulation for liver resections and breast reductions, though it's gentle approach makes it perfect for cases with a lot of bleeding, or operations near sensitive structures, including orthopedics, spinal cases, gynecology, urology, open general 1 4 0 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