With the arrival of practice-based commissioning and locally imposed restrictions on referral to secondary care for certain conditions, times are changing. The result of which means that both now and in the future more minor surgery will be performed away from hospital dermatology departments.
Whereas before there were no incentives for GPs to purchase expensive operating equipment, many now are turning to this as a way of saving money in the long term.
I recently tested a very useful piece of equipment, the Surtron 120, which will make operating easier and cosmetically more pleasing and allow a keen GP to do more than was previously possible.
Many of you will be familiar with cautery machines, having seen them used to stem bleeding in operations. They consisted of a variable heat source that allowed the operator basically to fry vessels or tissue to cut them or stop them bleeding. Cautery is still widely used, both with large mains-powered devices and smaller battery-operated units.
The next step up from these are hyfrecators, which work by passing a current of electricity from the tip of the instrument across a small gap to the patient, so causing an arc that will stop bleeding and allow controlled tissue destruction for dermatology work.
The Surtron 120
The handbook describes the Surtron 120 as 'electrosurgical equipment for monopolar cutting, soft coagulation, forced coagulation and bipolar coagulation'.
All these it does to a high standard, but it is its ability to cut that puts it head and shoulders above a hyfrecator, with higher power, a wider selection of useable tips and the option of mono- or bipolar modes. The cut areas have less thermal damage, and are more free of debris, meaning faster healing and less scarring.
There is also no pattern that this machine cannot cut. For example, unlike a normal scalpel, it can cut zig zags for Z-plasties without the tip leaving the tissue.
In the monopolar cut mode, it works by delivering a very concentrated current at the point where the tip is applied to the tissue, which in essence produces an intense heat and the equivalent of an intracellular explosion, so destroying the affected cells.
As the tip is then passed through the tissue, a very fine and precise cut is produced with minimal damage to surrounding tissue, which is helpful when it comes to histological examination and healing.
When pure coagulation is required, the tip can be easily swapped for a broader electrode so reducing the density of the current and dissipating the energy over a wider area.
The effect of this is to dry the cells rather than exploding them, resulting in coagulation. Treated cells then act to protect the deeper cells from damage, allowing for very accurate and precise treatment.
When coagulating, the tip is best held against the vessel before applying the power, which should then be stopped as soon as the tissue blanches. Unlike normal cautery, where a fragile clotted vessel is produced, this method effectively welds the end of the vessel, so decreasing bruising and healing times.
In the bipolar mode, the tips are replaced by forceps, which can be used to hold tissue before the current is applied; otherwise the operation is very similar.
Directions for use
The handbook that accompanied the device also includes directions regarding the placement of the 'Patient Plate'. This is a flat 6 x 4 inch plate, which has to be positioned close to a well-vascularised muscle, unlike other electrosurgery machines which, have to be in contact with the skin.
During treatment, patients should avoid being in contact with large areas of metal such as the legs of operating tables.
As with any electrosurgical device, its use is contraindicated in patients with pacemakers or those on oxygen for fear of explosion.
It was easy to assemble. A standard mains connector plugged into the rear, and a foot switch could be attached alongside.
This piece of equipment won't be for everyone, cost being a major factor, but for those GPs who are keen to save money and perform more minor surgery away from secondary care, the Surtron 120 is a great instrument.
Dr Stollery is a GP in Kibworth and clinical assistant in dermatology, Leicester Royal Infirmary.
Model: The Surtron electrosurgical unit
Description: Surtron 120W electrosurgical unit
Williams catalogue code: W65655
Price: £1,756.63 incl VAT
Special introductory offer: Save 10 per cent, £1,579.99 incl VAT
(Allow 7-10 days for delivery).