ELECTROSURGERY AND THE ADVENT OF THE BOVIE - THE HISTORY OF ELECTROCAUTERY

Objectives: “Bovie” is synonymous with electricity used for cutting and hemostasis. William Bovie, a scientist and biophysicist, discovered that high frequency alternating-currents could be used to incise tissue while cauterizing. The purpose of this presentation is to discuss the history and development of an instrument that is used in almost every modern operating room today.

Methods: This presentation discusses a literature review of the history and principles behind modern day electrocautery.

Results: The earliest use of heat for hemostasis was in the 16th century with the application of hot metals and caustic chemicals. John Marshall, an English surgeon, recorded the use of cautery in 1851 for therapeutic purposes. He used heated platinum wire through fistula tracts to cauterize and cause wound healing, closing fistula tracts. This technique is still used today to treat neonatal inguinal hernias, where laparoscopic monopolar fulguration of the peritoneal surface at internal inguinal ring closes these defects. The invention of true electrocautery would not occur until 1889, when Jaques Arsene d’Arsonval and Nikola Tesla began studying the use of alternating current and high frequency waves for different uses. They understood the conductive potential of harnessing electricity and believed that this could eventually be applied to medicine and surgery. In 1908, German physician Karl Franz Nagelschmidt coined the term “diathermy” and began trialing these principles on patients. However, the first true electrocautery devices were not established until 1926, when William T. Bovie and Harvey Cushing created the first true electrosurgery device. Developed by Bovie for neurosurgery, Cushing used this instrument to cut and cauterize, essentially improving blood loss complications over cold steel. On October first of that same year, the first every case of electrocautery was used to resect a cranial tumor with minimal blood loss, a malignancy previously considered unresectable due to concerns of blood loss with traditional cutting tools. Over the next century, modern electrocautery instruments became more refined, but to this day, we rely on the same instrument that required the knowledge of multiple generations of physicists and surgeons to develop.

Conclusion: Life-changing and lifesaving procedures rely on electrocautery to complete procedures in a blood sparing fashion. If it was not for the principles developed by Marshall, d’Arsonvai, Tesla, and Nagelschmidt, William Bovie would not have been able to create this revolutionary invention that allows safe incisions to be made with excellent hemostasis.