The term scalpel comes from bastoria, which means stick in Latin, and the term scalpel comes from scalpere which means to incise in Latin. Regardless, whether it is called a scalpel or a scalpel, this small instrument is used to make incisions in organic tissue. There is nevertheless a difference between the two depending on the use made of it.

We prefer to reserve the term scalpel for the practice of incisions in surgery, and the term scalpel for laboratory dissection experiments.

Composition

The surgeon uses two kinds of scalpel: the cold scalpel, which cuts through tissue with a blade, and the electric scalpel, which uses an electrical pulse to cut with great precision and cauterize.

Blade scalpels are:

• either for single use: their blade cannot be dismantled, their handle is made of plastic, and the whole is disposable;
• or reusable: their blade is removable and disposable, and their metal handle must be sterilized between each use. There are different types of handles that we choose according to their shape and their compatibility with the blades used.

The electrosurgical unit consists of an electric current generator which transmits an electrical impulse between two electrodes, one of them, in the form of a needle, acting as a scalpel.

The scalpel, or rather the scalpels, are part of the surgeon’s range of essential tools. He uses them to make incisions on the surface of the skin or deep in organs.

The blade scalpel

The scalpel blade, like the scalpel in dissection, allows incisions to be made in the patient’s tissue. The surgeon will choose his scalpel blade according to the type of incision he wants to make. There is a whole range of disposable blades which differ from each other by their shape and therefore the use intended for them. We find blades of straight, rounded, curved, sickle, etc.

Electrocautery

The electrosurgical unit is particularly useful for surgery of the viscera, dental surgery, the removal of tumors, in short, the surgery of richly vascularized tissues.

The tissues are incised using a high frequency electric current which can be either monopolar or bipolar.

• In monopolar mode, the incision is coupled with cauterization of the incised tissue, which prevents bleeding and promotes faster and less painful healing. The current, which flows from the scalpel electrode to a plate placed under the patient, passes through the patient;
• In bipolar mode, only cauterization occurs. The current can be transmitted to the site to be cauterized via another instrument (clamps for example).

The advantages of the electrosurgical unit

• The needle of the electric scalpel is very fine and therefore allows a clean and very high precision work;
• Its controlled hemostatic function also contributes to the precision of the work which remains “clean” because the sections performed do not cause local bleeding.

The disadvantages of the electrosurgical unit

• Because of the burns it causes, the electrosurgical unit cannot be used on the skin;
• The use of electric current is accompanied by the release of smoke which can be toxic if inhaled;
• The smoke can cause a risk of burns to adjacent tissues or nerves.

The future of the electrosurgical unit

The electric scalpel has been around for fifty years now and its usefulness is well established. Its drawbacks related to thermal release can be overcome by the use of ultrasound, thermofusion or even the use of laser.

The stages of operation

The blade scalpel is held like a pen most often for maximum precision. In certain situations or when access is difficult, the scalpel can be held in palmar pronation.

The electrosurgical unit is operated by the surgeon using a foot pedal, which leaves his hands free to operate.

Precautions to take

For blade scalpels

The handles of the bladed scalpels must be sterilized between each use. The disposable blades are made of stainless steel, sterilized by irradiation, packaged in individual bags and meet European CE standards and “Surgical instruments – Metallic materials Part 1 Stainless steel” standards. Used blades should be disposed of in suitable containers or incinerated.

For the electrosurgical unit

For the proper functioning of the electrosurgical unit, a few precautions must be taken:

• the floor must be antistatic;
• well-insulated outlets;
• it must be connected directly to the mains;
• the network must be protected by a fuse with a nominal current of 10 amperes;
• air must circulate freely around the generator to avoid overheating.

The different blade models

The blades of cold scalpels are identified by a number and can be mounted on a handle which is also identified by a number. Here are some of the most common models:

• blades n ° 10, 6 and 13 are the “classic” blades, they have a curved edge and are used for precise and fine incisions in the skin or the muscle, or in an artery (during a bypass) or in the bronchi;
• blade # 10A has a longer cutting edge and allows for incisions in soft tissue;
• blade n ° 15 is a reduced model of blade n ° 10 and allows excisions of skin lesions (of a sebaceous cyst for example);
• blades No. 10R and 14 in the shape of a butter knife blade are used for cosmetic surgery (especially of the face);
• chopper-shaped blades No. 9 and 25 are very useful for podiatrists;
• the crescent shaped blade no.12 with the cutting edge inside the crescent is used for removing sutures and also in dental, parotid, nasal, oral and pelvic surgery.

The history of the scalpel

The scalpel is mentioned for the first time in 1564 by the famous surgeon Ambroise Paré in one of his Ten Books of Surgery. This term would have Italian roots, since at that time a bistorio was a small dagger in Italy.