ScalpeL versus Cutting Electrocautery

Photo credit: Iwan Gabovitch / Foter / CC BY

Safety in the operating theatre is paramount. Yet 12,000 injuries to surgeons and nurses occur every year in the NHS due to scalpels. The consequences are significant. Injured staff take sickness leave, putting a greater strain on a stretched workforce. Some injuries even result in the transmission of HIV and hepatitis. Treating these injuries, and in some cases dealing with lawsuits, is also costly to the NHS.

The service the NHS provides to patients is affected by scalpel injuries. However they are largely preventable. There is a safe alternative to the scalpel called diathermy. This is a blunt-tipped instrument that uses a safe form of electricity to cut tissues. It has been in use for over 100 years. Surgeons routinely use it for dissecting. However they still use the scalpel to cut the skin.

To persuade surgeons to stop using the scalpel, first we need to prove that the alternative, diathermy, is at least as good if not better. This has already been done for infection, healing, pain and bleeding. However surgeons still use the scalpel because they believe it produces a better scar. Surprisingly, this has never been proven or disproven.

We therefore need a clinical trial to compare the scar result for scalpel against diathermy. We believe that the scar result is the same. If we prove this, then scalpels can be taken off the operating set and scalpel injuries can be prevented.

This trial was developed by the London Surgical Research Group, the Reconstructive Surgical Trials Network, Pragmatic Clinical Trials Unit, University of West England and Queen Mary University of London. Support came from the Royal College of Surgeons of England and Research Design Services London, with backing from the Health and Safety Executive and Safer Needles Network.

London Surgical Research Group