Optimising Electrocautery Use in General Surgery: Comparative Performance of Monopolar and Bipolar Systems with Emphasis on Smoke Safety

Abstract

Electrocautery remains one of the most ubiquitous and indispensable instruments in the contemporary operating theatre, enabling surgeons to achieve precise tissue dissection and reliable haemostasis across virtually every subspeciality of general surgery. The two principal modalities — monopolar and bipolar electrocautery — operate on fundamentally distinct electrophysical principles and confer different clinical profiles with respect to cutting efficiency, haemostatic capacity, lateral thermal spread, and safety. Despite their widespread adoption, a significant proportion of surgical practitioners retain incomplete knowledge of the underlying biophysical mechanisms and the associated complication profiles of these devices. Simultaneously, the combustion by-products generated during electrocautery — collectively termed surgical smoke — represent an underappreciated occupational health hazard for surgeons, theatre nurses, anaesthetists, and other perioperative personnel. Surgical smoke contains ultrafine particulate matter, volatile organic compounds, polycyclic aromatic hydrocarbons, and viable biological material including bacterial and viral fragments, all of which carry carcinogenic, mutagenic, and infective potential. This narrative review synthesises the current published evidence on the biophysical principles and comparative clinical performance of monopolar and bipolar electrocautery systems in general surgical practice, and critically evaluates the chemical composition, health implications, and mitigation strategies associated with surgical smoke. The review identifies that monopolar devices offer superior cutting versatility but produce greater lateral thermal spread and substantially higher volumes of surgical smoke than bipolar counterparts. Advanced bipolar vessel-sealing platforms provide safer haemostasis in proximity-sensitive anatomical regions. Smoke evacuation using high-efficiency local exhaust ventilation represents the primary recommended protective strategy, yet compliance remains globally suboptimal. Formal training programmes in surgical energy safety are essential but inconsistently implemented. This review underscores the urgent need for standardised institutional protocols, enhanced educational curricula, and updated regulatory frameworks to protect both patients and operating theatre personnel.