Learning to Use
BiPAD® Hand Switch for Bipolar Forceps
The use of the BIPAD® hand-switch allows the surgeon to open and close the bipolar forceps without activating the generator and then to activate the generator by hand at will.
Some experienced surgeons pick up the BiPAD®-equipped forceps and begin using the hand-switch with absolutely no instruction. It’s quite remarkable to watch these surgeons examine the device then figure out on their own how to hold and activate the forceps with the BiPAD® hand switch. They are even able to discern that the actuary arm can be shortened or lengthened as needed.
Likewise, we have observed that most residents and fellows transition to BiPAD® hand switching effortlessly. They learn to adjust the length of the actuator arm with little or no instruction. They also learn that the actuator arm is malleable. Bending the arm to accommodate the surgeon’s hands can improve comfort and reduce learning time.
Many experienced surgeons can convert from bipolar foot pedal to bipolar hand with BiPAD® with only a few minutes of pre-operative instruction and a few hours of intra-operative use (ie, a case or two).
Some surgeons who have been using the bipolar foot pedal for many years have to expend more effort learning to use the BiPAD® hand-switch. Most of these surgeons feel comfortable using the BiPAD® in the operating room with fifteen minutes of pre-operative instruction. However, some surgeons feel more comfortable with thirty to forty five minutes of hands-on exposure training before going to the operating room. Regardless, our clinical support specialists can provide this instruction and, in addition, initial guidance during the first few to five surgeries.
Pre-operating room exposure can employ a “BiPAD® training simulator.” All of our salespeople and clinical support specialists have simulators available for trainman surgeons. The simulator provides audio feedback. It beeps when the forceps tips are opposed and buzzes when the generator is activated.
Learning to use the BiPAD hand-switch often means molding the BiPAD® device to their hands during this period of adjustment. First, the length of the actuator arm can be shortened or lengthened for comfort. Second, the actuator arm is malleable - it can be bent to adjust to the surgeon’s hand.
Bending takes three forms: 1) up, 2) down, or 3) inwards towards the forceps.
1) If you bend the arm up, you can engage the switch with your second digit while holding the forceps with your first and third digits.
2) If you bend the arm down, you can engage the switch with digits four or five.
3) If you bend the arm inwards toward the forceps, you can prevent inadvertent activation until the forceps are approximated. If you bend the arm so that the tip of the actuator arm touches the forceps, then the BiPAD hand-switch will not activate until the forceps are closed - the tips approximated. This is because the actuator arm hits the forceps blade before it can activate the hand switch.
Why do surgeons make an effort?
BiPAD® saves time. It reduces the surgeon’s postural pain. BiPAD® ultimately makes it easier to use bipolar forceps for hemostasis. All of these are true.
However, the main reason that drives many surgeons to learn to use the BiPAD® hand-switch is to prevent asking nurses and staff to crawl under the table to relocate the bipolar foot pedal during surgery for two reasons:
First, it impairs these valued team members to get down onto the floor and crawl under the operating table.
Second, and just as important, crawling on the floor under the operating table during surgery exposes staff to infectious agents. The foot pedal is rarely cleaned and even more rarely adequately covered. The floor under the operating table is often covered with bodily fluids. Exposing staff to these pathogens puts them at risk and, by its very nature, increases the risk of surgical site infections.
Recommendations for new users who need to adapt to BiPAD® hand-switching:
The surgeon should have been exposed to the BiPAD hand switch before starting surgery and decided how to use the BiPAD® hand switch, dedicated index finger, index finger on the forceps with the actuator arm, and the inside of that finger and the barrel hold.
1. First, the scrub nurse should apply a steri-strip to the main housing and the actuator assembly. This makes it easier for the surgeon to adjust the length of the actuator arm.
2. If the surgeon uses the BiPAD® with his second finger, then bend the arm up about 15°.
3. If the surgeon will hold the forceps in the usual fashion and move the middle of his second digit inwards toward the forceps to activate, then:
1. The scrub nurse should bend the actuator arm towards the midline (i.e., towards the forceps) with the forceps removed, then insert the forceps and confirm that the BiPAD® does not activate the generator until the forceps tips are opposed.
2. The surgeon can activate the generator using the BiPAD® hand switch when the forceps tips are opposed.
4. If the surgeon uses digits four or five to activate the BiPAD® hand switch, the scrub nurse should bend the arm downward about 70°.
See the video: “Learning to use BiPAD®: for Experienced Surgeons.”