Background: Monopolar electrosurgery, one of the most widely used techniques in surgery, requires two electrodes: a working electrode and a return electrode. Commonly, adhesive or "sticky" pads that attach directly to the patient are used as return electrodes. Acting as electrolytic conductors, adhesive pads are highly effective, but require some effort to apply and remove, and if improperly placed or partially detached may lead to high electrical current density and the potential for pad site burns. Alternatively, a capacitive return electrode, such as the Mega Soft pad, may be used that works on the same principle as a two-plate capacitor. Objective: This article details the technology underlying capacitive electrodes, reviews the scientific literature to-date, and provides recommendations on how to best use the Mega Soft pad. Results: No direct contact is required between the pad and patient, and the return electrode is designed so that current density is limited regardless of pad placement, reducing the risk of pad site burn. Although the technology is now mature, having been in the field for over 20 years, best practices for optimal performance from capacitive return electrodes are still not widespread, and misunderstandings persist regarding use of capacitive electrodes with contact monitoring systems and implantable electronic devices. Conclusion: With proper training, capacitive return electrodes may be substituted for conventional adhesive pads with the benefits of easier application and reduced risk of pad site burns.

Background: In the current conditions of the COVID-19 pandemic, it is imperative that surgical plume be effectively removed from both open and laparoscopic procedures, especially when energized devices are being utilized. This study evaluated a new Megadyne Smoke Evacuator, to establish its performance in removing smoke, while improving visibility at the surgical site and lessening the risk of staff exposure to the components of surgical smoke, such as chemicals, particulates, viruses and bacteria. Methods:The smoke evacuator was evaluated by nurses and surgeons in both open and laparoscopic simulated procedures. Nurses were asked to setup and operate the smoke evacuator, and surgeons performed a variety of electrosurgery procedures in an animate porcine model. Both groups were then asked to evaluate the device via a questionnaire.Results: Over 90% of the nurses (n=18) agreed that the Megadyne Smoke Evacuator was easy to set up, understand the settings and change the filter. Surgeons agreed that the smoke evacuator operated effectively in open (94%, 17/18) and laparoscopic (100%, 16/16) procedures. Conclusion:Given the risks inherent in performing surgery today, it is more important than ever to use an effective method of smoke evacuation. With an ULPA filter capable of blocking particles as small as 20 nm with high efficiency, the Megadyne Smoke Evacuator lowers the risk of exposure to small viruses, cellular debris, bacteria and other particles. In addition to having a range of flow rates amenable to open procedures, the device can be used in all steps of laparoscopy, including the process of desufflation.