Performance evaluation of electrosurgical pencils: insights into surgical smoke mitigation and thermal damage reduction.

Background: Electrosurgical pencils (ESPs) are essential in modern surgery; however, concerns remain regarding their exposure to surgical smoke and thermal tissue damage. This study quantitatively evaluated four ESPs with a particular focus on two critical aspects: surgical smoke generation and minimization of thermal damage to the surrounding tissues. Methods: Full-thickness incisions were made on the porcine dorsal skin using six instruments: scalpel, uncoated Bovie, coated Bovie, PlasmaBlade, and Duoblade (with and without suction). Surgical smoke was measured by particle counting, blood loss was quantified, and histological analyses (hematoxylin and eosin, Masson's trichrome, CD3, and α-smooth muscle actin staining) were performed to assess the wound scar width and densities of CD3-positive lymphocytes and myofibroblasts. Results: Duoblades, especially those with suction, consistently produced the lowest level of surgical smoke, reducing particle counts by up to 96.1% compared to the uncoated Bovie. It also achieved the greatest reduction in blood loss (93.3% less than that of the scalpel) and resulted in the narrowest scar width among the ESPs. The wound scar width and densities of CD3-positive lymphocytes and myofibroblasts were reduced more rapidly in Duoblade-incised wounds than in those with other ESPs. Discussion: Device design and energy delivery significantly affect the surgical smoke and tissue outcomes. Duoblade dielectric heating and integrated suction provide superior environmental safety and wound healing, while maintaining excellent hemostasis. The Duoblade has a suction function that reduces the surgical smoke.