Why don’t more surgeons use obsidian scalpels?
You can check the answer of the people under the question at Quora “obsidian surgical knife“
Why don’t more surgeons use obsidian scalpels?
You can check the answer of the people under the question at Quora “obsidian surgical knife“
Because a surprising amount of surgery doesn’t use a scalpel.
Imagine I gave you an orange, and told you to peel it with nothing but a scalpel. You would have juice everywhere and make a mess. In fact, it’s a lot easier to separate the peel/ pith from the orange using your thumbs: there is a nice little plane your thumbs get into, and they slide nicely along it. You can separate the peel from the flesh quickly and neatly and not make a mess.
Surgery is like this too. It’s much gentler, neater and more elegant to use blunt surgical techniques most of the time (though there are of course exceptions).
And like peeling an orange, you still need something sharp to cut the skin; after that the scalpel can just sit on the tray.
A disposable steel scalpel blade costs pennies and does a fine job. Why would I spend a fortune on an obsidian blade for the same purpose?
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Since we found Prions can’t be killed by normal sterilization procedures it is SOP to trash almost all the instruments after a surgery. An Obsidian scalpel costs $85.00 each. The most expensive disposable steel scalpel blade I could find cost $0.30 cents each and most expensive steel blade I could find costs 30 cents each.
Just brush the blade of an Obsidian scalpel against something hard and it breaks. Your out 30 cents with the steel blade to get an clean one.
There appear to be methods to sterilize obsidian that has been in contact with Prions of TSE diseases.
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Thank you anonymous for the A2A
TL;DR: While sharper and with arguably better results, obsidian scalpels are also more brittle (potentially more dangerous) and significantly more expensive than stainless steel scalpels, which are adequate for most surgery.
Obsidian has been used as a tool for thousands of years, valued for its ability to be extremely sharp and smooth, even at a microscopic level.
On that image, you can clearly see the difference on electron microscopy between obsidian and stainless steel. The obsidian is impossibly smooth while the stainless steel might as well be a brick covered in sandpaper. In fact, it is suggested that because obsidian scalpels are so perfectly smooth (it is only 30 angstroms thick as well), they may reduce inflammation and the wounds they generate may heal faster. Some physicians are a fan, however they are not FDA approved and obsidian can also be very brittle. Lateral pressure is not well tolerated at all and so they are more prone to breaking compared to their steel cousins, and are potentially dangerous for that reason.
The price difference is also significant. A single obsidian scalpel will cost $83 (not counting bulk discounts of course), likely because they have to be hand made given how brittle obsidian is. For comparison, I can get a 10 pack of disposable sterile stainless steel scalpels on Amazon for $8.99. For most circumstances you probably don’t truly need the fine edge of obsidian compared to the added cost.
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Too fragile
Too expensive
A steel scalpel is every bit sharp enough
… and the main reason is (3).
Interestingly enough, most surgery does not rely a whole lot on the scalpel. While the average person may imagine surgeons in the operating room just going to town with scalpels the whole time, that’s not actually how it goes :-). In most types of surgery, the scalpel is used for making the skin incision, and that’s pretty much “it”.
A super-sharp cutting instrument like a scalpel is good at one thing – cutting – which has both an upside of utility and a downside of potential harms. When you really need to cut, you need a good cutting tool, but a sharp cutter is also indiscriminate… for instance, it goes through blood vessels, and not just the areterial “bleeders” that you can suture off or cauterize, but also through the microvasculature that invests all tissues. So if surgeons relied on sharp dissection to separate tissues, there’d be a lot more bleeding, which would be directly harmful to the patient in the case of significant blood loss, but also an immediate disadvantage because blood obscures the surgical field. The bloodless field is one of the great advances of modern surgery. To achieve this, you need ways of cutting that produce concomitant coagulation, and there are two primary kinds of instruments for this: electrocautery, and ultrasonic ablation/coagulation instruments. Electrocautery includes both “unipolar” and “bipolar” variants. The “unipolar” kind is basically your classic Bovie electrocautery instrument ( so classic, that it’s called a “Bovie” whether or not it’s actually manufactured by the Bovie Medical corporation, which also makes bipolar instruments and other stuff). In a typical open general surgery procedure, the scalpel is used just to make a skin-deep incision exposing the subcutaneous fat. You then set the scalpel aside and take up the Bovie, using it to basically sizzle your way through those fat layers, by distracting the tissue to the sides and then making a stroke with the instrument, and then repeating this process. When you get a bit of bleeding, you can see those focal bleeding vessels and cauterize them directly with the Bovie tip, or you can grab a little arterial bleeder with forceps or a hemostat at the bleeding site or proximal to it, and then touch the Bovie tip to the metal instrument and actuate it, and sizzle off the bleeder that way. Going this way, you very quickly get through the fat layer and expose the peritoneum (membrane layers lining the abdominal cavity) with no significant bleeding, and then you use the Bovie to open up the peritoneum as well.
There are also laser scalpels used in more specialized applications, which have the same sort of advantages as electrocautery and ultrasound instruments, viz. simultaneous tissue ablation and cauterization.
Other specific cutting applications are served by even more specialized cutting instruments. One example of this is the various GI staplers used in bowel surgeries, which simultaneously cut and staple all in one go.
Even more basic than cutting, though, are various forms of blunt dissection . This is where you use a blunt instrument, or often just your fingers/hands, to separate tissue planes and slide structures apart. There’s a very useful technique where you use scissors to bluntly dissect… rather than the way you’re used to using scissors, e.g. with paper, i.e. advancing the open scissors and then closing them to cut between the sharp scissor blades, instead you advance the closed blunt-tip scissor to push your way in, and then spread the blades open to separate the tissues. Anyway, blunt dissection is less traumatic to tissues than sharp dissection and therefore results in quicker and better healing. Also, it runs much less of a risk of causing injury through inadvertent damage to structures, which gets back to your original question and why a sharper cutting instrument is better, generally speaking, but only up to a point . (No pun intended). The sharper the cutting instrument, the less “haptic” or tactile feedback you get when cutting through various tissues, and therefore the more likely you are to carry your cut too far into some structure that you didn’t mean to cut, or to unnecessarily cut through neurovascular bundles (structures composed of an artery, vein and nerve branch running together).
Anyway the point of all this is while sometimes you do need to cut, sharp cutting actually has a limited role in most surgery, and the point of that is that “good enough” cutting really means “good enough” for those few situations in which only sharp cutting will do (like making skin incisions). So, imagine if you had something like a lightsaber, that would just cut through tissue effortlessly… you can see now how that still might not actually be a great thing!
Okay, all that was a hopefully more interesting than boring aside about surgical techniques and the importance of scalpels relative to other ways of opening/separating tissues. There’s also a bigger picture perspective on your question which I think is more interesting…
In the case of the steel scalpel, you have (a) an illustration of the principle that “good enough is good enough”, and (b) an instance of having achieved “good enough”. For another example: adding more pixel density to a display device results in greater image resolution… up to a point , but beyond that it only increases the cost and complexity of the device.
In the case of the scalpel, it’s a bit more nuanced. The only purpose of the scalpel is to cut. All of its utility comes owes to its ability to cut. However, its potential harms also owe to its ability to cut. Of its various attributes, arguably only one of them – sharpness – relates to its cutting ability. So, the sharper it is, the more useful it is (at least up to a point where it no longer makes any difference, sort of like the pixels example), but also the more potentially harmful it is. On top of that, in the case of the obsidian scalpel, you have the other trade-offs relating to brittleness and manufacturing cost. So while an obsidian scalpel is indeed sharper, for most applications it is in virtually every way less desirable than a steel scalpel, and most surgeons would not trade a steel scalpel for a drawer full of obsidian ones.
For another example, consider a riding lawn mower. It’s gotta have some speed to it, because that’s the whole point of the thing, as long as it’s cutting the grass! But a top speed of 50 MPH clearly would be excessive… at that speed you aren’t even cutting the grass, and meanwhile the machine becomes a safety hazard. So more of of something, even an essential quality, isn’t always better.
I would suggest that some variation on these themes will show up underlying the answers to most “why don’t” sort of questions… the themes of (a) trade-offs, in terms of cost/benefit, risk/reward, benefit/harm or whatever the case may be, and (b) good enough is good enough. As my Dad, a retired civil engineer, likes to say: “Everything is an optimization problem.” These are cross-cutting themes (again no pun intended) to be found at multiple levels in technology, health care, economics, public policy, building, manufacturing, international relations, etc.
The opportunities are found in figuring out ways to re-balance or re-align the cost-benefit tradeoffs, or to recognize when current solutions actually overshoot a true “good enough” point which could be achieved with something cheaper/simpler/safer, or by changing the game so that what until now was not good enough is now good enough.
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Because the blades cost a fortune, AND, their unique sharpness is really at best utility in dissecting REALLY small arterial structures – as in coronary arteries.
Beyond that, such a (larger) blade would be of no utility whatever in, say, an abdominal surgery.
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3 main reasons they are not used
They are extremely expensive
They lack FDA approval and if something goes wrong the liability is completely on the surgeon and hospital’s wallet and third and most importantly
They are too brittle toward side force and when they break they shatter into the wound and are a total PITA to clean out.
With cost being so important and no realistic support that they produce anything clinically better then good old stainless steal or for that matter carbon steal (one use) blades they are only a good alternative if you are doing research o…
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Because in most cases, the risks and limitations (blades are fragile and cannot be large) are not justified by the superior cut.
They are however, increasingly used in microsurgey and scar repair, where their ability to but without tearing open cells is valuable.
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Obsidian scalpels only have an advantage over steel scalpels in situations where reducing visible scarring is desirable. In almost every case, steel scalpels are preferable to obsidian because they are cheap, strong, and extremely sharp. It is true that obsidian scalpels are shaper than steel, but in most cases a steel scalpel is more than sharp enough to complete a procedure, but without the disadvantages of obsidian (high cost, low strength). Obsidian scalpels are most often used by plastic surgeons and dermatologists (but still rarely) because some claim that the sharper blade greatly reduces the amount of visible scarring from a procedure. While there is some logical sense to this, there is very little in the way of actual research to prove this assertion, making it mostly subjective. Lastly, of the doctors who would use obsidian scalpels, it is generally only by doctors in private practice or contractors. Doctors working for incorporated hospitals or clinics, and university hospitals are often not allowed to use obsidian, or the hospital will refuse to pay for them.
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I’m not a surgeon (although I hope to be one someday) but obsidian scalpels are very brittle and can leave fragments inside a patients skin. Although cuts made from these scalpels heal much faster than a normal steel scalpel, you wouldn’t want obsidian pieces inside of tissue.
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Surgical steel scalpels are sharper and cheaper to manufacture. Not all surgical tools have the same quality, nor sterile gloves. One of the world’s premier surgical tool makers is the country of Germany
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Ideally obsidian scalpels are outstanding for aesthetic surgery such as cosmetic. Another option would be neurosurgery in that you could cut between the axons which would not only lessen physical cellular damage, but cut down (pun intended) on secondary inflammation of surrounding cells.
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