What Is a Bovie Cautery?

Bovie cautery is a surgical procedure performed with the use of a “bovie," a medical device that cuts and seals, or cauterizes, tissues and blood vessels by way of a direct electrical current. A scapel is not used. Touching body tissues with heated prongs on the end of the bovie transfers heat to the tissues, destroying those in immediate contact and cauterizing adjacent tissues. For this reason, bovie cautery is also called “thermocautery” or “electrocautery.”

Bovie cautery works by directly applying an electrically heated prong to tissue that needs to be cauterized, so it is most accurately characterized as electrocautery, rather than electrosurgery. A modern electrosurgical unit (ESU) can have added instruments and settings that allow electrocautery functions, such as a surgical blade, or “bovie knife,” that allows surgeons to rapidly cauterize and clear operative fields when performing major surgeries of the spine, thorax, and abdomen.

Portable bovie cautery units are widely used today in emergency rooms and in outpatient settings such as clinics and doctor’s offices where medical procedures can also be performed. These bovie units are increasingly used for outpatient surgery in many medical specialties, including plastic surgery, dermatology, gynecology, urology, dentistry, and otolaryngology. A suction bovie is widely used to perform adenoidectomies, because it has a hollow central stem that is used to suck blood from the throat area during surgery, allowing better vision of the area and also helping to improve patient comfort.

Portable bovies are battery-powered and shaped like a pen; some newer shapes resemble a pencil and use microtips. These portable units can achieve a temperature of 2,200°F (1,204°C) without requiring high-frequency currents or generators. Their length generally varies from around 3.5 inches (8.9 cm) to 8 inches (20.3 cm), and they can have disposable or replaceable wire loop tips varying from 3/16-inch (5 mm) to microtip sizes of 2/5-inch (0.1 cm) to about 1/16-inch (0.2 cm).

Bovie cautery is used to cut and coagulate animal and human tissue. It is widely used as a cauterizing agent in veterinary surgery. This form of cautery, along with lasers, is now largely used instead of treatment by freezing, or cryotherapy, to treat tumors and warts in humans. Traditional chemocautery, using cauterizing agents such as silver nitrate, tends to be favored by veterinarians for animal treatment.

Extensive safety procedures are taken in operating rooms when using the bovie apparatus, because severe burns can result during the use of high-frequency alternating current without adequate protection. Fire, shock, and smoke inhalation are other hazards. Outpatient cautery, however, presents few of these hazards because it uses self-contained, battery-operated units and less extensive surgical areas. It has also been noted in clinical literature that the use of bovie cautery has reduced operative time, bleeding, and infection, as well as reducing patient pain.

Dr. William T. Bovie created the Bovie in the 1920s. The patent was officially granted to Dr. Bovie in 1931 after a successful reoperation performed by Dr. Harvey Cushing.

Dr. Cushing had initially been operating on his patient but the patient began to bleed severely, leading him to abandon resectioning the patient’s parietal tumor in favor of staunching the flow. Luckily, Dr. Cushing remembered his colleagues discussing Dr. Bovie’s new invention which utilized electrosurgery. 

Dr. Cushing then contacted Dr. Bovie and requested that he bring his cauterizing machine to the subsequent surgery as an additional tool to control the excessive bleeding.

The operation was a huge success and, thanks to Dr. Cushing’s request, the standard cauterizing machine we know today is a Bovie.

Dr. Cushing continued to utilize Dr. Bovie’s machine in surgery. The pair worked to improve the instrument, which started out the size of an office desk. Nowadays, there are portable variations of the Bovie the size of a pen. 

In 1928, Dr. Cushing’s case series was published in Surgery, Gynecology, and Obstetrics, the leading medical journal for American surgeons at the time, garnering a favorable reputation for electrosurgery. Surgeons across the world continue to utilize the initial findings of Dr. Bovie in operating rooms everywhere.

Dr. Bovie moved on to teaching at Colby College towards the end of his career, where he encouraged his students to think outside the box as he had when he created his cauterizing machine. Dr. William Bovie passed away in 1958, but his legacy lives on.

Bovie pads, or grounding pads, are necessary instruments when utilizing a Bovie in surgery. Since Bovie cautery uses electricity, doctors need to ensure the patient’s safety by using grounding pads to prevent electrocution. 

Surgeons place the grounding pad on the patient’s body before surgery. This safety measure protects the patient from the harmful effects of electricity.

When Dr. Cushing first utilized Dr. Bovie’s machine, there was an incident where a grounding pad would have been helpful. During surgery, the electrical current short-circuited and traveled up Dr. Cushing’s arm, exiting through his headlamp. Occurrences like this are why doctors today consider all safety measures during procedures.

The grounding pad is especially essential when operating on patients with pacemakers or ICDs (implanted cardioverter-defibrillators). When using a Bovie on a patient with either of these devices, the Bovie pad must be placed as far away from them as possible. 

Otherwise, the current from the Bovie can affect the current from the pacemaker or ICD, thereby altering the patient’s heart rate. 

Bovie pads are not reusable and must be disposed of after each use for sanitary reasons. They are typically placed on the patient’s thigh to keep it out of harm’s way and away from the patient’s heart.

The Bovie is most commonly used within the surgical and dermatology fields. Within surgery, a Bovie is used to cauterize wounds during procedures quickly. Within dermatology, doctors use a Bovie for a multitude of medical procedures.

Dermatologists use electrosurgery to remove all types of skin lesions. This list includes:

Surgeons must numb the area around the lesions before removing them. The doctor then uses a Bovie to dry and burn off the lesion. This process results in minimal scarring and few complications post-surgery.

Electrosurgery is also a standard treatment for some types of acne. Acne typically forms when the hair follicles on the skin become plugged with a mixture of sebum and dead skin cells. A Bovie can be used to clear away and sterilize these hair follicles when other acne treatments aren’t strong enough. This treatment is typically used for acne on the chin and forehead.

Additionally, electrosurgery using a Bovie is a common procedure for scar revision. This process is when unwanted tissue, such as scar tissue, is removed without putting pressure on the skin. 

The surrounding tissue is not damaged because the Bovie can be easily directed for precise movement. Doctors often recommend using scar creams after this procedure to eliminate scar tissue further.