Overview of electrosurgery
- Jon Ivar Einarsson, MD, PhD, MPH
Jon Ivar Einarsson, MD, PhD, MPH
- Director of Minimally Invasive Gynecologic Surgery
- Brigham and Women's Hospital
- Jon Gould, MD
Jon Gould, MD
- Professor of Surgery
- Medical College of Wisconsin
- Section Editors
- Hilary Sanfey, MD
Hilary Sanfey, MD
- Section Editor — General Surgical Principles
- Professor of Surgery
- SIU School of Medicine
- Tommaso Falcone, MD, FRCSC, FACOG
Tommaso Falcone, MD, FRCSC, FACOG
- Section Editor — Minimally Invasive Gynecologic Surgery
- Professor of Obstetrics and Gynecology
- Cleveland Clinic Lerner College of Medicine
Electrosurgery refers to the cutting and coagulation of tissue using high-frequency electrical current . Physicians using this technique must be knowledgeable about prevention and management of potential complications of electrosurgical procedures. In addition, they should understand the mechanism of action and how to troubleshoot equipment. Education on the principles of electrosurgery is important , as electrosurgical complications are relatively common .
Electrical current is created by the movement of electrons; voltage is the force that causes this movement. There are two types of electrical current: direct current (DC), where the electrons always flow in the same direction (eg, simple battery), and alternating current (AC), where the current changes direction periodically (eg, electrical wall outlet). A cycle is the time required to pass through one complete positive and one complete negative alternation of current or voltage. Frequency refers to the number of cycles in one second and is measured in hertz (Hz).
Electrosurgical units (ESU) used in operating rooms convert standard electrical frequencies from the wall outlet, which are 50 to 60 Hz, to much higher frequencies, 500,000 to 3,000,000 Hz . This is important to minimize nerve and muscle stimulation, which occurs at electrical currents below 10,000 Hz . The possible effects of applying electrical current to tissue are fulguration, desiccation/coagulation, or vaporization/ablation (figure 1).
When comparing the creation of a surgical incision in the skin using a scalpel versus electrosurgery, no significant differences have been identified regarding infection rates or scar appearance; however, postoperative wound pain is less with electrosurgery . In a randomized trial, pain scores on day one were lower for the diathermy group, but were no different on days two through five .
Monopolar versus bipolar — Electrosurgery can be performed using either a monopolar or a bipolar instrument. The main difference between these modalities is the pathway of the current.
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- BASIC PRINCIPLES
- Monopolar versus bipolar
- Cutting and coagulation currents
- Desiccation, vaporization, and fulguration
- Time, power, tissue, and electrode
- Thermal spread
- Smoke plume
- CLINICAL USE
- Monopolar electrosurgery
- Bipolar electrosurgery
- Laparoscopic procedures
- Hysteroscopic procedures
- IMPROVING SAFETY
- Electrode monitoring
- Inspect for faulty insulation
- Avoid skin contact with metals
- Avoid electromagnetic interference
- ADVANCED ELECTROSURGICAL DEVICES
- Ligasure device
- PlasmaKinetic tissue management system
- ALTERNATIVE ENERGY SOURCES
- Ultrasonic cutting and coagulating device
- SUMMARY AND RECOMMENDATIONS