Electrosurgery is a procedure that converts the electrical energy (current) to heat energy that may be used for various medical purposes, such as to stop the bleeding (hemostasis) or to destroy abnormal skin growths.
Electrosurgery is used for the treatment of various conditions which include:
Benign (noncancerous) conditions, such as:
- Acne keloidalis nuchae (a type of acne affecting the neck and scalp)
- Acrochordon (skin tags)
- Angioma (a noncancerous mass-type formed by blood vessels)
- Molluscum (a type of viral infection, which causes raised, flesh-colored bumps on the skin)
- Verrucae (a contagious and often painful wart)
- Mucous cysts
- Nevi (a type of birthmark or mole)
- Pyogenic granulomas (a noncancerous blood vessel tumor found on the skin)
- Seborrheic keratoses (a type of noncancerous skin growth)
- Sebaceous hyperplasia (enlarged sebaceous glands with trapped sebum)
- Syringomas (noncancerous tumors typically found on the eyelids and cheeks)
- Rhinophyma (bumps on the nose due to enlargement of sebaceous glands)
- Squamous cell carcinoma in situ without extensive follicular involvement
- Nodular basal cell cancer
- Superficial basal cell cancer
Achieving hemostasis (stopping blood loss)
What does electrosurgery mean?
Electrosurgery is a procedure that uses electric current at various voltages (200 to 10,000 V) through the skin to generate heat. It may be used to stop bleeding (hemostasis) or destroying abnormal skin growths. Electrosurgery requires a power supply and a handpiece with one or more electrodes. A switch on the handpiece or a footswitch controls the device.
Electrosurgery includes various modalities that use electricity to cause thermal destruction of tissue through dehydration, coagulation, or vaporization. High-frequency electrosurgery and electrocautery are the two most commonly used types of electrosurgery.
Electrocautery or thermocautery differs from the other types of electrosurgery since it does not involve passing the current through the patient. Hence, it can be safely used in patients with implanted electrical devices, such as cardiac pacemakers, implantable cardioverter-defibrillators, and deep-brain stimulators.
Electrosurgery includes different modalities:
- Electrofulguration (acts by generating sparks)
- Electrodesiccation (acts by causing dehydration of superficial tissue)
- Electrocoagulation (acts by causing bleeding blood vessels to clot)
- Electrosection (involves cutting through tissue)
- Thermocautery (electric current is passed through a resistant metal wire electrode, generating heat. The electrode is placed on or near the tissue to be treated)
- Radiofrequency devices (very high frequency, more than 1,500 kHz, is used for cutting)
What are the risks of electrosurgery?
The risks associated with electrosurgery can affect both the patient and healthcare professionals. They include:
- Electric shock: It can be minimized using the earthing of indifferent electrodes. The surgeon should wear plastic surgical gloves to prevent an electric shock.
- Electric/thermal burns: Electrosurgery bears the risk of fire or explosion if flammable materials, such as alcohol, oxygen, and bowel gases, are near the treatment site. Burns can be minimized by various measures, such as the use of nonflammable cleansers like chlorhexidine or povidone-iodine, and making sure that the person being treated is not in contact with metal objects, and ensuring that the electrode is not placed over a bony prominence, scar tissue, or implanted metal.
- Spread of infection and production of toxic gases: Infection can spread via the treatment electrode, surgical smoke, and aerosolized blood microdroplets. Aerosolized blood droplets can be propelled up to 30 cm and can be infectious if inhaled. Surgical smoke generated during the procedure can spread viruses and bacteria. The smoke also carries hazardous chemicals and cancer-causing substances (carcinogens). The risk of infection can be lowered by using a smoke-evacuation system, along with facial masks, protective eyewear, and surgical gloves. Disposable or sterilized electrodes also help to prevent the spread of infections.
- Malfunction of cardiac pacemaker and defibrillators: There is a risk of malfunctioning of implanted cardiac devices due to the passage of electric current through the patient’s body.
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