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Electrosurgery Explained

Electricity has been applied in therapeutic and medicinal procedures for over a century, yet a lot of confusion and uncertainty continues to surround the practice. It’s understandable – electricity has proven to possess devastatingly destructive capabilities when used incorrectly. How can anyone really be comfortable putting themselves at the mercy of such a force?

In reality, electrosurgery can actually prove to be a very effective approach. In this blog, Team Med hope to clear the matter by breaking down and explaining electrosurgery.

Application of Electrical Currents

We will spare you a lesson in electrophysics. Delving into the realms of currents, voltages, amps and watts is unnecessarily complicated to for someone to grasp the basic foundations of electrosurgery. Essentially, all that needs to be known is that electrosurgical units (ESU) or generators are brought into use, which produce various current waveforms, depending on the desired result with the tissue.

Currents are classified as either direct (constant in direction and/or magnitude) or alternating (varying direction). Direct currents are not used in electrosurgery because of their trend of depolarising neural and muscular tissue. Alternating current waveforms are desirable as they can be altered with the use of multiple signals, known as modulation. The speed at which a current flow changes direction is called frequency, and measured in Hertz (Hz), or, if a current alters direction one million times per second, that would be one megahertz (MHz). Electrosurgical generators mostly run between 400 000 Hz and 2.5 MHz, but can extend to 3.5 MHz.

Application on Tissue

All effect on tissue during electrosurgery will be due to heat, either internally or externally from a source of energy. Heat is produced partly from the tissues resistance to current flow, but mostly from the rapid vibration of molecules within the tissues, and varies in intensity based upon the desired result of the surgeon. These include:

Desiccation

Applied over a wide range, desiccation is generated by a low current and a relatively higher voltage, producing a low current density. The process is designed to shrink cells and shrivel elongated nuclei, whilst also preserving the cellular detail. It does this due to the resultant loss of water from the cells.

Coagulation

Coagulation refers to the process of transitioning a liquid into a solid (or semi-solid) state. It occurs during electrosurgery when higher current densities are applied than those used in desiccation, which will result in higher temperatures being produced on the tissue. Tissue fluids will subsequently boil away, leaving proteins to become natured and forming a white coagulum. Cellular definition will be somewhat lost, as the tissue structures fuse to form a mass with a hyalinised look. 

Fulguration

Unlike coagulation and desiccation, fulguration is the result of electrical arcs making contact with the tissue in an array of different points over a broad area. This generates a high, localised, instantaneous current density, but also a low average current density. Fulguration is characterised as the destruction of the superficial area of tissue, such as small growths.

Vaporisation

Vaporisation is the cutting of tissue via the use of an electrical current, causing the ‘vaporisation’ of cells. The process is born from current density, such as a dampened current made to divide tissue.

Find the Best Products from the Professionals in the Industry

Electrosurgery is used routinely in a variety of practices, such as eye surgery and gynaecology. Plenty of clinical results have accumulated since its introduction, and there is a multitude of uses for the equipment across the field. If you would like to learn more about electrosurgery, or purchase high quality electrosurgical accessories, contact the professionals at Team Med today. We are always happy to help.

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