Electrosurgery is a common form of surgery in which tissue is heated in a variety of different ways for different results. Specifically, electrosurgery utilises alternating high-frequency radio currents in order to alter soft surrounding tissue.

While the basic concepts of electrosurgery might make perfect sense, it can nonetheless be a very complex subfield of surgery. The experts at Team Med have taken this information and broken it down for our readers so that you can gain a better understanding of this fascinating form of surgery.

Approaches to electrosurgery

Currents can be used to modify tissue in several different ways:

Cutting: cutting actions are possible with electrosurgery instruments by utilising electrical sparks. These sparks concentrate heat at the relevant site on the patient, but this approach requires that the surgeon hold the electrode slightly away from the skin. This approach allows for greater heat to form, which makes for the easier vaporisation of tissue.

Desiccation/coagulation: the desiccation of tissue involves the dehydration of specific areas, while coagulation involves liquid blood turning into a gel. During electrosurgery, these processes occur between 60 and 99 degrees Celsius and usually occur at the same time. Because of less heat being used, skin does not vaporise and open as it does with cutting, and skin instead dehydrates on the surface.

Fulguration: unlike the direct contact of desiccation, fulguration involves the instrument being placed above the targeted area to coagulate and char the tissue over a wide area. The space between the skin and the electrode requires higher voltage than used in the cutting current to overcome the high impedance of air.

Other things to consider in electrosurgery

It isn’t just the type of waveform or power setting used that can impact electrosurgery. The following also have an impact on electrosurgery:

Time:the longer a generator is activated, the greater heat is produced. Greater heat means that heat travels further when applied to tissue.

Size of electrode:the smaller the electrode, the higher the concentration of heat. This means that a smaller power setting will produce the same effect as a higher one if used in conjunction with a smaller electrode.

Type of tissue being operated on:different tissue have different densities, which means that a one size fits all approach to power is not possible when operating electrodes in microsurgery.

Electrosurgery versus electrocautery

Electrosurgery and electrocautery are often confused due to the similar nature of the instruments used, although they are quite different and are useful in different contexts. Electrocautery uses direct current, rather than the alternate current used in electrosurgery.

The direct current in this case means that the electrical current does not enter the patient’s body, but instead it is just the heated wire coming into contact with the body of the patient. Electrosurgery involves electricity current entering the body of the patient to complete the circuit. Electrocautery can therefore be more likened to using devices similar to soldering irons.

The first instance of electrosurgery

Although electrosurgery might seem like a very new concept, its use in medicine has occurred for almost a century. The first commercial electrosurgical instrument was developed in William T. Bovie, with its implementation following closely in 1926. This first example of surgery was performed by famed neurosurgeon Harvey Cushing and involved the removal of mass from a patient’s head.

Bleeding had been a considerable obstacle prior to the introduction of Bovie’s device, and its use in surgery marked a very important milestone. Bovie used the knowledge that electric current generated above certain frequencies was capable of cutting tissue without inducing muscular contraction, which allowed for far less risky procedures.