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Electrosurgery , Electrocoagulation , Electrofulguration , Electrodesiccation , Electrosection , Electrocautery. Electrosurgery: use of electricity to cause thermal tissue destruction, most commonly in the form of tissue Dehydration coagulation vaporization .
ionizes an electrically conductive medium, usually
isotonic saline solution, which transmits heat to cause superficial epidermal and dermal damage with minimal collateral tissue destruction.
resistance to the passage of high-frequency alternating current converts electrical energy to heat, resulting in thermal tissue damage.
Heat generation occurs within the tissue, while the treatment electrode remains 'cold'.
This method includes :
Electrocautery: in which direct or high-frequency alternating current heats an element, which causes thermal injury by direct heat transference.
The thinner the electrosurgical tip (i.e. decreasing the cross-sectional area of the conductor, A), the greater the current density, j, at the point of electrode contact.
High current density results in greater tissue injury, and is the basis of surgical diathermy
sufficient amount decrease current density to a level of
nondestructive tissue warming.
to impede the passage of an electric current, and is measured in ohms.
Identify: cardiac pacemakers or implantable cardiodefibrillators
May dysfunction in the presence of electromagnetic radiations
(risk of ignite)
Use moist packing over anus to prevent ignition of methane
Monopolar v.s Bipolar is not correct for electrosurgery because we use alternating current :
It is correct for electrolysis that use direct current
'mono-' and 'bi-' terminal : the number of treatment electrodes used in electrosurgery.
electrodes are used for this purpose.
Second electrode: an indifferent electrode, serving to complete an electrical circuit that begins in the electrosurgical unit, flows through the patient, and then returns to the unit.
electrodesiccation and electrofulguration, are monoterminal:electrons are
dispersed randomly to the environment,
use markedly damped, high-voltage, low-amperage current in a monoterminal
fashion to produce superficial tissue destruction
Electrodesiccation: the electrode contacts the skin and superficial skin dehydration occurs as
a result of Ohmic heating
usually heal rapidly with minimal scarring
Because of their low amperage, electrodesiccation and electro fulguration are best suited for superficial and relatively avascular lesions, such as verrucae and seborrheic keratosis.
In electrocoagulation, one applies and slowly moves the electrode across the lesion until slightly pink to pale coagulation occurs.
deep destruction provided by electrocoagulation results in scarring, and this should be noted when discussing therapeutic alternatives with the patient.
directly to the bleeding vessel, or by using biterminal forceps.
With either method, the heat generated seals the vessel by fusion of its collagen and elastic fibers, and the operative field must be dry for maximal efficacy.
It is useful for vascular lesions such as PG
electrosection requires almost no manual pressure from the operator because the electrode glides through tissue with minimal resistance.
likely too high.
likely too low.
alternating current to heat a surgical tip to cause tissue desiccation, coagulation, or necrosis by direct heat transference to tissue.
use the minimum power setting necessary to achieve the desired effect
carbonized tissue, which decreases current density and insulates against current flow, thereby reducing cutting and coagulation effect.
often useful to combine routine electrosurgery with other surgical modalities (e.g. use of a scalpel, curette or scissors to remove the bulk of a large lesion before use of electrosurgery to treat the base).
the operative field should be dry because current flowing from the electrode is diffused by blood.
amount of tissue necessary to seal the vessel
Another problem during electrocoagulation is an apparently sudden decrease in power. Instead of increasing the power setting:
confirm good contact between the indifferent
electrode and the patient to ensure adequate current drainoff,
Incisions made with electrocoagulation should be avoided because animal
they are associated with higher postoperative infection rates than incisions made with a scalpel or with electrosection
excision, however, wire loop electrodes may be used to remove tissue efficiently
Reports of impaired wound healing and increased postoperative infection rates associated with early model electrosection units have discouraged the widespread use of electrosection for skin incision.
decreased postoperative pain
than conventional scalpel surgery, while providing
comparable postoperative wound healing and infection rates.
Superficial electrosurgical wounds heal well by second intention with basic wound care principles-specifically, cleansing with hydrogen peroxide or saline daily followed by application of an antibiotic ointment and protective dressing.