Electrosurgery--Part 3. Uses of electrosurgery.
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Electrosurgery↗
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Electrosurgery--Part II. The principles of electrosurgery.
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Electrosurgery↗
Electrosurgery--Part 4. The hazards of electrosurgery and principles of safe use.
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Electrosurgery↗
Pulpal and periodontal effects of electrosurgery involving cervical metallic restorations.
The pulpal and periodontal effects of electrosurgery involving teeth restored with Class V cervical amalgams and nonrestored teeth were evaluated in three cynomolgus monkeys. Electrosurgical current was delivered for 1 second with a fully rectified unit at an output intensity consistent with normal clinical usage. Experimental conditions included electrosurgery involving restored teeth, electrosurgery involving unrestored enamel, restored teeth not subjected to electrosurgery, and teeth which were neither restored nor subjected to electrosurgery. No pulpal or periodontal tissue changes were observed in the latter three groups of teeth. Electrosurgery involving cervical restorations consistently resulted in coagulation necrosis of the pulp and extensive resorption of cementum, dentin, and interradicular bone in the furcation area of multirooted teeth. The results suggest that inadvertent contact with cervical restorations during electrosurgical procedures may endanger both the pulp and the periodontal attachment apparatus.
Animals↗
Monitoring instrumentation. Isolated inputs, electrosurgery filtering, burns protection: what does it mean?
1. 50Hz Interference : the patient's body acts as can an antenna picking up several volts of 50 Hz noise from the power line. Differential amplifiers are the key separating the 1 mV E.C.G. signal wanted from 50Hz. Further reduction of this interference is possible with the help of high input impedance amplifiers and proper electrode techniques. 2. Isolated inputs : electrodes internal to the body give rise to potential hazards. Isolated inputs prevent dangerous currents from flowing directly through the patient to ground, should he come into contact with 50Hz AC power. Even micro-shocks caused by leakage currents as low as 50 micro-amps are prevented. These can cause ventricular fibrillation when applied directly to the heart. 3. Electrosurgery interference : electrosurgery machines generate high frequency signals with amplitudes of several hundred volts. This interference is minimized by low-pass filtering, shielding of the input circuitry and using proper monitoring and electrosurgery techniques. (Electrodes, cables, monitor and electrosurgery machine positioning). 4. Patient burns protection :isolated inputs do not protect against high frequency eleectrosurgery currents. Burns occur if the normal return path is interrupted and the current flows to ground through the monitor. Burns can be prevented by making sure that the patient is in intimate contact with the return patient plate, by using high frequency blocks (chokes) close to the E.G.C. electrodes sites and by using isolated-output electrosurgery units. 5. Monitor protection against damage from defibrillator pulses and electrosurgery currents : very sensitive input amplifiers must be able to survive up to 6,000 volt levels. 6. Battery powered monitors have a unique problem : Lack of a connection to ground. Whereas this is most often considered a safety advantage, it can be a hazard if the patient or operator becomes the link from the equipment to ground for a dangerously high current. A very expensive cabinet design could eliminate the above hazard and make the battery powered monitor the ideal operating room instrument.
Burns, Electric↗
The effect of technique on histology of arthroscopic partial meniscectomy with electrosurgery.
Fifty-one patients had arthroscopic partial meniscectomies with electrosurgery between 1982 and 1985. Two patients who had undergone prior meniscectomies with electrosurgery had biopsies of the old excision site at repeat arthroscopy, necessitated by new injuries. Three different combinations of electrocautery tips and either a standard electrocautery generator or a new electrocautery generator specifically designed for arthroscopic electrosurgery were used in different combinations. Depth of damage as defined by the Trichrome stain was measured by a micrometer. A rating summary of the quality of resection technique was also performed. Overall, the newly developed electrocautery generator and the newly developed electrocautery tips were not beneficial in reducing the depth of damage. The average depth of damage was .29 mm. Forty-seven percent of patients showed no histologic evidence of damage from the electrosurgical resection. The two individuals with repeat biopsies showed normal histology. Arthroscopic partial meniscectomy with electrosurgery causes a very thin layer of tissue damage. This appears to resolve with time. Recently developed instruments specifically designed for arthroscopic electrosurgery do not appear to decrease the depth of damage.
Adolescent↗
A comparative analysis of adhesion reduction, tissue effects, and incising characteristics of electrosurgery, CO2 laser, and Nd:YAG laser at operative laparoscopy: an animal study.
In this study, the relative efficacy and tissue effects of lasers and electrosurgery at operative laparoscopy were evaluated. Thirty rabbits underwent surgical procedures to create extensive intraperitoneal adhesions. The animals were then randomly assigned to laparoscopic adhesiolysis utilizing either electrosurgery, CO2 laser, or Nd:YAG laser exclusively for the assigned group. Each surgical tool was utilized at its optimal power density to achieve the best results. The depth of thermal injury on ovarian and uterine tissues, and the speed at which various segments of the uterine horn were transected were also compared. All three modalities significantly reduced (p < 0.01) intraperitoneal adhesions by approximately 50%. The depth of thermal injury was threefold greater with the Nd:YAG laser than either electrosurgery or the CO2 at both ovarian and uterine tissues (p < 0.001). The speed of transection across the uterine horn was significantly slower (p < 0.001) with the Nd:YAG (2.6 +/- 0.3 sec) than either the CO2 laser (1.4 +/- 0.2 sec) or electrosurgery (1.5 +/- 0.2 sec). From this study, the authors conclude that the Nd:YAG laser causes more tissue damage and is less efficient at incising tissue than either CO2 or electrosurgery, but that all three modalities are equally effective for laparoscopic adhesiolysis.
Animals↗
A method to measure operating variables in electrosurgery.
Variables affecting tissue response to electrosurgical wounding have been identified and discussed. An electronic measuring device was designed and built to record actual power generated at the active electrode during surgical use of an electrosurgery instrument. In addition, this electronic device measures the amount of time the active electrode is in contact with tissue. Coupled with an electrosurgery unit producing a documented waveform and an electrosurgery electrode having a controlled-depth gauge, variables affecting tissue response to electrosurgery wounding may be measured.
Electricity↗
The status of electrosurgery in dermatologic practice.
A survey was made of the electrosurgical practices of the members of the American Society of Dermatologic Surgery. Results showed that the majority prefer the traditional electrosurgical units, with the Hyfrecator (Birtcher Corp.) being by far the most popular. The most common forms of high-frequency electrosurgery are electrocoagulation and electrodesiccation. Very few dermatologists use cutting current, although many own machines with this capability. The majority do not use a strict sterile technic when performing electrosurgery. However, there appears to be an increasing awareness of contamination risks, and many dermatologists have started using disposable or sterilizable treatment electrodes. High-frequency electrosurgery is by far the most common method of electrosurgery. Electrocautery and surgical galvanism are very rarely used.
Dermatology↗
In-vivo studies of uterine electrosurgery.
OBJECTIVE: To study the effects of electrosurgery on the living human uterus. DESIGN: Prospective observational study. SUBJECTS: Nine women with recurrent refractory dysfunctional uterine bleeding, listed for hysterectomy. INTERVENTION: Experimental endometrial resection on patients immediately prior to hysterectomy. MAIN OUTCOME MEASURES: The influence of power output, duration of exposure and repetition of consecutive surgical applications on the size of the zone of thermal necrosis in uterine tissue. RESULTS: Resection of the endometrium was associated with a narrow zone of thermal necrosis of between 0.69 and 0.76 mm which was not dependent on power output. Duration of exposure, however, was directly related to tissue necrosis (1.44 vs 1.88 mm for 1s and 5s, respectively). Coagulation by pin-point desiccation caused a zone of thermal necrosis of 3.30-3.77 mm that was independent of either power or duration of exposure to electrical energy. Thermal transmission through the uterus in situ, during electrosurgery was minimal, the maximum recorded rise in temperature from the baseline was 0.4 degrees C. The differences between the in vitro and in vivo effects of electrosurgery are highlighted and the possible reasons for these differences explored. CONCLUSIONS: The potential for unwanted thermally-induced damage to the uterus is small.
Electrosurgery↗
Excisional electrosurgery (endothermy) in dermatology.
The physical characteristics of electrosurgery are reviewed and the peculiar behavior of the cutting current is described. The indications for excisional by electrosurgery are discussed and the procedure is described. The advantages and disadvantages of the method are given. It is concluded that the overall results of excisional electrosurgery compare very favorably with other surgical procedures on the skin.
Basal Cell Carcinoma↗
A comparitive study of the healing of wounds made by scalpel and electrosurgery in rabbits.
A study in the rabbit of the healing of wounds made by electrosurgery and scalpel showed less damage to the tissues arose with the scalpel and healing was more advanced at 24 and 48 hours. More extensive bleeding occurred when electrosurgery was used on the tongue. At 72 hours extensive fibrous tissue was seen but infiltration with inflammatory cells was heavier where electrosurgery was used. Epithelium had covered all wounds at seven days but basal cell layers were not complete and papillae had not reappeared on the tongue.
Animals↗
Electrosurgery-induced endotracheal tube ignition during tracheotomy.
Electrosurgery was the most common source of ignition for operating room fires prior to the advent of lasers. When combined with volatile anesthetic mixtures, electrosurgery has caused ignition of plastic, rubber, paper, enteric gases, and combustible preparation solutions. We report on an intubated patient whose polyvinyl chloride endotracheal tube ignited during a tracheotomy performed with an electrosurgical unit. The oxygen-rich environment, the polyvinyl chloride tube, and the heat generated by the electrosurgical unit combined to produce a fire. Since otolaryngologists are called upon often to perform tracheotomies on intubated patients, it is imperative that they understand the factors involved in the development of such a fire. This case is presented with an explanation of why this type of fire occurs. A brief review of the literature is included. Different kinds of electrosurgical units, precautions as to their use, and the management of electrosurgery-induced endotracheal tube fires are also discussed.
Child, Preschool↗
Laparoscopic cholecystectomy: laser versus electrosurgery.
Laparoscopic cholecystectomy has been reported to be a safe and effective way to remove a diseased gallbladder with essentially no morbidity or mortality (1,2). This procedure was first introduced in Europe using electrosurgery, and later introduced in the United States using the laser (1). No clinical trial compares the laser to the standard electrosurgery method. In a review, as well as an ongoing study, morbidity, mortality, intraoperative procedures, indications, and cost effectiveness are considered in these two groups. Three hundred cases were reviewed with 150 patients in each group. There were no deaths or significant complications in either group. In the laser group, bleeding seemed slightly more excessive during removal of the gallbladder from the liver bed and required more time to control. The electrosurgery group required slightly less operative time and was less costly. The postoperative recovery time was the same in each group.
Activities of Daily Living↗
Fundamentals of electrosurgery.
Electrosurgery uses electricity to remove tissue, coagulate bleeding, or destroy tumors. Modern units, first developed for application in neurosurgery, are now available in office models that are most commonly used by the family physician for cutaneous surgery. Electrosurgery can accomplish cutting, coagulation, desiccation, and fulguration. Electrosurgical equipment for the office is relatively inexpensive and portable. The main advantage of this surgical modality is rapid completion of the procedure with minimal surgical time, because hemostasis occurs at the time of the incision. After some basic instruction and initial practice on animal tissue, which are provided through the guidance of several excellent texts or continuing education courses, the family physician can readily apply electrosurgery in an office-based practice safely, efficiently, and with satisfying results.
Clinical Protocols↗
Direct-current potentials created by arcing during monopolar radiofrequency electrosurgery.
Muscle and nerve stimulation during radiofrequency electrosurgery has been a well-known phenomenon for over 50 years. However, as electrosurgery expands into new procedures, such as tissue ablation in the heart, the mechanism of the potentially deleterious stimulation becomes more important. This article presents data showing that large DC currents are generated during electrosurgery and that these potentials increase with increasing sparking at the active electrode. The data also show DC potentials generated by various generators, different operation modes (cut, coagulation, fulguration), and operations on tissues of various impedances.
Electric Conductivity↗
Self-sterilization of the electrosurgery electrode.
Sterilization of the electrode used in electrosurgery has been assumed to occur at the instant of contact of the energized electrode tip to a grounded source. This study evaluated whether the time of electrode activation or the amount of energy delivered is important in the self-sterilization process. Standard bacteriologic culturing techniques were employed to assess sterility of the electrode tip following activation. Total time of application of the current and the energy used were recorded on audiotape and later tabulated. The data indicate that the time of energizing and the energy units used are critical in the sterilization of the electrode tip. These results confirm that self-sterilization of the electrosurgery electrode tip occurs, but full confidence is not realized with the time intervals commonly employed in clinical practice. The electrode tip must be considered a potential source of bacterial contamination of electrosurgically managed dental procedures.
Electric Conductivity↗
Education and engineering solutions for potential problems with laparoscopic monopolar electrosurgery.
The potential problems of monopolar electrosurgery relate to unrecognized energy transfer ("stray current") outside the view of the laparoscope. Mechanisms of stray current and unrecognized tissue injury include: (1) insulation breaks in electrodes; (2) capacitive coupling, or induced currents through the intact insulation of the active electrode to surrounding cannulas or other instruments; and (3) direct coupling (or unintended contact) between the active electrode and other metal instruments or cannulas within the abdomen. Capacitive coupling poses the greatest risk for injury when the outer conductor (trocar cannula or irrigation cannula) is electrically isolated from the abdominal wall by a plastic nonconductor. Capacitive coupling is increased by the coagulation mode (versus cut), open circuit (versus tissue contact with the electrode), 5-mm cannulas (versus 11 mm), and higher voltage generators. The safety of electrosurgery can be enhanced by surgical education regarding the biophysics of radio frequency electrical energy, technical choices in instruments using all-metal cannula systems, and engineering developments with a dynamically monitored system for insulation failure and capacitive coupling.
Electric Conductivity↗