First Year Fellows Endoscopy Course (Aug 8-9)

3-Electrocautery
Pdf Summary
Electrocauterization is an important tool used in endoscopy, but it can also be potentially dangerous. It is important to understand the basic terms and principles of electrocautery. Current refers to the flow of electrons, voltage is the force pushing the current through a resistance, and current density is the amount of current flowing through a given area. Electrocauterization works by producing heat at the cellular level, which is achieved through high-frequency alternating current flowing through tissue. The heat produced can be used for cutting or coagulation, depending on the voltage and current density used. The different temperature/thermal effects can be achieved by changing the waveform. It is important to note that above 350kHz, there is only a thermal effect, meaning there is no risk of electrocuting the patient. Electrocautery units come with different settings and options, including monopolar and bipolar circuits, and it is important to become familiar with the unit and its settings for different procedures. The grounding pad completes the electrical circuit and disperses the current, and its placement should be clean and dry, avoid bony prominences, and be as close to the electrosurgical site as possible. Hair can increase resistance and build current density, so it is important to avoid tenting. When using electrocautery in patients with pacemakers or ICDs, caution should be taken, and consultation with a cardiology specialist may be necessary. Argon plasma coagulation (APC) is a technique that uses ionized argon gas to deliver monopolar current to the tissue for coagulation and ablation purposes. APC has advantages such as non-contact delivery, even and uniform coagulation, and thinner eschar. The physician should take responsibility for understanding the electrical concepts and setting up the equipment properly.
Keywords
Electrocauterization
Endoscopy
Current
Voltage
Heat
Cutting
Coagulation
Waveform
Thermal effect
Argon plasma coagulation