First Year Fellows Endoscopy Course (August 4-5)

3-Electrocautery

Pdf Summary

Electrocautery is a potentially dangerous tool used in endoscopy that produces high-frequency alternating current. It is used for tissue heating or diathermy. During electrosurgery, the patient isn't electrocuted because the therapeutic basis of electrosurgery is the production of heat at a cellular level. Heat is produced through high-frequency alternating current that flows through tissue. There are different temperature/thermal effects achieved by changing the waveform. Cutting tissue requires higher voltage and high current density, while coagulation requires lower voltage and lower current density.<br /><br />The tighter the snare, the more focused the energy and higher the current density. Snare closure and transection are important in procedures like polypectomy and sphincterotomy. There are two types of electrosurgical procedures: bipolar and monopolar. Bipolar procedures have no current through the body and use a device that carries delivery and return electrodes to affect contact tissue. Monopolar procedures require a grounding pad and have the current conducted by the body.<br /><br />When using a grounding pad, there are several rules for safety, including ensuring the area is clean and dry, avoiding bony prominences, and placing the pad close to the electrosurgical site. Hair increases resistance and builds current density. Pad placement should be on a well-vascularized area, ideally on the flank or thigh. The grounding pad should be placed away from EKG electrodes and precautions should be taken in patients with pacemakers or ICDs.<br /><br />Argon Plasma Coagulation (APC) is a non-contact technique that delivers monopolar current to the tissue using ionized argon gas. It is used for various applications such as treating vascular ectasias, tissue ablation, and adjunctive therapy for fistula closure. The physician should have a good understanding of electrical concepts and how to set up the equipment. It is important to know and be familiar with the current generator and electrocautery devices being used.

Keywords

Electrocautery

Endoscopy

High-frequency alternating current

Tissue heating

Diathermy

Electrosurgery

Cellular level

Temperature/thermal effects

Bipolar procedures

Monopolar procedures