First Year Fellows Endoscopy Course (August 7 - 8)

3-Electrocautery

Pdf Summary

Electrocautery is a potentially dangerous tool used in endoscopy. It is important to understand the basic terms related to electrosurgery, such as current, circuit, voltage, and current density. The electrosurgical generator produces high frequency alternating current, which is why patients are not electrocuted during electrosurgery. The therapeutic basis of electrosurgery is the production of heat at the cellular level. Heat is produced by high-frequency alternating current passing through tissue, causing cells to boil and burst in cutting mode, or desiccate and shrink in coagulation mode. Different temperature/thermal effects can be achieved by changing the waveform. The resistance of tissues, conductors, and insulators affect the flow of current in the circuit. Electrosurgery can be performed using a monopolar or bipolar circuit, and grounding pads are used to complete the electrical circuit. Proper pad placement and avoiding hair are important for safety during the procedure. Specific precautions should be taken for patients with pacemakers and implantable cardioverter-defibrillators. Argon plasma coagulation (APC) is a technique that delivers monopolar current to tissue using ionized argon gas. APC offers advantages such as non-contact application, even and uniform coagulation, and thinner eschar. Factors to consider when using APC include intention (coagulation or ablation), anatomy, water content of tissue, probe type, distance from tissue, power and argon flow rate, and frequency of delivery. It is the responsibility of the physician to have a good understanding of the equipment and to be able to set it up correctly.

Keywords

Electrocautery

endoscopy

electrosurgery

current

circuit

voltage

heat production

monopolar circuit

bipolar circuit

argon plasma coagulation