First Year Fellows Endoscopy Course (July 28-29)

3-Electrocautery

Pdf Summary

Electrocautery is a potentially dangerous tool used in endoscopy. It works by producing high frequency alternating current, which heats the tissue at the cellular level. The heat produced by the current is what allows for cutting and coagulation of tissue. Different temperature and thermal effects are achieved by changing the waveform. The resistance to the flow of current is determined by the conductor or insulator material the current passes through. The tighter the snare, the more focused the energy and higher the current density. There are two types of electrocautery: bipolar and monopolar. Bipolar electrocautery does not pass current through the body and requires no grounding pad, while monopolar electrocautery conducts current through the body and requires a grounding pad. When using a grounding pad, it is important to follow safety guidelines such as keeping the area clean and dry and avoiding bony prominences, prosthetics, and scars. Placement of the grounding pad should be on a well-vascularized area, ideally on the flank or thigh, and kept away from active electrocardiogram electrodes. Special precautions should be taken for patients with pacemakers and implantable cardioverter-defibrillators (ICDs), and an arrhythmia specialist should be consulted. Argon plasma coagulation (APC) is a non-contact method of delivering monopolar current to tissue and has advantages such as seeking the best area of conductivity, even and uniform coagulation, and thin eschar formation. It can be used in various applications such as treating vascular ectasias and tissue ablation. Physicians should have a good understanding of electrical concepts, know how to set up the equipment, and take responsibility for ensuring patient safety during electrocautery procedures.

Keywords

Electrocautery

Endoscopy

Tissue heating

Cutting and coagulation

Bipolar electrocautery

Monopolar electrocautery

Grounding pad

Safety guidelines

Argon plasma coagulation

Patient safety