First Year Fellows Endoscopy Course (July 31 - August 1)

3-Electrocautery

Pdf Summary

Electrocautery is a potentially dangerous tool used in endoscopy. This summary provides information on basic electrosurgical terms, the production of heat in electrosurgery, the different effects on tissue temperature, and the use of electrocautery in endoscopy procedures.<br /><br />The electrosurgical generator produces high-frequency alternating current that is used for cutting and coagulation. It can be used in both monopolar and bipolar circuits. The patient is not electrocuted during electrosurgery because above a frequency of 350 kHz, there is only a thermal effect and no neuromuscular stimulation or formation of acids/bases.<br /><br />The therapeutic basis of electrosurgery is the production of heat at a cellular level. Heat is produced by high-frequency alternating current passing through tissue. Different temperature effects can be achieved by changing the waveform.<br /><br />Electrosurgery requires a complete circuit. In monopolar electrosurgery, the current is conducted by the body and a grounding pad is necessary to complete the electrical circuit and disperse the current. In bipolar electrosurgery, there is no current through the body and no grounding pad is needed.<br /><br />Pad placement for grounding should be clean and dry, close to the electrosurgical site, and avoid bony prominences, prosthetics, and scars. Hair increases resistance and builds current density, making it important to avoid tenting.<br /><br />For patients with pacemakers, proper precautions should be taken, and for patients with implantable cardioverter-defibrillators (ICDs), a magnet and external defibrillator should be available.<br /><br />Argon plasma coagulation (APC) is a non-contact method that uses argon gas to deliver monopolar current to the tissue. It can be used for vascular ectasias, tissue ablation, and as an adjunct to fistula closure. The settings for APC can be adjusted depending on the intention, anatomic considerations, water content of tissue, probe type, distance from tissue, power, argon flow rate, and frequency of delivery.<br /><br />It is important for physicians to understand the electrical concepts and how to set up the equipment for electrosurgery. Knowing the current generator and electrocautery devices is essential for safe and effective use.

Keywords

Electrocautery

Endoscopy

Electrosurgical terms

Heat production in electrosurgery

Tissue temperature effects

Monopolar electrosurgery

Bipolar electrosurgery

Grounding pad placement

Pacemakers and electrosurgery

Argon plasma coagulation (APC)