Overview of Electrosurgery
Electrosurgery is a procedure often used in skin surgeries. During electrosurgery, electrical energy is used to either superficially or deeply cut or coagulate, that is, stop bleeding by creating blood clots. The skin doesn’t conduct electricity well. When energy is applied to the skin, it builds up and turns into heat. Exactly what happens during electrosurgery depends on the specific type of electrical energy being used. The energy can do things like dry up the tissue, stop bleeding, or cut the skin.
It was Harvard physicist William Bovie who made a major breakthrough in the field of electrosurgery. He designed a machine that could both cut the tissue and stop the bleeding. Back in the 1920s, a brain surgeon used his device to control bleeding during operations. Today, this has become such a cornerstone of surgery that the electrosurgery tools and even the act of performing electrosurgery are often referred to as “bovie”.
In the field of dermatology, or skin health, electrosurgery comes in several forms. These range from electrocautery and electrofulguration, both designed to stop bleeding, to electrodesiccation, which dries up the tissue, and biterminal electrocoagulation, which does both. Some dermatologists may also use electrolysis, which removes hair, and electrosection, which cuts the skin.
Why do People Need Electrosurgery
Electrosurgery is a procedure used to treat a variety of skin issues, and there are different methods used for different conditions. For example, if you only have a problem with the outer layer of your skin, a technique called electrodesiccation can be used. This uses a special device to dehydrate the affected skin, causing very minor damage that tends not to leave scars. There’s also another method called electrofulguration. In this technique, the device is held away from the skin, creating a spark that damages the skin’s surface in a controlled way. Both of these techniques are typically used by skin doctors or dermatologists to treat a range of conditions.
Electrofulguration or electrodesiccation can be used to treat skin conditions like skin tags, actinic keratosis (scaly patches caused by sun damage), small blood vessel growths (angiomas), nevus (moles or birthmarks), seborrheic keratosis (growths that can look like warts), flat warts (verruca plana), or to stop minor bleeding during surgery.
For more severe issues, a technique called electrocoagulation can be used. This method is used to treat conditions like angiofibromas (small, benign tumors), types of skin cancer (basal cell carcinoma, Bowen’s disease, squamous cell carcinoma), the removal of an ingrown toenail, eruptions due to overactive oil glands (sebaceous hyperplasia), arterial bleeding, benign skin tumors (such as syringoma, trichoepithelioma), or typical warts (verruca vulgaris).
Finally, electrosection can be used when cuts or removal of skin are needed. It’s often used for conditions like acne keloidalis nuchae (a condition causing keloid scars on the back of the neck), eyelid surgery, rhinophyma repair (a skin condition affecting the nose), scar revision, and removing benign skin lesions. Electrosection provides the advantage of immediate bleeding control as the cuts are made. However, this method also creates a smoke plume, which can slightly affect indoor air quality and cause a smell that may be unpleasant for the patient.
When a Person Should Avoid Electrosurgery
Although not entirely prohibited, there’s a heated discussion about using electrosurgery (surgery that uses electrical energy) on patients with heart pacemakers or a device called an implantable cardiac defibrillator (ICD) which gives the heart electric shocks when needed. The issue arises because the electrical energy used during the surgery might disrupt the work of these devices. This disturbance can lead to effects like missed heartbeats, the ICD giving unnecessary shocks, a slow heartbeat, or even heart stoppage. It could also reprogram the pacemaker unintentionally. Even though most of today’s implanted devices are designed to block out external electric signals, there’s still a slim chance of interference.
For patients with these heart devices, surgeons are advised to keep the electrosurgery as brief as possible, not exceeding 5 seconds, and to keep the power low. They should avoid using a certain mode specifically for cutting tissue, and steer clear of the area close to the heart device. Also, by focusing the electric current on a really small area, such as using an instrument called bipolar forceps, the risk is minimized. In the field of skin treatments, no instances of disturbing a pacemaker or ICD have been recorded.
For patients at high risk, surgeons should use a special type of cautery that doesn’t involve electric current, thus eliminating any risk of interference with the heart devices. This method might cause a bit more tissue damage, but it is safer for these patients. Magnets can also be handy in lower-risk operations. When placed over a heart device, a magnet can make it ignore all electric signals and work at a fixed rate, making it safe during the surgery.
Equipment used for Electrosurgery
When a doctor performs electrosurgery, they need certain equipment. This includes the electrosurgical device, which is the main machine used in the procedure. They also use sterile sleeves that are placed over the handle of this device, and disposable tips for the electrode, which is a part that carries electricity to the body.
Another important piece of equipment is a smoke evacuator. This is a system that sucks up and removes the smoke that can be produced during electrosurgery. This is an important safety measure because the smoke can change genetic material in a harmful way. That’s why doctors must have all these tools on hand when performing electrosurgery.
Who is needed to perform Electrosurgery?
To use an electrosurgical device, you need specific medical professionals. This includes an operator who has been specially trained on how to use this device. They are supported by surgical assistants, who are also part of the team. Their job is to provide any required help during the process. This equipment is important in some surgeries and these professionals make sure it’s used correctly and safely.
Preparing for Electrosurgery
Before demonstrating an electrosurgical procedure, it’s crucial to sanitize the area around the surgery with a disinfectant like chlorhexidine or povidone-iodine. Alcohol should be used with caution as it can cause a fire if it’s not fully dried before the procedure starts. Before the procedure begins, painkillers should be given, unless you’re dealing with a minor issue like small facial veins. For more intense procedures like nose surgery, a nerve block, or treatment to numb a certain area, could be more beneficial.
During the procedure, the surgeon should make sure that sterile covers are used to protect the wand handle, and fresh disposable tips for the electrode should be used. Both the surgeon and their assisting team should wear protective items like eye protection, gloves, and masks. This is to prevent any exposure to potentially harmful microbes or altering substances that could be present in the smoke produced during the surgery. A smoke-clearing machine should be on standby to get rid of smoke from the procedure area.
A smoke-clearing machine with a strong air filter and a high suction speed that falls between 100 to 150 feet per minute is usually recommended. The smoke-clearing machine should be positioned very close, within 2 inches, to the surgery area to effectively capture airborne particles.
Before starting, the surgeon should carefully identify the correct setup based on the specific surgical procedure to be carried out.
How is Electrosurgery performed
Electrocautery, a technique invented in 1875, was the first step towards modern electrosurgery. It’s important to understand that these two terms aren’t the same. The basic difference lies in the type of electricity that’s used. In electrocautery, direct current is used. This means electric current continues to flow in one direction around the circuit, like how a battery works. This method is designed to stop bleeding through a metal wire that resists the electricity flow and generates heat. This can sometimes harm the tissues around the area and slow the healing process. It’s often used, however, for patients who have a pacemaker or defibrillator as it doesn’t disrupt the function of these devices.
In 1907, two doctors, Walter de Keating-Hart and Pozzi, developed a new approach named “fulguration.” It’s a process that uses heat created by electricity to treat skin without directly touching it with an electrode, a device that conducts electricity. They found that this method could kill tumor cells by cutting off their food supply. Later, in 1911, another method named “desiccation” was introduced by William Clark, which dries out the tissue using small sparks of electric energy.
Techniques like electrodesiccation and electrofulguration are usually used for skin conditions that affect only the outermost layer. Electrodesiccation uses a high-voltage spark that dehydrates the tissue it contacts, while electrofulguration works at a small distance from the tissue, causing superficial damage by creating a layer of carbon that protects deeper tissues from heat. This electrical current is shallow, so it can’t seal nearby blood vessels.
A few years later, in 1909, Doyen introduced electrocoagulation, a technique that used the electricity to touch the tissue directly. This method claimed to destroy tumor cells more effectively. Electrocoagulation might result in greater tissue damage because it penetrates deeper than electrodesiccation or electrofulguration. This technique can stop bleeding through two methods. One method involves directly touching the bleeding vessel with an electrode. The other involves using an electrode to touch forceps, a kind of surgical tool, that have been clamped on the bleeding vessel.
Electrocoagulation can also be used to simultaneously cut and stop bleeding, which can’t be done with other electrosurgery techniques. The “cutting” method involves using a undamped or uncontrolled electrical current that can vaporize tissue without stopping bleeding. A variety of electrodes can be used in this method, and the most commonly used one is a straight, narrow electrode for skin incisions. This technique causes some tissue charring around the cut area due to the high heat used.
Possible Complications of Electrosurgery
When doctors use electrosurgery (a type of surgery that uses electrical current), there can be some complications like delayed bleeding and scarring with lighter patches of skin. But, you don’t need to worry too much – if there’s delayed bleeding, it can usually be stopped by applying constant pressure to the wound area for about 20 minutes.
Other possible issues include things like risk of fire, burns from heat, catching an infection from the electrode used in surgery, or even breathing in smoke. The chance of fire can increase if there’s alcohol, oxygen, or bowel gases nearby. For example, aluminum chloride, which is often used for controlling bleeding, can contain around 90% alcohol. That’s why it’s crucial for the doctor to make sure the area is thoroughly dried before starting electrosurgery. They also need to be extra careful when working near the rear end due to flammable gases present in the bowel.
Additionally, the smoke created by electrosurgery can contain harmful gases and leftover bits from cells, including parts that can cause disease. Doctors control this by using special machines that help them get rid of the smoke.
What Else Should I Know About Electrosurgery?
Electrosurgery is a technique often used in skin treatments, whether it’s for removing harmless or harmful growths or for cosmetic purposes like treating severe acne or other skin conditions. Electrodesiccation and scraping (curettage) are also frequently used in dermatology clinics to treat surface skin cancers like in-situ squamous cell carcinoma or basal cell carcinoma. These are both types of skin cancer
It’s important to know that these treatment methods are different and it’s crucial that the right one is used for each specific situation. This ensures that the surgery is effective and produces the best possible results for the patient.
