The Basics of Using the Electrosurgical Cautery Machine

To perform unipolar electrosurgery correctly, a complete circuit is required, including: electrodes, patient, return electrode (ground plate), and electrosurgical generator (ECH). An electrocautery device (Bovie, moxibustion, or electrosurgical device) (Figure 23-35, A) uses high-frequency electrical energy to cut tissue or coagulate bleeding. Electrosurgery involves the use of high-frequency alternating current to cut, shock, dissect, ablate, or coagulate tissue.

Both methods differ from electrocautery in that they absorb electrical current through the tissue rather than using it to heat an electrode to be placed at a specific point in the tissue. As mentioned above, electrosurgical devices use alternating current to achieve the frequency required to cut and coagulate tissue. In monopolar mode, the patient is connected to a grounding pad from the electrocautery unit, and the electrosurgical "pencil" is used to close the circuit through the patient when it touches the bleeding tissue (Fig. 23-35, B). HF electrosurgery is performed using an HF electrosurgical generator (also known as an electrosurgical unit or ESU) and a handpiece that includes one or two electrodes: a monopolar or bipolar instrument.

Modern electrosurgical equipment is equipped with built-in safety features to prevent burns caused by poor contact between the patient and the return electrode when using monopolar mode. The current oscillates between the active electrode and the dispersive electrode, with the entire patient sandwiched between them. Electrocautery refers to direct current (electrons flow in one direction), while electrosurgery uses alternating current.

Surgeons use pointed or blade-like electrodes called "active electrodes" to contact tissues and induce tissue effects...vaporization and linear propagation, called electrosurgical incisions, or combined seals for drying and protein coagulation. A blood vessel used to stop bleeding. Electrocoagulation uses electric current to heat a wire and then applies it to the target tissue to burn or solidify a specific area of ​​the tissue. For high-throughput surgery during anesthesia, the monopolar mode relies on good electrical contact between a large area of ​​the body (usually at least the entire back of the patient) and the return electrode or pad (also called dispersion pad) or patient plate). In simple terms, the working principle of electrosurgery is to concentrate the current on the active electrode to achieve the desired tissue effect, and to dilute the current on the scattering (returning) electrode when used to prevent unnecessary burns.

In a bipolar electrosurgical circuit, there are no discrete electrodes, and current only flows in the tissue between the two jaws of the bipolar instrument, so a low voltage with a 100% duty cycle (cutting waveform) is used (Figure 3). Since current will flow from the electrosurgical device through the patient, the patient must be properly grounded to avoid electric shock. At high frequencies (100 kHz to 5 MHz), alternating currents of various voltages (200-10,000 volts) pass through the tissue to generate heat. Although in some cases electrical devices that produce heated probes can be used to cauterize tissue, electrosurgery and electrocautery are a different technique.

Heat is generated by the tissue's resistance to electrical current, and the tools used to deliver current are electrodes, including blades, round balls, needles, and ring configurations. Although electrocautery is a form of electrosurgery, it is inappropriate to refer to electrosurgical techniques that use a cold electrode tip as electrocautery. Modern high-frequency electrosurgical devices transmit electrical energy to human tissues through an electrode for cold treatment. Electrocauterization involves passing a direct or alternating electric current through a wire electrode, which heats it up.

In monopolar electrosurgery, current travels from an electrode in the handpiece through the body to a dispersing pad, which sends the current back to the generator. However, the term electrosurgery is commonly used to describe operations that use alternating current to cut and coagulate tissue. Electrocauterization, also known as thermal moxibustion, refers to the process in which a DC or AC current is passed through a durable metal wire electrode, generating heat.

Due to the use of larger active electrodes in contact mode, the three main waveforms can cause drying and condensation at low current densities. In electrocautery equipment, direct current is usually used to heat the metal object at the end of the tip, which is then used for cauterization. It is not synonymous with electrocautery. It is moxibustion. It uses electric heating equipment instead of passing electricity through the tissue being burned. Although the slice waveform (continuous) is usually used for tissue cutting, the fusion and coagulation waveform (discontinuous) can also be used for cutting to obtain high current density by increasing the power output or reducing the size of the active electrode.

The raised portion of the pyogenic granulomas can be shaved off with a scalpel or ring electrode using cutting / coagulation current. Patient supervisors should not touch the patient while using the electrosurgical unit, as they may be subject to shock. During electrocautery, current does not pass through the tissues or body as in electrosurgery. Electrosurgery is the surgical application of high-frequency electricity to heat tissue by evaporation, drying, coagulation, and electric shock.

In electrocautery, the tip of the electrode, not the human tissue, acts as a source of electrical resistance. During electrocautery, the tip of the electrode overheats and can cause tissue burns. Electrosurgical units have several functions and electrodes that differ depending on the surgical application. Compared to electrosurgery, electrocautery does not require a closed circuit and does not pass current through the body.

Alternatively, you can use a medical oscilloscope to show the actual waveform of the device under test (DUT). One of the best ways to reduce learning curves for infrequently used testing tools and new or rarely planned tests is to standardize the procedure. Most manufacturer's performance verification procedures require electrical safety checks, including ground wire resistance and chassis leakage. A specific standard for electrosurgical devices, IEC 60601-2-2, specifies the maximum levels of radio frequency dispersion and specifies the elements and their locations for these measurements.