Electrosurgery is a type of skin lesion removal method which is used to cut or excise tissue, as well as to control bleeding, and destroy benign and malignant skin lesions. Electrosurgery is a simple procedure that can be used to treat a wide range of skin lesions, particularly minor superficial lesions (skin tags and small angiomas).
Electrosurgery has four main methods: electrodesiccation, fulguration, electrocoagulation, and electrosection which are described later in the article. Modern, high-frequency electrosurgical devices use a cool treatment electrode to transfer electrical energy to human tissue. The majority of electrosurgical units operate at frequencies just below AM radio frequency band. Human tissue’s electrical resistance helps in the conversion of electrical energy to molecular energy, causing denaturation of intracellular and extracellular proteins, resulting in coagulation or desiccation effects. When intracellular water is heated over the boiling point, the cell membrane ruptures, resulting in a cutting effect.
Electrosurgery is frequently misunderstood as electrocautery. The electrode tip, rather than human tissue, is the source of electrical resistance in electrocautery. The electrode tip becomes hot during electrocautery, which can cause tissue burns. While electrocautery is a type of electrosurgery, calling electrosurgical procedures that employ a cool electrode tip is incorrect.
The different methods of electrosurgery1:
A fine needle, wire loop, diamond, elliptical, or triangle-shaped electrode tip is used to cut tissue in electrosection. It is slowly advanced into the tissue, allowing a steam envelope to form around the tip and generating a smooth cutting effect with little sense of pressure against the tissue by the operator. In other words, Electrosection makes use of a monopolar electrode to generate a low-voltage, high-amperage current at a higher power than electrocoagulation. The current is concentrated to vaporize tissue with little heat damage to the surrounding area.
Electrocoagulation is good for clotting small blood vessels (less than 2 to 3 mm in diameter) in deep and superficial surgery. Usually, a 2- to 5-mm metallic sphere at the end of a treatment electrode is the best tip for hemostasis of small vessels. These electrode tips can be put directly to the relatively dry surface of a surgical bed that has been compressed for a brief period of time, or indirectly by touching a hemostat or Adson’s forceps that is used to grab the little bleeder. Electrosection has major advantages, including the ability to do almost bloodless surgery and a reduction in treatment time. The best way to reduce blood loss is to combine electrosection and electrocoagulation currents, resulting in a partially damp current with great cutting and coagulating capacity1.
Electrodesiccation is a fast and easy office technique that involves superheating the skin with an electric current administered through a needle-shaped electrode. In electrodesiccation an active electrode touches or is inserted into the skin to cause tissue damage. Fine telangiectasias and spider angiomas can be treated with electrodesiccation.
The electrode is held away from the skin to produce a sparking at the skin surface and more shallow tissue destruction in fulguration. Fulguration is particularly effective in the treatment of superficial epidermal lesions, such as superficial basal cell carcinoma of the trunk. Electrodesiccation and fulguration are monoterminal methods, meaning they can be performed on a patient with a single treatment electrode. Because it requires two electrodes, electrosection is called a biterminal technique.
There are some complications involved in electrosurgery like any other surgeries like:
- If flammable elements such as alcohol, oxygen, or other gases are present near the treatment site, electrosurgery poses a risk of fire or explosion. Using nonflammable cleansers like chlorhexidine or povidone-iodine, can all help to reduce burns. Ensuring that the individual being treated is not in contact with metal items, and making sure that the electrode is not put over a bony prominence, scar tissue, or implanted metal is also important.
- Smoke-related injuries are nearly commonly found in laparoscopic procedures and are caused by impaired vision. Impaired vision causes the active electrode to make inappropriate contact with tissue, resulting in thermal damage.
- Various toxic components are present in the smoke released when the active electrode comes into contact with tissue. These include gases, such as benzene, nitriles, hydrocyanide and other hydrocarbons, and formaldehyde. Smoke also contains bodily fluids including blood, fatty acids, and viruses, all of which can spread illnesses2.
- The thermal energy also converts part of the blood to methemoglobin and carboxyhemoglobins. Despite wearing masks, these particles are easily inhaled. Various workplace health and safety organizations in many countries currently encourage, but do not necessitate, the use of suction equipment in operating theatres to evacuate such smoke2.
- Electric shock is also one of the risks which can be minimized by the used of plastic surgical gloves, and use of earthing and indifferent electrodes.
- 1.Hainer M.D. B, Usatine M.D. R. Electrosurgery for the skin. aafp.org. Published 2002. Accessed 2021. https://www.aafp.org/afp/2002/1001/p1259.html#afp20021001p1259-b1
- 2.Siddaiah-Subramanya M, Tiang KW, Nyandowe M. Complications, Implications, and Prevention of Electrosurgical Injuries: Corner Stone of Diathermy Use for Junior Surgical Trainees. Surg J. Published online September 14, 2017:e148-e153. doi:10.1055/s-0037-1606547