Electrocautery is a surgical technique used for tissue cutting, coagulation (sealing blood vessels), and tissue destruction through the application of high-frequency electrical current. There are two primary types of electrocautery: monopolar and bipolar.
Monopolar Electrocautery:
Principle: Monopolar electrocautery consists of a handheld device that delivers electrical current to the target tissue via an active electrode. The current flows from the active electrode, through the tissue, and returns to the generator via a grounding pad attached to the patient's skin at a distant site.
Settings and Indications:
- Cutting (Pure Cut): High-frequency current (typically 300–500 kHz) is applied continuously to generate heat, resulting in tissue vaporization and cutting. This setting is suitable for precise incisions in tissues with minimal blood supply, such as skin or subcutaneous tissue.
- Example Setting: Power level of 40–60 watts for skin incisions.
- Coagulation (Blend): Combines cutting and coagulation functions by alternating between high-frequency current bursts and low-frequency current. This produces both cutting and hemostatic effects, making it suitable for procedures requiring simultaneous incision and hemostasis.
- Example Setting: Power level of 40–60 watts for incisions with controlled bleeding.
- Desiccation: Continuous application of high-frequency current for tissue drying and superficial tissue destruction. Used for removing small lesions or tumors without significant bleeding.
- Example Setting: Power level of 20–40 watts for desiccation of skin lesions.
- Fulguration: Pulsed application of high-frequency current for tissue destruction and hemostasis. Suitable for coagulating small blood vessels and treating superficial lesions.
- Example Setting: Power level of 20–40 watts for coagulation of superficial bleeding.
Bipolar Electrocautery:
Principle: Bipolar electrocautery utilizes two closely spaced electrodes within the handheld device. The electrical current flows directly between these electrodes, effectively confining the energy to the target tissue without requiring a distant grounding pad.
Settings and Indications:
- Tissue Sealing: Delivers controlled thermal energy to tissue, causing collagen denaturation and vessel sealing without significant charring or tissue damage. Ideal for sealing small to medium-sized blood vessels and tissues with minimal collateral damage.
- Example Setting: Power level of 20–40 watts for sealing blood vessels up to 5 mm in diameter.
- Hemostasis: Provides rapid coagulation and sealing of blood vessels while minimizing thermal spread and tissue damage. Suitable for procedures requiring precise vessel sealing in delicate tissues.
- Example Setting: Power level of 20–40 watts for coagulation of bleeding in neurosurgical procedures.
- Tissue Cutting with Sealing (Ultrasonic): Combines cutting and sealing functions using ultrasonic vibration and thermal energy. Enables precise tissue dissection with simultaneous vessel sealing, reducing blood loss and operative time.
- Example Setting: Power level of 20–40 watts for ultrasonic dissection and vessel sealing in laparoscopic surgery.
These settings and indications are general guidelines, and actual parameters may vary based on factors such as tissue type, thickness, and surgical technique. Surgeons should adjust settings based on individual patient characteristics and procedural requirements to achieve optimal outcomes while minimizing tissue damage and complications.
