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Electrocautery

  • Author: Mohsin R Mir, MD; Chief Editor: Erik D Schraga, MD  more...
 
Updated: Oct 06, 2015
 

Background

Electrocautery, also known as thermal cautery, refers to a process in which a direct or alternating current is passed through a resistant metal wire electrode, generating heat. The heated electrode is then applied to living tissue to achieve hemostasis or varying degrees of tissue destruction.[1] Electrocautery can be used in various minor surgical procedures in dermatology, ophthalmology, otolaryngology, plastic surgery, and urology.

In electrocautery, the current does not pass through the patient; thus, the procedure can be safely used in patients with implanted electrical devices such as cardiac pacemakers, implantable cardioverter-defibrillators, and deep-brain stimulators.[2, 3, 4]

In contrast, electrosurgery is a group of commonly used procedures that utilize the passage of high-frequency alternating electrical current through living tissue to achieve varying degrees of tissue destruction.[1, 5, 6] Different forms of electrosurgery include electrocoagulation, electrofulguration, electrodesiccation, and electrosection. Electrosurgery produces electromagnetic interference, which can interfere with implanted medical devices.[2, 3, 4]

Electrosurgery is not a synonym for electrocautery but is often erroneously referred to as electrocautery in practice and literature.

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Indications

Electrocautery is a safe and effective method of hemostasis during cutaneous surgery.[7] It is also useful in the treatment of various small benign skin lesions,[1, 6] although only lesions that do not require histological review should be treated with electrocautery.

Electrocautery shares many indications with electrosurgery and is of particular importance in patients who have implanted electrical devices in whom external electromagnetic interference should be avoided.[2, 4]  Furthermore, unlike electrosurgical instruments, electrocautery devices maintain function in a wet field. 

Low temperatures can be used for superficial tissue destruction in the treatment of superficial and relatively avascular lesions, including the following:

A dermal curette may be used concurrently to remove the lesion.

Higher temperatures are effective in removing thicker skin lesions, such as the following:

Other indications for electrocautery include the following:

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Contraindications

There are no absolute contraindications to electrocautery.

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Technical Considerations

Each electrocautery device can deliver heat at a single temperature or range of temperatures, between 100o C and 1200o C. Most devices also include interchangeable tips such as loops, fine tips, and needle tips.

Physicians must consider the histologic properties of the tissue to be treated, the area and depth of destruction desired, possible complications, and capabilities of the different electrocautery devices. A common principle of all electrosurgical procedures is to use the least amount of power possible to achieve the desired effect, limiting damage to the adjacent tissue.

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Best Practices

Complication prevention

As with any procedure, there are potential risks to the patient, as well as the operating physician.

Burns

There is a risk of fire or explosion if flammable materials are in close proximity to the treatment site.[5, 14] Alcohol, oxygen, and bowel gas are all highly flammable. Alcohol cleansers should be avoided; if they are used, they should be allowed to dry completely. If the patient uses a portable oxygen generator, it should be stopped briefly for the procedure. Eschar buildup should be removed from the surgical electrode to avoid sparking or flaming.[5]

Transmission of infection

The same principles of infection transmission apply to both electrosurgery and electrocautery. The 3 potential modes for infection transmission in these procedures include the treatment electrode, surgical smoke, and aerosolized blood microdroplets. Experimental studies involving animal skin have shown transmission of hepatitis B virus, human papillomavirus (HPV), and Staphylococcus aureus from an inoculated site to an uninfected site by means of the contaminated electrodesiccation electrode.[15]

During electrosurgical procedures, aerosolized blood droplets can be propelled a distance of up to 30 cm and can be infectious if inhaled.[16] Surgical smoke can also contain viable viruses and bacteria, in addition to hazardous chemicals and carcinogens. Viable HPV virus has been identified in the vapor of warts being treated with electrocoagulation.[17]

To prevent the risks of infection transmission, a smoke-evacuating system should be used, along with facial masks, protective eye wear, and surgical gloves. Disposable or sterilized electrodes should be used.

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Outcomes

Electrocautery is a safe and effective method of treatment for benign cutaneous lesions and hemostasis for surgical patients.[1, 2, 6, 7]

Studies have also shown that thermal cautery occlusion in vasectomies is more effective than clipping and excision of a segment of the vas.[10, 11]

Furthermore, surgical lacrimal punctual occlusion for dry eyes using a thermal cautery device is associated with low recanalization rates, higher visual acuity, and overall greater subjective improvement in symptoms.[12, 13]

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Contributor Information and Disclosures
Author

Mohsin R Mir, MD Director, High Risk Skin Cancer Clinic, Assistant Professor, Mohs Surgery, Laser and Cosmetic Surgery, Department of Dermatology, Baylor College of Medicine

Mohsin R Mir, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery, American Society for Dermatologic Surgery

Disclosure: Nothing to disclose.

Coauthor(s)

Grace Shou-en Sun, MD Resident Physician, Department of Dermatology, Baylor College of Medicine

Disclosure: Nothing to disclose.

Connie M Wang Baylor College of Medicine

Connie M Wang is a member of the following medical societies: Texas Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Erik D Schraga, MD Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

References
  1. Pollock SV. Electrosurgery. Bolognia JL, Jorizzo JL and Rapini RP. Dermatology. Mosby Elsevier; 2008. 2nd edition: Ch140.

  2. Riordan AT, Gamache C, Fosko SW. Electrosurgery and cardiac devices. J Am Acad Dermatol. 1997 Aug. 37(2 Pt 1):250-5. [Medline].

  3. Weaver J, Kim SJ, Lee MH, Torres A. Cutaneous electrosurgery in a patient with a deep brain stimulator. Dermatol Surg. 1999 May. 25(5):415-7. [Medline].

  4. Sebben JE. Electrosurgery and cardiac pacemakers. J Am Acad Dermatol. 1983 Sep. 9(3):457-63. [Medline].

  5. Massarweh NN, Cosgriff N, Slakey DP. Electrosurgery: history, principles, and current and future uses. J Am Coll Surg. 2006 Mar. 202(3):520-30. [Medline].

  6. Soon SL, Washington CV. Electrosurgery, electrocoagulation, electrodesiccation, electrofulguration, electrosection, electrocautery. Robinson JK, Hanke CW, Siegel DM, et al. Surgery of the Skin. 2nd edition. Elsevier; 2010. Ch 9.

  7. Lane JE, O'brien EM, Kent DE. Optimization of thermocautery in excisional dermatologic surgery. Dermatol Surg. 2006 May. 32(5):669-75. [Medline].

  8. Hainer BL. Electrosurgery for the skin. Am Fam Physician. 2002 Oct 1. 66(7):1259-66. [Medline].

  9. Laughlin SA, Dudley DK. Electrosurgery. Clin Dermatol. 1992 Jul-Sep. 10(3):285-90. [Medline].

  10. Labrecque M, Nazerali H, Mondor M, Fortin V, Nasution M. Effectiveness and complications associated with 2 vasectomy occlusion techniques. J Urol. 2002 Dec. 168(6):2495-8; discussion 2498. [Medline].

  11. Schmidt SS, Minckler TM. The vas after vasectomy: comparison of cauterization methods. Urology. 1992 Nov. 40(5):468-70. [Medline].

  12. Hutnik CM, Probst LE. Argon laser punctal therapy versus thermal cautery for the treatment of aqueous deficiency dry eye syndrome. Can J Ophthalmol. 1998 Dec. 33(7):365-72. [Medline].

  13. Ohba E, Dogru M, Hosaka E, Yamazaki A, Asaga R, Tatematsu Y. Surgical punctal occlusion with a high heat-energy releasing cautery device for severe dry eye with recurrent punctal plug extrusion. Am J Ophthalmol. 2011 Mar. 151(3):483-7.e1. [Medline].

  14. Sebben JE. The hazards of electrosurgery. J Am Acad Dermatol. 1987 Apr. 16(4):869-72. [Medline].

  15. Bennet RG, Kraffert CA. Bacterial transference during electrodesiccation and electrocoagulation. Arch Dermatol. 1990. 126(6):751-755.

  16. Lewin JM, Brauer JA, Ostad A. Surgical smoke and the dermatologist. J Am Acad Dermatol. 2011 Sep. 65(3):636-41. [Medline].

  17. Berberian BJ, Burnett JW. The potential role of common dermatologic practice technics in transmitting disease. J Am Acad Dermatol. 1986 Nov. 15(5 Pt 1):1057-8. [Medline].

  18. Harris DW. ABC of dermatology. Procedures. Br Med J (Clin Res Ed). 1988 Mar 12. 296(6624):769-71. [Medline]. [Full Text].

  19. Spiller WF, Spiller RF. Cryoanesthesia and electrosurgical treatment of benign skin tumors. Cutis. 1985 Jun. 35(6):551-2. [Medline].

 
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