Electrosurgery Periprocedural Care

Informed consent should take place prior to any procedure involving electrosurgery. The clinician should review the risks and benefits of the recommended electrosurgical modality, as well as alternative therapies. Most often, the informed consent is documented on a form that outlines these risks, benefits, and alternatives and that both the patient and clinician sign. Below is a sample informed consent for ED&C.

ELECTRODESICCATION AND CURETTAGE (ED&C)

This is a general summary about this procedure and does NOT list every possible benefit, risk, or adverse event ever reported about this procedure.

What is ELECTRODESICCATION AND CURETTAGE (ED&C)?

See the list below:

• It is a surgical technique which involves sequential curettage (scraping) of a skin lesion followed by electrodesiccation (a form of electronic cautery). The sequence is generally repeated 3 or 4 times.

• It is an alternative to more invasive surgery.

• It is used to treat benign and superficial malignant skin lesions including but not limited to: seborrheic keratosis, actinic keratosis, nodular and superficial basal cell carcinoma, squamous cell carcinoma in-situ.

Benefits, alternatives, risks:

Benefits may include treatment of skin lesions, lower cost (compared to more invasive surgery), and rapid delivery of treatment.

Alternatives vary depending on the type of lesion being treated but may include observation, excision, topical chemotherapy, cryotherapy and curettage, and excision.

Risks include discomfort, pain, bleeding, burns, electric shock, recurrence, conversion to excision, infection, changes in pigmentation, and scar. Please contact your doctor if these or other adverse symptoms occur.

Absolute Contraindication: Implanted cardiac defibrillator

Relative Contraindications: Cardiac pacemaker, implanted deep-brain stimulator, other implantable electrical device, and bleeding disorders.

Please sign below if the following statements apply to you:

I understand the information provided to me above.

I understand that I can ask my health care provider for any additional information or clarification.

I have been given the opportunity to ask my health care provider about alternative therapies.

_____________________________________________________________________________________

Patient Parent Health Care Proxy Date Time

_____________________________________________________________________________________

Practitioner’s signature: MD, APRN, PA-C Date Time

The preprocedure workup should be focused on identifying and minimizing risks. The patient’s history should be reviewed to identify risk factors for excessive bleeding and disease conditions that may affect healing. The history and physical examination should identify patients with IEDs. Once an IED is identified, further investigation is warranted. ^[3]

The IED should be characterized by type, medical indication, anatomic location, date of implantation, programmability, date of last interrogation, symptoms if turned off, and need for postoperative interrogation. Depending on the complexity of the planned procedure and type of electrosurgery required, it may be necessary to contact the physician managing the device, as well as the respective industry representative. ^[3]

Electrosurgical equipment is manufactured and distributed by multiple vendors. Office-based units come in a wide variety of styles, and most units have a range of optional features. The images below depict several types of electrosurgical equipment but do not represent all of the available brands or options. The authors have no affiliation with the makers of these devices and this is not intended as an endorsement.

An office-based, portable electrosurgical unit.

View Media Gallery

Electrosurgical tips: disposable blunt tip, disposable sharp tip, and reusable fine needle tip (front to back).

View Media Gallery

Handheld electrocautery unit with cap.

View Media Gallery

Handheld electrocautery unit with activated (hot) tip.

View Media Gallery

An evacuator such as the one shown, may be used to safely remove electrosurgical smoke.

View Media Gallery

Patients should be instructed to remove all metal objects, including jewelry, and avoid contact with grounded metal objects during the procedure. ^[1] This will help minimize the risk of inadvertent shocks and electrical burns.