Electrocautery 

Updated: Dec 14, 2017
Author: Mohsin R Mir, MD; Chief Editor: Erik D Schraga, MD 

Overview

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.[2]

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.[3, 4, 5]

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, 6, 7] Different forms of electrosurgery include electrocoagulation, electrofulguration, electrodesiccation, and electrosection. Electrosurgery produces electromagnetic interference, which can interfere with implanted medical devices.[3, 4, 5]

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

Indications

Electrocautery is a safe and effective method of hemostasis during cutaneous surgery.[8] It is also useful in the treatment of various small benign skin lesions,[1, 7] 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.[3, 5]  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:

  • Seborrheic keratoses[7, 9, 10]

  • Acrochordons[7, 9, 10]

  • Molluscum[7]

  • Verrucae[7, 9]

  • Syringomas[7, 9]

  • Small angiomas[7, 9]

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

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

  • Sebaceous hyperplasia[7, 9]

  • Pyogenic granulomas[7, 9]

  • Hemostasis of vessels in surgery[7, 9]

Other indications for electrocautery include the following:

  • Vasectomy[11, 12]

  • Punctual occlusion (for dry eye syndrome)[13, 14]

Contraindications

There are no absolute contraindications to electrocautery.

Technical Considerations

Each electrocautery device can deliver heat at a single temperature or range of temperatures, between 100oC and 1200oC. 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.

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.[6, 15] 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.[6]

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.[16]

During electrosurgical procedures, aerosolized blood droplets can be propelled a distance of up to 30 cm and can be infectious if inhaled.[17] 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.[18]

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.

Outcomes

Electrocautery is a safe and effective method of treatment for benign cutaneous lesions and hemostasis for surgical patients.[1, 3, 7, 8, 19, 20]

Studies have also shown that thermal cautery occlusion in vasectomies is more effective than clipping and excision of a segment of the vas.[11, 12]

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.[13, 14]

 

Periprocedural Care

Patient Education & Consent

The steps, risks, benefits, possible complications, and alternatives of electrocautery should be explained to the patient. Consent from the patient or a legal patient representative must be obtained prior to the procedure.

Equipment

Equipment includes but is not limited to the following:

  • Surgical mask with eye protection

  • Gloves

  • Antiseptic solution

  • Fenestrated drape

  • Lidocaine 1% with or without epinephrine

  • Syringe

  • Injection needles

  • Gauze, 4 x 4 inch

  • Dental rolls

  • Electrocautery (thermal cautery) unit/disposable pen

  • Electrode tips

  • Sterile hand sheath

  • Smoke evacuator

  • Marking pen

    Electrocautery device Electrocautery device

Electrocautery devices can be in the form of disposable battery-powered pens or line-powered thermal cautery units.

Line-powered thermal cautery units

Line-powered thermal cautery units are capable of producing a range of temperatures, adjustable by the operator to achieve the desired effect on the tissue. They are better able to maintain a constant temperature during use as opposed to battery-powered cauteries, which drop in temperature upon contact with tissue. Line-powered thermal cauteries cost between $600.00-900.00, which typically includes various interchangeable disposable or reusable electrode tips.

Disposable battery-powered cauteries

Disposable battery-powered cauteries are sterilely packaged for single use. Each box typically contains 10 individually packaged cauteries with noninterchangeable tips and cost around $130.00. Each cautery produces a fixed temperature that is not adjustable. Reusable battery-powered cauteries are also available and are commonly sold in kits that contain high-temperature and low-temperature cautery handles, battery replacements, and interchangeable tips. These products typically cost less than $100.00.

Patient Preparation

Preoperative care for electrocautery involves identifying and eliminating potential safety hazards to the patient and operating team. A thorough patient history and physical should be performed to determine the patient’s general medical condition; to identify any risk factors for excessive bleeding, susceptibility to infection, or poor wound healing; and to note any allergies to antiseptics, anesthetics, and dressings, among others.

The treatment team wears gloves and masks, and smoke-evacuation equipment should be available. The lesion and the area surrounding are cleaned with nonalcohol solution such as chlorhexidine or povidone iodine. For malignant lesions, marking the clinical border of the tumor may be useful, as anesthetics can blur the margins. If alcohol is used, ensure that the area is dry before beginning the procedure.

Anesthesia

Local injection of 1% lidocaine is typically used prior to in-office procedures. Lidocaine with epinephrine can be used for vasoconstrictive effects if injected 15 minutes prior to the start of the procedure. Depending on the tolerance of the patient, some procedures, such as removal of acrochordons or small angiomas, do not require anesthesia.[21] Alternatively, instead of lidocaine, liquid nitrogen can be used as cryoanesthesia prior to procedures.[21, 22]

Monitoring & Follow-up

Superficial wounds are allowed to heal by secondary intention with daily cleansing and application of petrolatum. The wound can be covered with a protective dressing or bandage. Larger wounds can be covered by Telfa­ sheets and secured with paper tape.[1]

Deep wounds are sutured and covered with a nonadherent dressing. A pressure dressing can be used to decrease the risk of bleeding during the first 2 days.[7]

 

Technique

Approach Considerations

In addition to hemostasis, achieved by direct contact of the electrode tip to the damaged vessel, electrocautery can be used in various procedures. Detailed descriptions of a few electrocautery procedures are described below.

Pinpoint Cautery

Spider angiomas are superficial vascular lesions composed of small veins that radiate from a central dilated arteriole. The pinpoint cautery technique can be used to treat superficial telangiectasias such as this.

The lesion is cleaned with nonalcohol antiseptic solution.

Anesthetic is not necessary for this procedure.

A glass slide is placed on the lesion with pressure to locate the feeding vessel.

A fine needle electrode tip is used in the electrocautery device.

The cold needle is placed into the lesion and current is applied for less than 1 second.

The scab that develops will fall off within 10 days.

Removal of Small Benign Lesions

Small benign lesions such as acrochordons, seborrheic keratoses, and molluscum can be removed in the manner below.

The lesion is cleaned and area anesthetized (see Periprocedural Care).

A pinpoint or ballpoint electrode tip is touched directly to the lesion.

The electrode should be inactivated once the lesion appears to become necrotic or separates from the dermis.

The lesion will fall off within 10 days, or a curette or gauze may be used to remove abnormal tissue.

Larger, more exophytic lesions can be shaved flat prior to electrocautery of the base.

Benign lesions can be removed until the surface of the skin appears flat with normal contours to avoid scarring and ensure good cosmesis.

For highly vascular lesions such as pyogenic granuloma, the lesion is injected using 1% lidocaine with epinephrine 15 minutes prior to the start of the procedure, allowing vasoconstriction to take full effect.

Surgical Punctal Occlusion

Punctal occlusion surgery is used in patients with severe dry eye disease who experience recurrent punctual plug extrusions or punctual plug complications.

The area is cleaned and anesthetized using an infratrochlear nerve block with lidocaine.

A high-temperature electrocautery device with a fine tip is inserted cold into the lacrimal punctum, the vertical portion of lacrimal canaliculus, and the horizontal portion of lacrimal canaliculus.

The device is then turned on until the surrounding punctual tissue becomes white (10-14 seconds).

The device is then removed slowly and antibiotic ointment is applied.