Electrosurgery

What is electrosurgery?

Electrosurgery is a treatment that uses electricity to make cuts, destroy tissue or stop bleeding. During electrosurgery, an electrosurgical unit (ESU) generates electricity. A healthcare provider uses an electrode to direct the electricity to the treatment site. This is usually an area of diseased or atypical soft tissue, including skin.

The electricity produces heat that damages the tissue. But in this case, the damage helps you heal. Electrosurgery removes unwanted growths and abnormal tissue. It seals blood vessels, stopping blood loss.

Your provider may use electrosurgery alone or in combination with other treatments.

Types of electrosurgery

Most types of electrosurgery use an alternating current (AC). This means that electricity passes back and forth through tissue. The resistance between the electrical current and tissue generates heat. Examples include:

• Electrofulguration. The electrode creates a spark. For most procedures, the provider holds the electrode a few millimeters above the treatment area. It doesn’t come into direct contact with tissue. This technique changes the top tissue layer only.
• Electrodessication. A provider applies the electrode directly to the treatment area. As the electricity passes through, it dries out the tissue.
• Electrocoagulation. The electricity can damage abnormal tissue at deeper layers than electrofulguration or electrodessication. It promotes blood clotting.
• Electrosection. The electricity makes precise cuts. Some people describe the process as being like a warm knife slicing through butter.

Electrocautery is a type of electrosurgery that uses a direct current (DC). Unlike AC, the electricity doesn’t pass through tissues. Instead, it flows through a probe and heats the tip. When a provider places the tip of the probe on tissue, the direct heat breaks down tissue or stops the bleeding.

What conditions are treated with electrosurgery?

Dermatologists commonly use electrosurgery to remove unwanted growths. For example, it can destroy benign (noncancerous) growths like skin tags or warts. Some forms of electrosurgery treat skin cancer.

Electrodessication & curettage (ED&C) treats squamous cell carcinoma and basal cell carcinoma. During this procedure, a dermatologist uses a sharp tool to scrape away the lesion (curettage). Then, they use electrosurgery to destroy any remaining cancer cells.

But providers across medical specialties use electrosurgery during all kinds of medical procedures. It’s commonly used during various forms of endoscopy. This procedure uses a scope to destroy or remove abnormal tissue inside your body.

What happens during electrosurgery?

First, you’ll get anesthesia so you don’t feel pain. During the procedure, an electrosurgical unit (ESU) will power a current and send it to an electrode. What happens next depends on the method.

Monopolar electrosurgery

Most electrosurgery is monopolar. This means that only one (“mono”) electrode tip comes into contact with your body.

1. The ESU sends the current to an active electrode.
2. The current from the electrode passes through tissue, heating it.
3. The current travels to a non-active electrode (dispersive electrode). It may be a grounding pad on your thigh or a plate you hold onto.
4. The current travels from the dispersive electrode back to the ESU.

Bipolar electrosurgery

With bipolar electrosurgery, two (“bi”) electrode tips touch your body. For example, your provider may use forceps to clasp the tissue being treated. One side contains the active electrode. The other side contains the return electrode.

1. The ESU sends the current to the active electrode.
2. The current from the electrode passes through the tissue to the return electrode.
3. The current travels from the return electrode back to the ESU, completing the circuit.

What are the potential benefits of electrosurgery?

Electrosurgery can remove atypical tissue without physical cuts from a scalpel. It allows healthcare providers to:

• Target the treatment area with little damage to surrounding tissue
• Remove tissue with little scarring
• Ablate (destroy) tissue quickly
• Stop bleeding fast

Electrosurgery and curettage cure basal cell carcinomas and squamous cell carcinomas 90% to 95% of the time.

What are the risks of electrosurgery?

Electrosurgery is safe, especially when you’re working with a healthcare provider who performs it regularly. As with any procedure, though, there are risks. Risks of electrosurgery include:

• Burns. Too much heat from the current can cause burns. Providers prevent this by ensuring that the ESU settings are correct. They start with the lowest possible power settings that also get the job done.
• Electric shock. There’s a risk of shock if the electricity isn’t grounded correctly. Your healthcare provider will take care that the setup is correct to prevent this from happening.
• Infections. A contaminated electrode can spread germs. Also, the smoke from electrosurgery can spread toxins and germs. Your provider can keep you safe by using sanitized electrodes. They’ll perform the procedure in a room with a smoke ventilation system.
• Bleeding. Tissue damage sometimes leads to excessive bleeding. Your provider will adjust the ESU settings to reduce the chances of this happening.
• Skin changes. Some types of electrosurgery can lighten your skin tone at the treatment site (hypopigmentation). Your provider will let you know if this is a risk based on your procedure.
• Problems with implants. Some types of electrosurgery can interfere with the electrical signals in pacemakers and defibrillators. Your provider will ensure electrosurgery doesn’t interfere with these devices.

How long will it take for me to feel better?

Healing takes about a week after electrosurgery to remove growths on the top layer of your skin. Deeper wounds may take two to four weeks or longer. The recovery times for endoscopy procedures that use electrosurgery vary. Your healthcare provider will explain your timeline based on your situation.

When should I call my healthcare provider?

For skin conditions, contact your healthcare provider if you have bleeding that doesn’t stop even after applying direct pressure for 20 minutes.

Your healthcare provider will let you know what changes in your body to look out for. Don’t hesitate to call your provider if you’re not healing as expected after electrosurgery.

Is electrosurgery the same as laser surgery?

Electrosurgery and laser surgery aren’t the same. While electrosurgery uses electricity, laser surgery uses energy from light to perform surgery. Like electrosurgery, lasers can perform different functions (like destroying tissue and stopping bleeding).