Electrosurgery pad/unit (ESU), also recognized as electrosurgical dispersive pad/unit, electrocautery grounding pad, or Bovie after the name of its inventor Dr. William T. Bovie, is a surgical device employed to make tissue incisions followed by intentional tissue damage by desiccation. They can also be used to control bleeding during a major surgery as they coagulate the blood.
Components of an electrosurgical unit
An electrosurgical unit consists of the following parts:
• Generator provides the power to operate the device.
• An active electrode or hand piece is the pencil-like segment of the electrosurgical unit which is directly used to conduct surgeries.
• A dispersive/return electrode/grounding pads/passive electrode for grounding the electric current run towards it from the active electrode after the electrosurgical pad placement.
• Foot pedal or control.
How does an electrosurgical unit work?
An ESU consists of a generator with a disposable handheld pen with multiple electrodes. When an electrosurgical unit is employed during surgery, tissue damage is done by utilizing a radiofrequency spark produced by high-powered and high-frequency (100 kilohertz to 5 megahertz) generators. This spark consisting of alternating current, at the voltage of 200 to 10,000 Volts, has the tendency to elevate the temperature of the localized area exposed to it, consequently damaging the tissue.
This dead tissue is then desiccated, vaporized, or charred. Although incisions can be made using a scalpel which is the conventional method, electrosurgery pads provide the additional advantage of cutting and agglomerating the tissue at the same time thus saving time and resources which were to be practiced otherwise.
Modes of electrosurgical operation
Electrosurgery can be done in two ways i.e. in bipolar mode and monopolar mode. In bipolar surgery, active as well as return electrodes are employed on the tissue. Tips of the forceps or scissors grasp the tissue to be damaged and current is passed between them. As one tip of the forceps functions as the return electrode, the use of a separate return electrode is unnecessary. The tissue, once incised, is coagulated in the fluid environment of the body thus giving the technique its other name i.e. wet field cautery.
However, in monopolar mode, the surgical tissue is only exposed to the active electrode while the return electrode, called a dispersive pad, is placed on the patient’s body farther from the surgical site. When the current is passed, it transmits between the two electrodes before being removed from the body via the return electrode, a phenomenon that gives it another name, the grounding pad.
Applications of an electrosurgical unit
The benefits that come with electrosurgery are many ranging from its employment in minor surgical operations to the most intricate ones. Some of these applications are as follows:
• ESU can be useful for the removal of common warts.
• Use of ESUs in reproductive-related surgeries is also extensive.
• Spider veins can be treated using an electrosurgical device.
• Hair removal surgeries can be performed by physicians with the help of electrosurgery.
• The electrosurgery pad find vast applications in open heart surgeries, laparoscopy, hysteroscopy, hemangiomas, seborrheic keratosis, actinic keratosis along with telagiectasia.
• Orthopedic surgeons also utilize these devices.
• Transplant operations also need the assistance of electrosurgical devices.
• Biopsy of malignant neoplasms can be performed with ESUs.
• Benign cutaneous lesions are treated by burning them with the help of an electric current produced by an ESU.
• Electrosurgical devices are also applicable in eye surgeries.
• Minor foot surgeries, along with other procedures, are performed using ESUs.
• Basal cell carcinomas, papillomas, pedunculated fibromas as well as keratoacanthomas are also treated with electrosurgery.
Advantages of using an electrosurgical unit
Electrosurgical units have various advantages when it comes to their use in surgeries. Some of these are given below:
• An electrosurgery consumes less time as compared to a tissue incision done using a scalpel.
• Quick results are obtained by practicing an electrosurgical procedure.
• The ESU is very handy as well as an easy to use the machine.
• The device is inexpensive thus reducing the surgical cost.
• The ESU needs very little maintenance. Except for the regular cleaning of the electrode tips, no special cleaning procedure is required.
What can go wrong?
• Electrosurgery pad, if not used with care, can result in localized epidermal burns due to the flow of heavy current through them.
• Sometimes, if this electric current comes in contact with a flammable liquid applied onto the body, a fire can start resulting in serious skin infections as well as tissue damage.
• Delayed hemorrhage can occur due to the sloughing off of the burnt tissue after the treatment resulting in postoperative bleeding.
• Nerves and vessels damage can occur if the frequency of the electric current is higher.
Electrosurgery units, though safe, should be used with care. Following precautionary measures must be taken while electrosurgery:
• Operating conditions provided by the supplier must be maintained. Usually, a temperature between 10 to 40ºC, along with 30 to 75% relative humidity is considered optimum.
• While using the electrosurgical unit, it should be ensured that the handpiece, when not in use, is placed in the non-conductive holster.
• The lowest possible voltage should be selected for the current flow during surgery as with higher voltages, the chances of burns also increase.
• Tips of the electrodes should be cleaned preferably after every use to remove any debris of the previously incised tissues or as it is known, an eschar, which can result in a spark or flame.
• A sponge should be used to clean the electrode tip as using a scratch pad can damage the electrodes.
• Flammable gases or liquids such as skin degreasers or rubbing alcohol should not be applied onto the skin of the patient undergoing electrosurgery. It is advised to remove any flammable substances from the vicinity of the ESU electrodes.
• If there is a necessity, flammable solutions such as alcohol-based disinfectants should be applied onto the skin at such a time before the surgery that all the solution must be dried up in time.
• The tip of the active electrodes must not be covered with rubber catheters or other materials.
• Wrapping the cables and cords around the metal instruments is not advised to decrease the chances of any fire.
• The physician using the electrosurgical unit should handle the device with dry hands. If the sterile gloves are to worn, these should be completely moisture free.
• In addition to this, the foot pedal should be kept dry as operating with ESU while standing on a wet surface can be dangerous.
• When not in use, the device should be stored at a temperature range of 10 to 60°C.
• As the grounding pads and hand piece of an electrosurgical pad are disposable, these electrosurgery accessories should be replaced frequently.
An electrosurgical unit is a safe, economical, and easy to use medical device exhibiting a multiplicity in its use. With some precautions, the device can be advantageous during several medical procedures ranging from basic medical operations to more complex surgeries. Moreover, its quick results, along with its affordability, make it a preferred choice by physicians.