Electrocautery

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

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:

  • Seborrheic keratoses [6, 8, 9]
  • Acrochordons [6, 8, 9]
  • Molluscum [6]
  • Verrucae [6, 8]
  • Syringomas [6, 8]
  • Small angiomas [6, 8]

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 [6, 8]
  • Pyogenic granulomas [6, 8]
  • Hemostasis of vessels in surgery [6, 8]

Other indications for electrocautery include the following:

  • Vasectomy [10, 11]
  • Punctual occlusion (for dry eye syndrome) [12, 13]
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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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