Electrosurgery

ELECTROSURGERY, the dissection and destruction of tissues using high-frequency alternating current. The terms electrosurgery and electric surgical apparatus were introduced in 1928 (Keyser). The basis of electrosurgery is the use of heat, the source of which is electrical energy (Joule). The possibility of serious and widespread application in operations electrosurgery acquired with the construction of special apparatus with a current interruption frequency of at least 100,000 per second. Electrosurgical equipment is already being manufactured in our country, and recently released Soviet-produced apparatuses are manufactured following the type of Siemens apparatuses (Fig. 1). In Germany, there are apparatuses from the Sanitas firm (Fig. 2) and Siemens-Reiniger-Veifa, and in America, Bovie apparatuses are known (Fig. 3). Necessary accessories to the apparatus include: an inactive electrode made of various metals, of significant area, necessarily well fixed to the patient's body; active electrodes in the form of needles, resembling small knives, loop-shaped, spherical, roller-shaped, plate-shaped, cylindrical; electrode holders in the form of various shaped handles, in most cases with interrupters on them. In the Bovie apparatus, when using handles without an interrupter, a foot interrupter is necessary. All of this is perfectly sterilizable, including the conductor cables to the active electrode. The apparatuses have two sections—one for the electrosurgical knife, the other for electrocoagulation. From the large number of ways to act on tissues, the most common are the following: electrotomy, acutomy—sharp and smooth dissection of tissues using a knife-shaped or needle-shaped electrode. Achieved by rapidly guiding the electrode over the dissected tissue surface in a strictly perpendicular position of the electrode to the tissues. Coagulotomy—dissection of tissues with white coloration along the path of the conducted electrode (crust of

Figure 1.

welding); achieved by slow guidance of the needle-shaped or knife-shaped electrode and with a more significant current strength. Coagulation—deep welding of tissues; achieved by means of an active electrode with a wide cross-section, with its tight adherence to the tissues and with the passage of a strong current. Carbonization—charring of tissues; achieved by means of the aforementioned electrodes, but with the condition of their loose adherence to the tissue surface. The air gap between the electrode and the tissues as a dielectric passes a stream of sparks that char the tissues. Electrocoria—disinfection of the wound surface with the killing of bacteria and their germs; achieved by means of a spatula-shaped electrode made of flexible metal under the condition of passing it over the wound surface in the manner of broom or brush movements. Fulguration—cauterization of

tissues with a spark resembling lightning, coming from a spherical electrode at a very high current voltage and at a distance of several centimeters from the surface of the cauterized tissue. Acutomy, coagulotomy, coagulation, and electrocoria are most frequently used. Operating with the electrosurgical knife, capillary bleeding from tissues is completely avoided, complete asepsis is achieved during incision, and there is comparatively negligible destruction from the action of heat on cells within the sphere of action of the electrosurgical knife with its correct

Figure 3.

application. The latter condition provides, as a rule, primary wound healing. Applying the electrosurgical knife in the removal of malignant tumors, theoretically, due to the absence of pressure on the dissected tissues, we do not squeeze malignant cells contained within them out of the lymphatic pathways and clefts into the lymph flow, and, killing them with the action of heat, we reduce the possibility of recurrence. The use of electrocoagulation makes it possible to stop bleeding from small-caliber arterioles and arteries. However, coagulation cannot be used near large arterial and nerve trunks out of fear of damaging them. In contrast to burning and charring of tissues (with the Paquelin apparatus), coagulation does not produce repeated hemorrhages and secondary infection. When electrocoagulation is used deep within tissues (muscle, liver), sharp reactive phenomena do not occur, as happens around necrotic areas from other causes. Electrocoagulation makes it possible to remove significant sections of parenchymatous organs (liver) without resorting to the placement of encircling sutures. In operations for malignant tumors, when the latter have reached such a stage of growth or are located anatomically such that removing them using ordinary surgical methods is impossible, the electrosurgical knife and electrocoagulation make it possible to destroy them. In the postoperative period in patients where electrosurgical methods are used, pain sensations are significantly reduced. When applying electrosurgical methods, it is necessary to be guided by the specific electrical conductivity of individual tissues. In electrocoagulation, it is important to take into account the duration of its action on tissues and to be familiar with the development of temperature at various depths of the coagulated tissue. During electrosurgical operations, explosions are possible during ether anesthesia, especially if one has to operate on the head. The field of application of electrosurgery: combating bleeding, operations on parenchymatous organs, the thyroid gland, amputations, resections, infected wounds, the urinary bladder, the prostate, hemorrhoids, fistulas, parasitic cysts, benign tumors, a number of skin diseases, and especially combating malignant tumors, in particular brain tumors. In combination with radiation therapy, electrosurgery significantly expands and improves the possibilities of combating particularly advanced cases of neoplasms.

A. Ochkin