Electrocoagulation is a surgical procedure of RF surgery in which tissue is intentionally damaged and removed by means of high-frequency current. In this context, the procedure can be used on tumors, for example, and at the same time as the incision is made, it closes the resulting wound. Electrocoagulation cannot take place in extremely dry tissues.
What is electrocoagulation?
Electrocoagulation is an electrosurgery surgical procedure in which tissue is intentionally damaged and removed using a high-frequency current. It is used on tumors, for example. In high-frequency surgery, a team of doctors passes high-frequency alternating current through the human body. The RF procedure aims to deliberately damage or cut tissue. Tissue structures are to be severed or completely removed. Unlike conventional cutting techniques, the wound can be closed together with the cut during HF surgery. This stops the bleeding because the vessels in the incision area are closed. The instrument used in HF surgery is the electroscalpel. One procedure from this surgical field is electrocoagulation. Electrocoagulation involves the delivery of a single spark that burns the tissue in a punctiform manner, thus separating tissue structures. Fast and at the same time efficient electrocoagulation and the associated hemostasis is used primarily in the context of a lack of spontaneous coagulation, for example in the case of bleeding associated with tumors. In the case of rather small vessels, the procedure replaces expensive fibrin glue or ligation. Electrocoagulation thus saves the physician both effort and money. The patient also benefits from the RF surgery procedure because of the immediate hemostasis.
Function, effect, and goals
The term coagulation can refer to two different surgical techniques. In addition to deep coagulation, electrical hemostasis exists in the sense of electrocoagulation. Deep coagulation is also electrocoagulation. The procedure heats the tissue up to 80 degrees Celsius. The heating is achieved via electrodes. In addition to ball and plate electrodes, roller electrodes are also used in this context. These instruments are used to remove tissue in the course of the operation. Electrocoagulation in the sense of deep coagulation uses a high current density. Only current without pulse modulation is used, i.e. unmodelled current. Physicians influence the depth of coagulation via the magnitude of the current. When large current is used, scabs form. This prevents the heat from spreading further into the depth. When the electrode is removed later, the physician removes the burnt tissue still attached to the electrode in the same step. If small current is used to high exposure time, the tissue around the electrode will cook. The burns extend slightly deeper than the electrode diameter. Electrocoagulation, in the sense of a hemostasis procedure, unlike deep coagulation, uses pulse-modulated RF current hanging from clamps and forceps. The tips of the instruments grip the area to be stanched, which narrows due to dehydration and closes completely at the end. This procedure of coagulation takes place in bipolar mode. Monopolar forceps are rarely used. At oozing sites, hemostasis takes place with large-area electrodes operated by pulse-modulated current. Other forms of coagulation include desiccation and fulguration. These are special forms of the procedure. Fulguration is performed as superficial coagulation. Intracellular and extracellular fluids evaporate in this procedure due to the spark from a tip of the electrode, which the physician passes a few millimeters over the tissue. Desiccation is generally the same as this procedure, but in this type of coagulation the needle electrode is inserted into the tissue. Soft coagulation is referred to when the current is less than 190 V. These methods do not produce sparks or electric arcs. In this way, unintentional cutting is excluded and carbonization is prevented. In addition, there is forced coagulation, which extends up to current strengths of 2.65 kV and generates arcs for a higher coagulation depth.Spray coagulation, in turn, works with currents of up to 4 kV, allowing particularly strong and long electric arcs to be generated to heat the tissue both exogenously and endogenously.
Risks, side effects, and hazards
Electrocoagulation is associated with some risks and side effects. As usual, the patient must expect the conventional risks and side effects of any surgery. These include, for example, unwanted bleeding, circulatory collapse due to the anesthetic, or complications in the neck area that may occur due to the ventilator. Like all other surgeries, electrocoagulation can cause nausea or vomiting due to the anesthetic. In addition, more or less severe pain may occur at the treated sites. Beyond the conventional surgical risks, electrocoagulation is associated with some specific risks and complications. These include, for example, the sticking effect, which can occur with both soft coagulation and forced coagulation. At higher current levels, an unexpectedly high spark impact cannot be completely ruled out, which in extreme cases can cause unplanned tissue damage or even removal. However, this risk is negligible as long as the patient is in the hands of professional RF surgeons who perform the procedure several times a day. Under certain circumstances, electrocoagulation is not possible. This is true, for example, if the tissue is extremely dry. In dry tissue, there is no sufficient current flow. For this reason, electrocoagulation cannot be performed at all in such tissue. Physicians must therefore determine exactly how dry the tissue to be treated is prior to the planned coagulation.
