Radiofrequency surgery is a surgical procedure for cutting tissue, coagulation of vessels or necrotizing various biological structures. The method has many advantages over standardized procedures and is mostly used successfully in microsurgery and neurosurgery, but also in general surgery.
What is electrosurgery?
HF surgery is now used in almost all areas of surgery. In many surgical supplies, this procedure uses cutting and simultaneous occlusion of blood vessels to advantage. High-frequency surgery, also known as electrosurgery, is a surgical procedure to selectively cut or damage tissue. By applying alternating current at a high frequency, the energy it generates is converted into heat. The heat generated can cut tissue and necrotize or sclerotize biological structures. The procedure of HF surgery is applied at a high frequency starting at 300,000 hertz, hence its name. The purpose of a high frequency is to only slightly irritate the nerve pathways due to the frequent change in the direction of the flow. At low frequency and the resulting small change of the flow direction, the nerve tracts are strongly irritated. This can lead to an electric shock and thus to cardiac arrhythmia or acute cardiac arrest. This neuromuscular irritant effect is also called faradic effect. During the application of high-frequency surgery, a so-called electrolytic effect occurs. This means that an ionic shift occurs in the corresponding tissue structures. The alternating current causes the ions in the high-frequency range to move back and forth at an increased rate, resulting in oscillations of the ions. The surgeon takes advantage of the resulting thermal effect. Depending on the current density, exposure time and resistance of the tissue, coagulation or tissue separation occurs.
Function, effect, and goals
Today, HF surgery is used in almost all areas of surgery. In many surgical supplies, this procedure uses cutting and simultaneous occlusion of blood vessels to advantage. In this way, targeted incisions can be made through tissue structures without significant blood loss. The most frequent application is in the treatment of damaged blood vessels, in order to close them by means of so-called coagulation and to stop the bleeding that occurs. Furthermore, benign and malignant myomas and tumors are devitalized and thus necrotized more and more frequently. The application spectrum of high-frequency surgery ranges from a minimally invasive procedure to a large coagulation incision. A special electrosurgical device is required for surgical treatment using HF surgery. This consists of a generator which converts the supply current into high-frequency alternating current. The alternating current is then transmitted to a special instrument with a metal tip or metal forceps. This metal tip is nothing more than a point-shaped active electrode. A high concentration of energy is thus generated at the small active electrode and can achieve the desired electrosurgical effect at the application site. When a metal tip is used, a so-called neutral electrode is applied over the entire surface under the tissue to be treated. This has no thermal effect and serves to close the circuit. High-frequency surgery is divided into two methods of application technique. A distinction is made between the monopolar and the bipolar technique. These two techniques differ in the path that the electric current takes to the neutral electrode. In the monopolar technique, a narrow active electrode is used as an attachment; this results in an increased alternating current concentration and thus an increased thermal effect. The neutral electrode is applied over a large area under the surgical site. This method is used to cut and coagulate tissue structures. Compared to cutting with a scalpel, this technique has the advantage that there is no heavy bleeding. The surrounding tissue is spared and the spread of germs is prevented. In the bipolar technique, the surgeon uses bipolar electrodes. The metal attachment is developed like a pair of pliers and is divided into two metallic ends. The Zang thus consists of an active electrode and a neutral electrode.A separate neutral electrode is not required here. By using these metal tips, both poles are in contact with the surgical area. This technique is mostly used in neurosurgery and microsurgery to use the thermal effect for coagulation and thus the occlusion of vessels. When using high-frequency surgery, it should always be borne in mind that different biological structures also have different resistance forces. In the case of blood, for example, this is 0.16 x 10 ohmmeter, compared to 3.3 x 10 ohmmeter in the case of fatty tissue. To ensure the safety of the patient, make sure that the patient is kept dry and isolated, that there is no contact with a grounded device and no skin contact with the physician or assistant. The surgeon should wear special gloves during the procedure
Risks, side effects, and hazards
If the surgeon adheres to all specified safety and hygiene standards during the use of radiofrequency surgery, this is a very safe surgical method. For example, if the neutral electrode is forgotten or incorrectly applied, severe burns can occur. The current is then not returned to the generator, but is discharged via the operating table or other grounded equipment. If burns occur on the patient, a distinction is made between endogenous, exogenous and pseudo burns. Endogenous burns occur when the current density in the tissue is too high. This can happen, for example, if the patient comes into contact with conductive and grounded equipment during the procedure. Exogenous burns, on the other hand, result from the combustion of liquids or gases. This can lead to small explosions and thus burns. The cause of these explosions can be skin disinfectants or anesthetic gases. One speaks of a pseudo-burn when neither the cause of an endogenous nor an exogenous burn is present. Furthermore, it should be noted that pacemakers can be damaged by the use of electrosurgery. Therefore, the risk should be weighed here and, if necessary, an internist should be consulted.
