Electrosurgical

Electrosurgical refers to procedures, devices, and techniques that use high-frequency alternating electrical current to alter biological tissue for surgical effect. Energy is delivered to tissue via an active electrode, and tissue impedance converts electrical energy into heat, enabling cutting, coagulation, desiccation, fulguration, or vessel sealing. In common usage, electrosurgery is sometimes contrasted with electrocautery; in electrosurgery the current passes through the patient between active and return electrodes, whereas cautery often describes heat delivered by a heated instrument.

Two main operating modes are used: cutting and coagulation. Cutting employs a continuous waveform to rapidly raise tissue temperatures for incision with limited coagulation, while coagulation uses intermittent or pulsed energy to achieve greater coagulation and hemostasis. Modern electrosurgical units can blend modes and offer programmable waveforms. Energy delivery can be monopolar, where current travels from the active electrode through the patient to a distant return pad, or bipolar, where current passes between two tips in the instrument itself.

Safety and practicality: The technique generates heat and surgical plume; risks include unintended burns, tissue damage, and interference with implanted devices. Practices to mitigate risk include correct dispersive pad placement and monitoring, smoke evacuation, electrical isolation where appropriate, and regular equipment checks.

Clinical use: Electrosurgery is widely employed for cutting, coagulation, sealing of vessels, desiccation, and tissue ablation across many specialties, including general surgery, gynecology, dermatology, and ENT. It offers rapid hemostasis and precision but can cause collateral damage if misapplied and may be limited by tissue type, impedance, or interference with implanted devices.

History: The modern electrosurgical unit originated in the early 20th century, with William T. Bovie contributing significantly in the 1920s–1930s, leading to widespread adoption, safety standards, and refinements in technique.