Electrosurgery

Electrosurgery is a cornerstone of modern dermatological practice, widely used for its effectiveness in achieving haemostasis and eliminating abnormal skin growths. This method uses high-frequency alternating electric currents, typically ranging from 200 to 10,000 volts, to generate controlled heat within tissue. The versatility and precision of electrosurgery make it an indispensable tool for a broad range of skin treatments.

How Electrosurgery Works

Electrosurgery operates by passing high-frequency alternating electric currents through tissue, producing heat that coagulates or destroys targeted cells. The equipment typically includes a power supply unit and a handpiece equipped with one or more electrodes. Operation is controlled via a switch on the handpiece or a foot pedal, allowing precise adjustment of energy delivery during the procedure.

It is important to distinguish electrosurgery from related but different techniques. True electrosurgery uses alternating current, whereas electrocautery (more accurately termed thermocautery) uses direct current to heat a probe. Diathermy, another term sometimes applied to electrosurgery, relies on molecular dipole rotation in high-frequency fields and is fundamentally different in mechanism.

Electrosurgical Techniques

Electrosurgery encompasses several specialized techniques, each tailored to specific clinical needs:

• Electrofulguration produces sparks that dehydrate and carbonize superficial tissues. The electrode remains slightly above the skin, generating an electric arc. This technique is commonly used for treating skin tags, warts, and seborrheic keratoses.
• Electrodesiccation involves direct contact with the skin, causing dehydration of surface and subdermal tissues. It is suitable for lesions such as syringomas, milia, and sebaceous hyperplasia, and is also used for hair removal and fine blood vessel treatment.
• Electrocoagulation targets deeper tissue, achieving haemostasis by coagulating blood vessels. This technique is essential for treating skin cancers and vascular conditions such as pyogenic granulomas.
• Electrosection combines cutting and coagulation, allowing for the excision of vascular lesions with minimal thermal damage to surrounding tissue. It is frequently used for the removal of benign moles, skin tags, and seborrheic keratoses.
• Thermocautery uses direct current to heat a probe that transfers thermal energy to tissue. Unlike other electrosurgical methods, the treating electrode itself remains cold. This technique is particularly suitable for patients with implanted cardiac devices.
• Radiofrequency devices operate at extremely high frequencies (greater than 1,500 kHz), providing precision cutting with minimal collateral tissue damage. These devices are often preferred for non-ablative skin tightening and other cosmetic applications.

Electrode Configurations

Electrosurgery can be categorized into three modalities based on electrode configuration. Monoterminal electrosurgery features a single electrode and does not require an indifferent electrode. Monopolar electrosurgery uses a pointed probe to deliver current, with an indifferent electrode placed on the patient to complete the circuit; this configuration requires careful grounding to prevent burns. Bipolar electrosurgery employs forceps with active and indifferent electrodes on each tine, confining the current to the tissue grasped by the forceps and minimizing risks for patients with implanted cardiac devices.

Safety Considerations

Despite its many advantages, electrosurgery carries risks including burns, electric shocks, infection transmission, and exposure to surgical smoke. Proper precautions are essential, including the use of smoke evacuators, insulated surfaces, and personal protective equipment to safeguard both patients and practitioners.

Patients with Cardiac Devices

Patients with implanted pacemakers or defibrillators require particular attention during electrosurgical procedures. The use of bipolar devices or thermocautery is recommended to prevent interference with the cardiac device. In complex cases, collaboration with a cardiologist may be arranged to ensure patient safety throughout the procedure.

At the Centre for Medical and Surgical Dermatology, electrosurgical procedures are performed by Dr. Maksym Breslavets using modern precision devices with enhanced safety features, including specialized electrodes and smoke evacuation systems.

Coverage and Referral Information

This treatment is classified as a procedural dermatology service. Procedural dermatology services are not covered by OHIP and do not require a physician referral. Appointments may be scheduled directly by contacting the Centre for Medical and Surgical Dermatology.