In high-frequency electrosurgical procedures, negative plate coagulation and cutting are two distinct operating modes, differing primarily in the temperature of the thermal effect. Simply put, cutting typically occurs at temperatures above 100°C, while coagulation is around 60-100°C. In practice, these two modes are rarely used independently. Instead, a combined coagulation-cutting mode-"cut-coagulation-cut-coagulation"-is employed to meet cutting requirements while minimizing the risk of bleeding.
Ⅰ.The Difference Between Electrocoagulation and Electrosurgical Resection
The most fundamental difference between electrocoagulation and electrosurgical resection lies in the temperature of the thermal effect. Electrosurgical resection generates a higher temperature, reaching over 100°C, while coagulation is relatively low, ranging from approximately 60-100°C. In practice, we typically avoid using either a pure cutting or pure coagulation mode, but rather a mixed coagulation-cutting mode to better control bleeding and risk.
Ⅱ. Common Problems
Difficulty in cutting (significant resistance) during the initial stage of cutting.
Inadvertent incision during the moment of cutting (causing a large wound).
Insufficient coagulation during cutting (causing bleeding).
Over-coagulation after bleeding (excessive heat conduction).
This can lead to complications such as pancreatitis or delayed perforation.
If you encounter these problems, you can try adjusting the high-frequency electrosurgical parameters. Different brands of high-frequency electrosurgical units have specific precautions that should be carefully considered before use.
Ⅲ. Precautions for Use
The output must be completely suspended: The high-voltage output must be strictly isolated from the housing and power supply. Moisture can affect the output suspension of the electrosurgical unit.
One control action can only activate one surgical electrode: Temporarily unused blades must be placed in an insulated container.
The electrosurgical unit can be operated for extended periods and can withstand multiple short circuits without affecting performance.
Before turning on the unit, ensure that all output powers are set to a low value to prevent sudden excessive power from being applied to the patient.
The negative electrode should be placed in a flat, vascularized, muscle area as close to the surgical site as possible (but no less than 15 cm). The local skin should be shaved and kept clean and dry. The electrode should not cross the surgical site and should be at least 15 cm away from the ECG electrodes. Metal implants, pacemakers, or ECG electrodes should not be in the loop. The long side of the electrode should be close to the direction of the high-frequency current.
Negative pad placement is not suitable for areas with sparse, irregular blood vessels, such as skin folds and bony prominences, scars, areas with thick fat, weight-bearing areas, and areas with fluid accumulation.
Ⅳ. Precautions for Negative Pad Placement
The pads should be firmly attached to the skin.
Keep the pads flat and avoid cutting or folding them.
Avoid soaking the pads during disinfection and rinsing.
Children under 15 kg should use infant pads.
By understanding these differences and precautions, you can better master the use of high-frequency electrosurgical units and ensure safe and effective surgery.