Electrosurgery Notes


  • Monopolar = 1 tip at the end of surgical electrode
  • Bipolar = 2 tip at the end of surgical electrode
  • Monoterminal = Use of treatment electrode without ground plate (indifferent electrode)
  • Biterminal = Both treatment and indifferent electrodes (ground plate) are used
monopolar electrosurgery
“Monopolar electrosurgery” by Community Eye Health is licensed under CC BY-NC 2.0.
bipolar electrosurgery
“Bipolar electrosurgery” by Community Eye Health is licensed under CC BY-NC 2.0. 

Electrosurgery modalities

ModalityElectrode configurationWaveformIndicationsRemarks
ElectrocauteryPatients with ICDs and pacemakersNo current passes through patient (direct heat transference to tissue)
ACUnaltered sine wave
a. High voltage, Low ampereCan be tolerated in patients with pacemakers at low dosage
ElectrodessicationMonoterminalMarkedly dampedSuperficial tissue destructionProbe directly contacts tissue
ElectrofulgurationMonoterminalMarkedly dampedProbe held far (spark effect)
b. High ampere, Low voltageCannot be tolerated in patients with pacemakers
ElectrocoagulationBiterminalSine wave – 6% on and 94% offDeep tissue destructionHigher contact surface area
Lower impedance
Lower current density
Electrosection (pure cut)BiterminalSinewave – 100% onCuttingVaporization
Lower contact surface area
Higher impedance
Higher current density
Blend (coagulation + cut)BiterminalSine wave – different proportions of on/offHemostasis + Cutting

Mnemonic: ABC

  1. Ampere high
  2. Biterminal
  3. Coagulation, Cut, Coagulation + Cut (blend)

Mnemonic: VMDeF

  1. Voltage high
  2. Monoterminal
  3. Dessication
  4. Fulguration


Mnemonic: ABCDE

1. Active electrode trauma: inappropriate contact or inadvertent activation

2. Blaze (fire): near alcohol source or oxygen

3. Current diversion: ACID

  • Alternate ground site burns
  • Capacitive coupling: Transfer of current between 2 conductors (electrode tip and metal cannula) separated by insulator through the electrostatic field (reduced by plastic cannula instead of metal cannula); risk increased with –
    • High voltage (coagulation mode)
    • Open activation (electrodes not in contact with tissue)
    • Increased impedance (wrapping of cable around metal clamps like towel clip or activation over previously coagulated tissue)
  • Insulation failure: Mainly with high voltage coagulation; smaller the break in insulation, higher the density of current dispersed
  • Direct coupling: Transfer of current from one conductive source to another
coupling injuries

4. Cardiac pacemaker: Interference from electromagnetic current; reduced by using –

  • Bipolar electrode
  • Short bursts of monopolar electrode
  • Application of dispersive electrode as far as possible from pacemaker
  • Immediate deactivation and activation of ICD preoperatively and postoperatively respectively

5. Dispersive electrode burns

  • Loss of contact of electrode with patient
  • Inappropriate application of electrode on bony prominences or adjacent to ECG leads

6. Explosions: in the vicinity of inflammable gas under pressure

Further reading: Complications, Implications, and Prevention of Electrosurgical Injuries: Corner Stone of Diathermy Use for Junior Surgical Trainees – PMC (nih.gov)

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