How much collateral tissue denaturing can one expect?

Although this depends on many factors with surgical technique being the most significant, in general, collateral tissue denaturing is on a par with, or better than, laser. The least possible is on the order of 140 microns in CUT mode ( minimal to modest concurrent hemostasis ) assuming good dose titration and deft technique, with up to 700-750 microns in BLEND mode ( strong concurrent hemostasis ) assuming average technique. Electrode size has a strong influence also, with thinner electrodes inducing less collateral effect. Note that electrosurgery involves a single pass of the electrode whereas laser requires multiple passes so that collateral tissue denaturing with laser depends strongly on the depth of incision whereas electrosurgery does not ( collateral tissue denaturing is constant along the sides of a uniform cross section electrode regardless of depth ).

FAQ Typical monopolar setup

 monopolar setup

The illustration shows the flow of electrosurgical energy through the body from the electrode ( tip ) to the dispersive plate. The advantage to this principle is the restraint of heat to the electrode site since current density over the dispersive pad is too low to generate significant heat. The disadvantage is current concentration within a narrow anatomic structure connecting the treatment site to the body.


FAQ Typical bipolar coagulation set up

bipolar coag 1bipolar coag 2

The above figures show how electrosurgical coagulating current introduced by a bipolar forceps is constrained to the immediate volume of tissue being treated. The figure on the left shows a bipolar forceps inducing superficial coagulation on the surface of an anatomic structure, and the one on the right shows vessel or tubal coagulation (also called electro-ligation). The advantage to this application is controllability, freedom from charring or burning, and it avoids involving the surrounding tissue, which makes it effective on anatomic structures where monopolar application is problematic. Note also that this application is effective in wet fields whereas monopolar forced coagulation is not.