Procedure

Radiofrequency Surgery

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Radiofrequency Surgery, Electrosurgery

  • Mechanism
  1. Uses tissue moisture to vaporize tissue
  2. Removal, destruction, or cutting of tissue
    1. Uses high frequency (3.8 Million cycles/second)
    2. Step-up transformer increases voltage
    3. Electric oscillating circuit increases frequency
  • Advantages
  1. Safe for technician
    1. Device tip is cold
    2. Low voltage
  2. No Hypopigmentation
  3. Quick
  4. Bleeding control
  5. Sterilizes site
  6. Low risk of fibrous scar
  7. Minimal tissue damage
  • Units
  1. Ellman Surgitron
  2. Cooper Surgical LEEP
    1. http://www.coopersurgical.com
  3. Valley Lab Force II
    1. http://www.valleylab.com/main.html
  4. Wallach Surgical Devices
    1. http://www.wallachsurgical.com/
  5. Circon (Cryomedics)
    1. http://www.circoncorp.com
  • Equipment (in addition to units above)
  1. Mask (HPV, HIV risk)
  2. Gloves
  3. Hand wand and foot control
  4. Smoke evacuator (eliminates smell and viral particles)
  5. Room filter
  • Technique
  1. Mark lesion for excision
  2. Inject Local Anesthesia at lesion
  3. Choose electrode tip
    1. Wire Loop electrode
    2. Wire electrode
    3. Ball electrode
  4. Set Wave form
    1. Cutting or Electrosection (most common setting)
      1. Background
        1. Fully rectified
        2. Fully filtered
        3. Least Heat, least tissue destruction
      2. Indications
        1. Raised lesions: Skin Tags, Pyogenic Granulomas
        2. Basal Cell Carcinoma
        3. Nevus resection (must cut full thickness)
    2. Cut and Coagulation blend
      1. Fully rectified
      2. Less heat than coagulation alone
      3. Indicated for cutting with minimal blood loss
    3. Coagulation
      1. Background
        1. Partially rectified
        2. More heat
        3. Most penetration and tissue damage
        4. Small ball tip (2-5 mm) applied
      2. Indications
        1. Clotting small blood vessels (Telangiectasias)
        2. Angiomas
    4. Electrodesiccation or Fulguration Indications
      1. Telangiectasias
      2. Spider angiomas
      3. Superficial Basal Cell Carcinoma
      4. Condyloma, molluscum, verrucae
      5. Actinic Keratosis
  5. Set Voltage (2 is a typical setting)
    1. Lowest setting
  • Complications
  1. Skin burns
  2. Electrical shocks
  3. HPV infection spread by smoke transmission
  4. Interference with implanted Pacemaker
  5. Eye Injury
  • Maintenance
  • Electrode tip care
  1. Sand paper (keep off carbon)
  2. Wet gauze while energized
  3. Ultrasonic cleaner for 3 minutes
  4. Cold sterilize versus autoclave
  5. Continue to reuse while wire is flexible
    1. If tip bends, dispose of it
  • References
  1. (1999) NPI Conference, Las Vegas
  2. DeWitt in Pfenninger (1994) Procedures, p. 91-101
  3. Hainer (2002) Am Fam Physician 66(7):1259-66 [PubMed]