Electrosurgery Safety Considerations During MIS

Insulation Failure

Many surgeons routinely use the coagulation waveform. This waveform is comparatively high in voltage. This voltage or “push” can spark through compromised insulation. Also, high voltage can “blow holes” in weak insulation. Breaks in insulation can create an alternate route for the current to flow. If this current is concentrated, it can cause significant injury.

You can get the desired coagulation effect without high voltage, simply by using the “cutting” current while holding the electrode in direct contact with tissue. This technique will reduce the likelihood of insulation failure. Remember, you can coagulate with the cutting current by holding the electrode in direct contact with tissue, thereby lowering the current concentration. By lowering current concentration you will reduce the rate at which heat is produced and rather than vaporize tissue you will coagulate—even though you are activating the “cutting” current.

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