MRCS

Surgical Diathermy

Definition:
Diathermy involves the use of high frequency alternating electrical current (A.C.
400kHz-10MHz) to produce a localised heating effect which in turn causes local tissue
destruction. It can be employed to cauterize, cut, desiccate and fulgurate (destroy) tissue.
It is also known as electrosurgery/electrocautery/electrocoagulation.
Note:
1. Greek root - Dia - through and thermy - heat.
2. Low frequency may stimulate neuromuscular tissue.

Types:
Monopolar
Current flows from generator to instrument then through patient to a second electrode
(indifferent return electrode) - the diathermy plate.
Due to surface area of instrument being much smaller than plate there is localised heat
produced at tip of instrument and relatively minimal heat at the plate.
Surface area of plate over 70cm3.
Higher power/wattage required.
Bipolar
Within the instrument two electrodes are combined e.g. forceps.
When the two forceps tips or electrodes are in contact the circuit is completed creating localised heat.
No patient plate electrode required.
Lower power/wattage required.
Safer in patients with pacemakers.

Modes:
The effect of diathermy relies on the current and wave-form.
Cutting
Continuous current with a sinus wave-form allowing cutting and parallel cauterizing of
the tissue edges.
Coagulation
Interrupted pulses of current with a square wave-form - mainly for cauterizing and
fulguration.
Blend
A mixture of both cutting and coagulation modes.

MRCS

Surgical Diathermy

Complications:
Complication

Cause

Burns

Superficial burns from pooling of flammable liquid - spirit based

skin preperations.
Erroneously placed patient plate electrode.
Retained heat in electrode.
Poorly insulated diathermy lead.
Inadvertent use.

Explosion

Ignition of volatile anaesthetic agents e.g. anaesthetic gases in

bowel.

Electrocution

Poorly insulated diathermy leads.

Pacemaker
interference

Can reprogram pacemaker.

Pacemaker wires may conduct current to the heart causing
myocardial burns.
Prevent - preferentially use bipolar. Only use monopolar in
short, low power waves and ensure plate is positioned so that
current travels away from pacemaker.

Channelling

Avoid use of diathermy on appendages/ narrow pedicles.

Coupling

Current can be induced in other insulated metal conductors e.g. metal laparoscopic ports.

Safety:
Ensure appropriate training.
Equipment maintenance.
Avoid incorrect placement of plates - ensuring good contact on dry skin and at least
70cm3 surface area.
Wipe excess spirit based liquids.
Sound when diathermy on.
Place in insulated quiver when not in use.
Ensure patient is not in contact with earthed materials.