The major modalities in electrosurgery are electrodesiccation, fulguration, electrocoagulation, and electrosection.
|
|
Polyp is identified, snare is passed over stalk and polyp is then removed Endoscopic polypectomy has been carried out since the early 1970s by both endoscopic snare removal and fulguration of polyps with hot biopsy forceps.
|
|
While the process is technically a process of electrocoagulation, the term "electrocautery" is sometimes loosely, nontechnically and incorrectly used to describe it. The process of vaporization can be used to ablate tissue targets, or, by linear extension, used to transect or cut tissue. While the processes of vaporization/ cutting and desiccation/coagulation are best accomplished with relatively low voltage, continuous or near continuous waveforms, the process of fulguration is performed with relatively high voltage modulated waveforms. Fulguration is a superficial type of coagulation, typically created by arcing modulated high voltage current to tissue that is rapidly desiccated and coagulated.
|
|
Radiofrequency ablation is a dermatosurgical procedure by using various forms of alternating current. Types of radiofrequency are electrosection, electrocoagulation, electrodessication and fulguration. The use of radiofrequency ablation has obtained importance as it can be used to treat most of the skin lesions with minimal side effects and complications.
|
|
It is essential to have the presence of a circuit in an electrosurgical unit, allowing current to flow. By changing the mode of activation of this current, electrosurgery may be used for the cutting or coagulation of soft tissues. The basic types of electrosurgical techniques are coagulation, desiccation, fulguration and electrosection (cutting). The majority of clinical operations are done by electrosection.
|
|
Surgery is rarely used for IC/BPS. Surgical intervention is very unpredictable, and is considered a treatment of last resort for severe refractory cases of interstitial cystitis. Some people who opt for surgical intervention continue to experience pain after surgery. Typical surgical interventions for refractory cases of IC/BPS include: bladder augmentation, urinary diversion, transurethral fulguration and resection of ulcers, and bladder removal (cystectomy).
|
|
This technique may be used for treating nodules under the skin where minimal damage to the skin surface is desired. In fulguration mode, the electrode is held away from the tissue, so that when the air gap between the electrode and the tissue is ionized, an electric arc discharge develops. In this approach, the burning to the tissue is more superficial, because the current is spread over the tissue area larger than the tip of electrode.Electrosurgery for the Skin.
|
|
In medicine, ablation is the same as removal of a part of biological tissue, usually by surgery. Surface ablation of the skin (dermabrasion, also called resurfacing because it induces regeneration) can be carried out by chemicals (chemoablation), by lasers (laser ablation), by freezing (cryoablation), or by electricity (fulguration). Its purpose is to remove skin spots, aged skin, wrinkles, thus rejuvenating it. Surface ablation is also employed in otolaryngology for several kinds of surgery, such as for snoring.
|
|
The ulcers can be removed through fulguration (burned off with the use of electricity or a laser) or resection (cutting around the ulcer, removing both the ulcer and the surrounding inflamed tissue). Some ulcers may recur in the same location. Many patients choose to live with the ulcers and treat the symptoms associated with them through bladder instillations and/or pain medication/therapy. Patients with interstitial cystitis may find relief by modifying their diet to remove foods and beverages that trigger symptoms.
|
|
In general, the diagnosis of endometriosis is confirmed during surgery, at which time ablative steps can be taken. Further steps depend on circumstances: a woman without infertility can be managed with hormonal medication that suppresses the natural cycle and pain medication, while an infertile woman may be treated expectantly after surgery, with fertility medication, or with IVF. As to the surgical procedure, ablation (or fulguration) of endometriosis (burning and vaporizing the lesions with an electric device) has shown a high rate of short-term recurrence after the procedure. The best surgical procedure with much lower rate of short-term recurrence is to excise (cut and remove) the lesions completely.
|
|
In 1927, Beer was awarded the first gold medal given by the International Society of Urology for his work with electro- fulguration. Ten years later he was awarded the Gold Key by the American Congress of Physical Therapy for his pioneering contributions to the treatment of vesical tumors. After Beer died in 1938 Reed Nesbit wrote regarding Beer's method of electrosurgery: > Development of this technique by its brilliant discoverer marked one of the > greatest advances in the history of urology; it led not only to radical > change in the therapeutic management of bladder tumors, but also paved the > way for subsequent electro- resection methods by proving that high-frequency > current could be employed effectively under water .
|
|
Radiofrequency ablation (RFA), also called fulguration, is a medical procedure in which part of the electrical conduction system of the heart, tumor or other dysfunctional tissue is ablated using the heat generated from medium frequency alternating current (in the range of 350–500 kHz). RFA is generally conducted in the outpatient setting, using either local anesthetics or conscious sedation anesthesia. When it is delivered via catheter, it is called radiofrequency catheter ablation. Two important advantages of radio frequency current (over previously used low frequency AC or pulses of DC) are that it does not directly stimulate nerves or heart muscle and therefore can often be used without the need for general anesthesia, and that it is very specific for treating the desired tissue without significant collateral damage.
|
|
In 2011, the American Urological Association released consensus-based guideline for the diagnosis and treatment of IC. They include treatments ranging from conservative to more invasive: # First-line treatments — education, self care (diet modification), stress management # Second-line treatments — physical therapy, oral medications (amitriptyline, cimetidine or hydroxyzine, pentosan polysulfate), bladder instillations (DMSO, heparin, or lidocaine) # Third-line treatments — treatment of Hunner's ulcers (laser, fulguration or triamcinolone injection), hydrodistention (low pressure, short duration) # Fourth-line treatments — neuromodulation (sacral or pudendal nerve) # Fifth-line treatments — cyclosporine A, botulinum toxin (BTX-A) # Sixth-line treatments — surgical intervention (urinary diversion, augmentation, cystectomy) The AUA guidelines also listed several discontinued treatments, including long-term oral antibiotics, intravesical bacillus Calmette Guerin, intravesical resiniferatoxin), high-pressure and long-duration hydrodistention, and systemic glucocorticoids.
|
|