Electrosurgery: Principles, Risks, Safety Considerations, and Modeling of Thermal Effects

International Journal of Biomedicine 15(4) (2025) 645-648 http://dx.doi.org/10.21103/Article15(4)_RA4 MINI REVIEW INTERNATIONAL JOURNAL OF BIOMEDICINE Electrosurgery: Principles, Risks, Safety Considerations, and Modeling of Thermal Effects Branislav Radjenović, Marija Radmilović-Radjenović* Institute of Physics, University of Belgrade, Belgrade, Serbia Abstract Electrosurgery has significantly transformed modern surgical practices, offering a versatile and effective approach for cutting, coagulating, and desiccating biological tissue with remarkable precision. This review provides a comprehensive exploration of the fundamental principles that underpin electrosurgery, including the electrical mechanisms, tissue interactions, and the various types of thermal injuries that may arise during procedures. It categorizes thermal injuries into direct and indirect types, elucidating the unique risks associated with patients who have implantable electromagnetic devices. Furthermore, the review emphasizes the critical role of modeling thermal effects in electrosurgical procedures, highlighting how computational simulations can predict tissue damage and enhance safety measures. By deepening the understanding of these intricate concepts, surgeons are better equipped to optimize patient outcomes, minimize complications, and ensure the safe application of electrosurgical techniques. Ultimately, this review aims to bridge existing knowledge gaps and promote best practices in the field of electrosurgery, reinforcing its role as a vital tool in contemporary surgical settings.(International Journal of Biomedicine. 2025;15(4):645-648.) Keywords: electrosurgery • thermal injures • electromagnetic devices For citation: Radjenović B, Radmilović-Radjenović M. Electrosurgery: Principles, Risks, Safety Considerations, and Modeling of Thermal Effects. International Journal of Biomedicine. 2025;15(4):645-648. doi:10.21103/Article15(4)_RA4 Introduction Electrosurgery has revolutionized surgical practices by providing a versatile and effective tool for cutting, coagulating, and desiccating biological tissue.1-3 By harnessing the effects of electric current, this technique enhances precision and efficiency in a wide range of surgical procedures, from minimally invasive laparoscopic surgeries to complex open surgeries. The ability to manipulate tissue with high accuracy not only improves surgical outcomes but also reduces recovery times and complications associated with traditional surgical methods. However, the use of electrosurgery is not without its challenges. As with any surgical technology, it introduces inherent risks and complications, particularly in the form of thermal injuries.4,5 These injuries can have significant consequences for patient safety, ranging from minor burns to severe internal damage. Understanding the underlying *Corresponding author: Dr. Marija Radmilović-Radjenović, Institute of Physics, University of Belgrade, Pregrevica 118, 11080 Belgrade, Serbia, E-mail: principles of electrosurgery—including electrical fundamentals, tissue interactions, and the mechanisms of potential hazards—is essential for surgeons striving to optimize patient outcomes and minimize risks. Electric currents flowing through the human body can lead to severe tissue injuries, commonly classified as direct and indirect thermal injuries.6 Direct injuries occur when an active electrode inadvertently contacts any part of the body outside the intended surgical site. In contrast, indirect injuries occur when the electrode unintentionally comes into contact with other metal instruments, causing the current to divert and affect surrounding tissues. Additionally, patients with implantable electromagnetic devices face unique risks, as electrosurgical devices can interact adversely with these implants, leading to specific injuries. Given these complexities, this review aims to explore the principles of electrosurgery, examine the factors that influence its effectiveness, and emphasize the importance of safety considerations in its application. By enhancing our understanding of electrosurgery, we can better equip surgeons to utilize this powerful tool safely and effectively, ultimately improving patient care in surgical settings. 646 B. Radjenović & M. Radmilović-Radjenović / International Journal of Biomedicine 15(4) (2025) 645-648 Principles of Electrosurgery Electrical Fundamentals The mechanics of electrosurgery are grounded in electrical principles. It employs alternating current, which causes cellular ions to oscillate, generating frictional heat. This process transforms electrical energy into mechanical and then thermal energy within the cells. Electrode arrangements used in electrosurgery can be roughly divided into two categories: unipolar and bipolar (Figure 1).7,8 Figure 1. Schematic view of dipole circuits: a) a small active electrode - unipolar (monopolar) and b) two equal-sized electrodes - bipolar. The primary difference between these modalities lies in the pathway of the current. The unipolar circuit consists of a small active electrode placed at the surgical site and a patient return electrode placed on the patient’s body. The current’s likely path is from the active electrode to the ground electrode and back to the electrosurgical generator, completing the circuit. The high current density produced at the active electrode creates a pronounced diathermic effect, causing tissue destruction at the operative site. On the other hand, a bipolar circuit uses two electrodes of equal size, creating a dipole circuit at the site of application. Upon applying a high current density through bipolar forceps, the small amount of tissue contained between the tips of the forceps is coagulated with minimal effect on surrounding tissue. Thermal Tissue Effects Figure 2 illustrates thermal tissue effects, which refer to the changes that occur in biological tissues when they are exposed to heat or cold.9 Electrosurgical cutting occurs when temperatures exceed 100°C, leading to cellular vaporization. The gradual temperature rise between 60°C and 95°C results in desiccation and coagulation. Desiccation is achieved through the loss of cellular water, while coagulation arises from thermal protein denaturation. The use of wider active electrodes generally reduces current density, making it more conducive to coagulation and desiccation. Fulguration is a specialized application of the coag waveform, executed with the active electrode positioned away from the tissue. This technique generates electric arcing that bridges the air gap, producing temperatures above 200°C and resulting in carbonization. The low duty cycle ensures rapid diminishment of current, thus preventing excessive heat accumulation in deeper tissues. Fulguration proves effective in controlling bleeding from raw surfaces, providing a valuable tool for surgical hemostasis. Figure 2. Tissue effects result from the changes that biological tissues (...truncated)