Practical tips for switching over to radiofrequency surgery

The previous chapter highlighted the practical points that have helped radiofrequency surgery to score over contemporary as well as the latest surgical techniques. Surgeons from any discipline of medicine always aim at delivering the best results. Their training institutes and the teaching faculty influence their practice. Overall, the techniques of scalpel, electrocautery, and cryosurgery have become commonplace in the majority of old and even many newer educational institutions. The use of newer techniques may get obstructed due to many unavoidable factors like educational curriculum changes, lack of budgeting, lack of teaching faculty, red-tapeism, and resistance to change. Let’s discuss this in brief:

Educational curriculum changes—These are the most difficult to overcome, because the decisions for this are made at the governmental level where the influence of medical faculty is lacking. Also, dermatology is a specialty that has gained importance only over the past decade, at least in India. The situation is likely to be far better in Western countries where curriculum updating takes place at a faster pace.
Lack of budgeting—The allotment and sanctioning of budgets is a matter of governmental authorities where again medical faculty lacks influence. Additionally, here again dermatology has only started gaining in the past decade. Private institutions are way ahead in investing.
Lack of teaching faculty—Teaching faculty need regular updating at all educational institutions, which is not happening in developing countries. Also, unless institutions invest in newer gadgets, how can teachers be updated?
Red-tapeism—Occasionally, this can become a much greater obstruction to sanctioning of the budgets to update the surgical departments.
Resistance to change—Any major change is always resisted by the old medical faculty. The reasons for this include hurting of egos to apprehension of learning and implementing newer techniques.

In this chapter, I have made an effort to help practitioners make a smooth transition to radiofrequency surgery. A clinician having a surgical practice of at least 5 years (but not using radiofrequency method) should not find it difficult to switch to dermatologic surgery with radiofrequency. Following are some very simple and easy-to-learn tips to facilitate this transition.

From Scalpel to Radiofrequency (RF) Surgery

When we consider the close comparison between the two modalities of Table 6.1, practitioners who are only used to scalpel surgery can very quickly gain expertise in radiofrequency surgery by following these tips and tricks:

Table 6.1Switch from scalpel to RF surgery

Scalpel surgery	RF surgery
Cutting tissue requires pressure	Pressureless cutting of tissue
Bleeding follows any cut	Bleeding well controlled during cut
Tissue cutting is not fine	Tissue cutting is fine
Lesion is usually excised in toto	Lesion is usually excised piece by piece
Excising vascular lesions requires electrocoagulation	Excising vascular lesions is facilitated due to blend mode and separate electrocoagulation mode as well as bipolar coagulation if required
Suturing is commonly required after excision	Suturing is not required commonly after excision
Shaping or sculpting of tissues not possible	Shaping or sculpting of tissues is possible on low power
Very difficult to finely excise superficial lesions	Very good for fine superficial excisions
Cut precision is difficult	Cut precision is absolutely sure
Time required may be more due to bleeding and suturing	Time required is less due to bloodless operative field