Radiofrequency surgery rehearsal or practice sessions

I strongly recommend rehearsal or practice sessions on pieces of meat or chicken before starting your work on patients. The time allotted to practice will never go to waste, in fact, it will cut short the learning curve for the new user. In this chapter I have made an effort to practically demonstrate the use of all modes or waveforms of radiofrequency surgery equipment. This will thus make the switch from other surgical modalities (refer to Chapter 6) much easier. Additionally, practice on meat or chicken will give the feel of the technique as well as the visual impact of the treated tissues. This will facilitate the applications dramatically.

Radiofrequency surgery has become very familiar with medical practitioners. Hence, many medical equipment manufacturers have invested in developing their own radiofrequency equipment. There is a lot of good quality equipment on the market. Radiofrequency surgery devices have been manufactured in many countries including the United States, Germany, South Korea, India, China, and Taiwan. This equipment varies in their parameters like the exact radiofrequency delivered (1 to 4 MHz), power, and the quality of cut and coagulation waveforms. I have used the Ellman Surgitron from the United States, hence here I am specifying the parameters accordingly. There will be some variations in the power settings when using other radiofrequency equipment.

Practice Session Suggestions and Tips

The following items will be required for a practice session1:

Radiofrequency surgery equipment
Electrodes such as a straight needle electrode, fine wire electrode (Vari-Tip), broad needle electrode, wire loop electrode, ball electrode, round blade or flat disclike Surgipen electrode
Surgical gloves
Tissue forceps
Normal saline bottle for moistening tissue
Four to five sufficiently large pieces of chicken or meat
Small, fine-bristle paintbrush and dark watercolor (only for understanding)

Before a practice session ensure the following:

Always confirm proper fitting of electrode in the handpiece. The insulated portion of the electrode must be fully inside the handpiece; there must be no gap left (Figures 10.1 and 10.2).
Always start from a lower power to reach optimum while cutting.
The angle at which the electrode is held, contact time of electrode to tissue, dragging of electrode in tissue, and sparking at the time of cut are important points to be keenly observed.
Always moisten the meat piece before working on it.
As a matter of pictorial way of understanding, which can make a concrete impact on the learning practitioner, I recommend trying it yourself with the use of a fine-bristle paintbrush with India ink on a drawing paper in the way shown in Figure 10.3.

Figure 10.1Electrode insulation must be inserted fully inside the headpiece. (Modified from Pollack SV, Laboratory exercises, in Electrosurgery of the Skin, 1st edition, New York, Churchill Livingstone, 1991, p. 75, Figure 14.1.)

Figure 10.2An incompletely inserted electrode can cause electric shock. (Modified from Pollack SV, Laboratory exercises, in Electrosurgery of the Skin, 1st edition, New York, Churchill Livingstone, 1991, p. 75, Figure 14.2.)

Figure 10.3A fine bristle paintbrush is comparable to a fine electrode (for thinnest cut). (Modified from Pollack SV, Laboratory exercises, in Electrosurgery of the Skin, 1st edition, New York, Churchill Livingstone, 1991, p. 80, Figure 14.9.)

You also need to ensure the following when getting ready for a practice session:

Radiofrequency surgery equipment is connected to the mains electricity supply.
Antenna plate is connected into the socket marked for it.
Handpiece is connected into the socket marked for it.
Foot pedal is connected and kept on the floor.
Meat piece wrapped in cellophane is opened.
Antenna plate is kept underneath the meat piece.
Equipment is switched on.

Applications of Waveforms

The next sections describe the exercises to be carried out for each of the waveforms used.

Electrosection or fully filtered current

This is a pure cutting current (waveform). Electrically, it is a continuous flow of nonpulsating high radiofrequency AC current. This is known to produce the least amount of lateral heat dispersion and hence the least tissue destruction. This is due to its properties of microsmooth dissection.

After primary preparation, as given earlier, a straight needle electrode is selected and inserted fully inside the handpiece. Power is set to a minimum of 2. The electrode is held perpendicular to the meat piece and touched gently to cut. At this low power, generally the electrode does not cut at all or will cut with some effort, but the cut is shabby and tissue pieces will stick to the electrode. This is the effect of low power.
Increase the power to 8 to 10 and make a cut. The resultant cut will be with sparking and some charring. This cut is not a good cut. It is inferior and more likely to cause tissue charring and damage leading to side effects or inferior cosmesis in practice. This power is very high.
After exploring different powers from 2 to 10, you will be able to find the optimum power setting for cutting the meat piece. The optimum power will allow a microsmooth or fine cut without charring and sparking. This power could be between 3 and 5. This power will help with pressureless incision and effortless cutting. The cuts made with such power will look very clean and fine as though the tissue has just split. Tissue will never stick to electrode.
Try the same using the fine wire or Vari-Tip electrode.
Try also the round loop electrode. You can try cutting with the loop by holding the tissue with forceps. You can practice with the loop to make superficial and deeper excisions. The loop electrode is used very commonly in dermatologic surgery (Figures 10.4 to 10.6).

Figure 10.4Holding a meat piece with forceps to cut with a round loop electrode. (Modified from Pollack SV, Laboratory exercises, in Electrosurgery of the Skin, 1st edition, New York, Churchill Livingstone, 1991, p. 80, Figure 14.10.)

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