Cauterization#Electrocautery

Cauterize is a Middle English word borrowed from the Old French {{lang|fro|cauteriser}}, from Late Latin {{lang|la|cauterizare}} "to burn or brand with a hot iron", from Ancient Greek {{lang|grc|καυτηριάζειν}} ({{transliteration|grc|kauteriazein}}), from {{lang|grc|καυτήρ}} ({{transliteration|grc|kauter}}), "burning or branding iron", and {{lang|grc|καίειν}} (kaiein) "to burn" (of caustic).{{cite book|title=Oxford Dictionary of English|page=277|chapter=cauterize|editor=Agnus Stevenson|publisher=OUP|year=2010|isbn=978-0-19-957112-3}}

Image:Cauter DSC09457.jpg

Cauterization has been used to stop heavy bleeding since antiquity. The process was described in the Edwin Smith Papyrus{{cite journal |last1=Sullivan |first1=Richard |title=The identity and work of the ancient Egyptian surgeon |journal=Journal of the Royal Society of Medicine |date=August 1996 |volume=89 |issue=8 |page=472 |doi=10.1177/014107689608900813 |pmid=8795503 |pmc=1295891 |doi-access=free}} and Hippocratic Corpus.{{Cite web |url=https://www.perseus.tufts.edu/GreekScience/Students/Chad/pre-soc.html |first=Chad |last=Colarusso |date=9 May 1995 |title=The Presocratic Influence upon Hippocratic Medicine |publisher=Tufts University |access-date=2008-11-07 |archive-url=https://web.archive.org/web/20011104165621/http://www.perseus.tufts.edu/GreekScience/Students/Chad/pre-soc.html |archive-date=2001-11-04 |url-status=dead }} It was primarily used to control hemorrhages, especially those resulting from surgery, in ancient Greece. Archigenes recommended cauterization in the event of hemorrhaging wounds, and Leonides of Alexandria described excising breast tumors and cauterizing the resulting wound in order to control bleeding.{{cite journal|title=Ancient Greek and Greco–Roman Methods in Modern Surgical Treatment of Cancer|journal=Annals of Surgical Oncology|volume=17|issue=3|pages=665–667|year=2010|first1=Niki |last1=Papavramidou |first2=Theodossis |last2=Papavramidis |first3=Thespis |last3=Demetriou|doi=10.1245/s10434-009-0886-6|pmid=20049643|pmc=2820670}} The Chinese {{lang|zh-Latn|Su wen}} recommends cauterization as a treatment for various ailments, including dog bites.{{cite book|page=314|chapter=Survey of the contents of the Su wen|title=Huang Di Nei Jing Su Wen: Nature, Knowledge, Imagery in an Ancient Chinese Medical Text|last1=Unschuld|first1=Paul U.|publisher=University of California Press|year=2003|isbn=978-0-520-23322-5}} Indigenous peoples of the Americas, ancient Arabs, and Persians also used the technique.{{cite book|title=Medicine Across Cultures|editor-first=Helaine |editor-last=Selin|pages=212, 226|publisher=Springer|isbn=978-0-306-48094-2|date=2006-04-11}}

Tools used in the ancient cauterization process ranged from heated lances to cauterizing knives. The piece of metal was heated over fire and applied to the wound.{{Cite web |url=http://www.hsl.virginia.edu/historical/artifacts/roman_surgical/ |title=Surgical Instruments from Ancient Rome |access-date=2008-11-07 |archive-url=https://web.archive.org/web/20090918091601/http://www.hsl.virginia.edu/historical/artifacts/roman_surgical/ |archive-date=2009-09-18 |url-status=dead }}

Cauterization continued to be used as a common treatment in medieval times. The Babylonian Talmud (redacted in 500 AD), alluding to the practice, states: "... and the effect of the hot iron comes and removes the traces of the stroke."Babylonian Talmud (Hullin 8a) While mainly employed to stop blood loss, it was also used in cases of tooth extraction and as a treatment for mental illness. In the Muslim world, scholars Al-Zahrawi and Avicenna wrote about techniques and instruments used for cauterization.{{cite book|title=Handbook to Life in the Medieval World |volume=1–3|page=497|chapter=Medicine, Science, and Technology|publisher=Infobase|year=2009|first1=Madeleine Pelner |last1=Cosman |first2=Linda Gale |last2=Jones|isbn=978-1-4381-0907-7}}

As late as the 20th-century, Bedouins of the Negev in Israel had it as their practice to take the root of the shaggy sparrow-wort (Thymelaea hirsuta), cut the root into splinters lengthwise, burn the splinter in fire, and then apply the red-hot tip of a splinter to the forehead of a person who was ill with ringworm (dermatophytosis).{{cite book|last=Ḳrispil|first=Nissim|author-link=|script-title=he:ילקוט הצמחים: צמחי הרפואה והתועלת של ארץ-ישראל|trans-title=A Bag of Plants: The Useful Plants of Israel|publisher=Cana |volume=3 (T–M) |year=1985 |location=Jerusalem |pages=738 |language=he|isbn=965-264-011-5 |oclc=959573975 }}

The technique of ligature of the arteries as an alternative to cauterization was later improved and used more effectively by Ambroise Paré.

{{Redirect-distinguish|Electrocautery|Electrosurgery}}

Image:Electrocauter 00.jpg

Electrocauterization is the process of destroying tissue (or cutting through soft tissue) using heat conduction from a metal probe heated by electric current. The procedure stops bleeding from small vessels (larger vessels being ligated). Electrocautery applies high frequency alternating current by a unipolar or bipolar method. It can be a continuous waveform to cut tissue, or intermittent to coagulate tissue.

The electrically produced heat in this process inherently can do numerous things to the tissue, depending on the waveform and power level, including cauterize, coagulate, cut, and dry (desiccate). Thus electrocautery, electrocoagulation, electrodesiccation, and electrocurettage are closely related and can co-occur in the same procedure when desired. Electrodesiccation and curettage is a common procedure.

In unipolar cauterization, the physician contacts the tissue with a single small electrode. The circuit's exit point is a large surface area, such as the buttocks, to prevent electrical burns. The amount of heat generated depends on the size of contact area, power setting or frequency of current, duration of application, and waveform. A constant waveform generates more heat than intermittent. The frequency used in cutting the tissue is higher than in coagulation mode.

Bipolar electrocautery passes the current between two tips of a forceps-like tool. It has the advantage of not disturbing other electrical body rhythms (such as the heart) and also coagulates tissue by pressure. Lateral thermal injury is greater in unipolar than bipolar devices.{{Cite book|title = Sabiston textbook of surgery |isbn = 978-1-4377-1560-6|page = 235|edition = 19th|year = 2012|last1 = Sabiston|first1 = David C.| publisher=Elsevier Saunders }}

Electrocauterization is preferable to chemical cauterization, because chemicals can leach into neighbouring tissue and cauterize outside of intended boundaries.See R. McElroy{{missing long citation|date=January 2025}} for details of various operations and the unintended effects of chemical cauterization Concern has also been raised regarding toxicity of the surgical smoke electrocautery produces. This contains chemicals that, through inhalation, may harm patients or medical staff.{{cite journal |doi=10.1007/s00464-011-1872-1 |title=A single-blind controlled study of electrocautery and ultrasonic scalpel smoke plumes in laparoscopic surgery |year=2011 |last1=Fitzgerald |first1=J. Edward F. |last2=Malik |first2=Momin |last3=Ahmed |first3=Irfan |journal=Surgical Endoscopy |volume=26 |issue=2 |pages=337–342 |pmid=21898022|s2cid=10211847 }}

Ultrasonic coagulation and ablation systems are also available.

Many chemical reactions can destroy tissue, and some are used routinely in medicine, most commonly to remove small skin lesions such as warts or necrotized tissue, or for hemostasis.{{Cite journal|last1=Jangra|first1=Ravi Shankar|last2=Gupta|first2=Sanjeev|last3=Gupta|first3=Somesh|last4=Dr|first4=Anu|date=2020-06-01|title=Chemical cautery pen|url=https://www.jaad.org/article/S0190-9622(19)30446-3/abstract|journal=Journal of the American Academy of Dermatology|language=en|volume=82|issue=6|pages=e193–e194|doi=10.1016/j.jaad.2019.03.032|issn=0190-9622|pmid=31653459|s2cid=204041953 }} Because chemicals can leach into areas not intended for cauterization, laser and electrical methods are preferable where practical.{{Cite journal|last1=Toner|first1=J. G.|last2=Walby|first2=A. P.|title=Comparison of electro and chemical cautery in the treatment of anterior epistaxis|url=https://pubmed.ncbi.nlm.nih.gov/2230555/|journal=The Journal of Laryngology and Otology|year=1990|volume=104|issue=8|pages=617–618|doi=10.1017/s0022215100113398|issn=0022-2151|pmid=2230555|s2cid=29538744 }} Some cauterizing agents are:

• Silver nitrate is the active ingredient of the lunar caustic, a stick that traditionally looks like a large match. It is dipped in water and pressed onto the lesion for a few moments.{{Cite book|last1=Ho|first1=Chuong|url=http://www.ncbi.nlm.nih.gov/books/NBK537873/|title=Topical Silver Nitrate for the Management of Hemostasis: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines|last2=Argáez|first2=Charlene|date=2018|publisher=Canadian Agency for Drugs and Technologies in Health|series=CADTH Rapid Response Reports|location=Ottawa, Ontario|pmid=30817105}}
• Trichloroacetic acid{{Cite journal|last1=Satpute|first1=Satish S.|last2=Joshi|first2=Samir V.|last3=Arora|first3=Ripudaman|last4=Prabha|first4=Neel|last5=Keche|first5=Prashant|last6=Nagarkar|first6=Nitin M.|title=Cryosurgery Vs Trichloroacetic Acid Chemical Cautery for the Treatment of Hypertrophied Nasal Turbinate: A Comparative Study|journal=Iranian Journal of Otorhinolaryngology|year=2020|volume=32|issue=112|pages=303–309|doi=10.22038/ijorl.2019.39039.2293|issn=2251-7251|pmc=7515624|pmid=33014907}}
• Cantharidin is an extract of the blister beetle that causes epidermal necrosis and blistering.{{Cite journal|last=Lipke|first=Michelle M.|title=An Armamentarium of Wart Treatments|journal=Clinical Medicine and Research|year=2006|volume=4|issue=4|pages=273–293|doi=10.3121/cmr.4.4.273|issn=1539-4182|pmc=1764803|pmid=17210977}} It is used to treat warts.{{Cite journal|last1=Recanati|first1=Maurice A.|last2=Kramer|first2=Katherine J.|last3=Maggio|first3=John J.|last4=Chao|first4=Conrad R.|date=2018|title=Cantharidin is Superior to Trichloroacetic Acid for the Treatment of Non-mucosal Genital Warts: A Pilot Randomized Controlled Trial|journal=Clinical and Experimental Obstetrics & Gynecology|volume=45|issue=3|pages=383–386|doi=10.12891/ceog4112.2018|issn=0390-6663|pmc=6075835|pmid=30078935}}

Frequent nosebleeds are most likely caused by an exposed blood vessel in the nose, usually one in Kiesselbach's plexus.

Even if the nose is not bleeding at the time, a physician may cauterize it to prevent future bleeding. Cauterization methods include burning the affected area with acid, hot metal, or lasers. Such a procedure is naturally quite painful. Sometimes, a physician uses liquid nitrogen as a less painful alternative, though it is less effective. A physician may apply cocaine in the few countries that allow it for medical use. Cocaine is the only local anesthetic that also produces vasoconstriction,{{cite web|url=http://www.ncemi.org/cse/cse0308.htm|website=ncemi.org|title=3.08 Epistaxis (Nosebleed)|access-date=2014-11-11|archive-url=https://web.archive.org/web/20140904102353/http://www.ncemi.org/cse/cse0308.htm|archive-date=2014-09-04|url-status=dead}} making it ideal for controlling nosebleeds.

More modern treatment applies silver nitrate after a local anesthetic. The procedure is generally painless, but after the anesthetic wears off, there may be pain for several days, and the nose may run for up to a week after this treatment.

Nasal cauterization can cause empty nose syndrome.{{Cite journal|last=Houser|first=Steven M.|date=2007-09-01|title=Surgical Treatment for Empty Nose Syndrome|journal=Archives of Otolaryngology–Head & Neck Surgery|language=en|volume=133|issue=9|pages=858–863|doi=10.1001/archotol.133.9.858|pmid=17875850|issn=0886-4470|quote = Although total turbinate excision is most frequently the cause of ENS, lesser procedures (eg, submucosal cautery, submucosal resection, cryosurgery) to reduce the turbinates may cause problems as well if performed in an overly aggressive manner.|doi-access=free}}{{Cite web|url=https://www.ffaair.org/maladies/asthme/syndrome-du-nez-vide-snv/|title=FFAAIR {{!}} Syndrome du Nez Vide (SNV)|website=www.ffaair.org|language=fr-FR|access-date=2019-09-11|quote = à la suite d'interventions endonasales diverses (turbinectomie, turbinoplastie, cautérisation...}}{{Cite web|url=http://www.ejo.eg.net/article.asp?issn=1012-5574;year=2016;volume=32;issue=3;spage=119;epage=129;aulast=Saafan#ref4|title=Empty nose syndrome: etiopathogenesis and management|last=Saafan|website=www.ejo.eg.net|access-date=2019-09-11|quote = ENS is a complication of middle and/or inferior turbinate surgery, most frequently total turbinate excision, but also with minor procedures such as submucosal cautery, submucosal resection, laser therapy, and cryosurgery if performed in an aggressive manner}}

Cauterization has been used for the circumcision of infants in the United States and Canada. The College of Physicians and Surgeons of Manitoba advises against its use in neonatal circumcision.{{Cite web |title=Neonatal Circumcision |url=https://cirp.org/library/statements/manitoba/ |access-date=2023-06-16 |website=Circumcision Information and Resource Pages}} This method of circumcision resulted in several infants having their penises severely burned."Family Is Awarded $850,000 For Circumcision Accident". The New York Times. November 2, 1975."David Reimer, 38, Subject of the John/Joan Case". The New York Times. May 12, 2004.Charles Seabrook. "$22.8 million in botched circumcision". Atlanta Constitution. March 12, 1991.{{cite news |last=Schmidt |first=William E. |url=https://www.nytimes.com/nbaseball1985/10/08/science/a-circumcision-method-draws-new-concern.html |title=A Circumcision Method Draws New Concern |work=The New York Times |date=October 8, 1985}}Vincent Lupo. "Family gets $2.75 million in wrongful surgery suit". '"Lake Charles American Press''. May 28, 1986.{{cite journal |pmid=2769863 |year=1989 |last1=Gearhart |first1=J. P. |last2=Rock |first2=J. A. |title=Total ablation of the penis after circumcision with electrocautery: A method of management and long-term followup |volume=142 |issue=3 |pages=799–801 |journal=The Journal of Urology | doi = 10.1016/S0022-5347(17)38893-6}}

• Cryosurgery
• Diathermy
• Singe

{{Reflist}}

• [https://web.archive.org/web/20131016205739/http://www.valleylab.com/education/poes/index.html Valleylab division of Covidien (no longer part of Tyco Healthcare), explaining the basics of electrosurgery]
• [http://www.dailyfilmdose.com/2009/04/cauterizing-wound-and-other-scenes-of.html Examples of Cauterizing the Wound in Cinema - Daily Film Dose]
• {{cite book|title= Biomed: From the Student's Perspective|edition= First |author= Villafane, Carlos |date=June 2009 |publisher=[Techniciansfriend.com] |isbn=978-1-61539-663-4 |url=http://www.biomedtechnicians.com}}

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