Diathermocoagulation

DIATHERMOCOAGULATION, a method of cauterizing tissues using high-frequency currents obtained from a diathermy apparatus. For diathermocoagulation, standard apparatuses are used with a current strength of up to 3–5 amperes, with the help of which one can achieve very deep and extensive tissue coagulation; in urology and otorhinolaryngology, small apparatuses are used, providing up to 0.5 amperes. The electrodes serve as follows: a plate of thin foil with a surface area of about 700 cm² as an indifferent electrode, and a different, or active, electrode in the form of a small ball, lancet, knife, or point. For diathermocoagulation in the cavities of the nose and pharynx, special electrodes have been proposed by various authors. The electrodes are connected to the apparatus using well-insulated wires. Coagulation during diathermocoagulation occurs to a greater depth than during coagulation with other types of electrical apparatuses. Diathermocoagulation does not cause bleeding, because thanks to the high temperature, the vessels become thrombosed, which makes it possible to operate without bleeding, and which is very important when removing tumors (both malignant and benign), because the risk of dissemination of a malignant tumor is very small thanks to the thrombosis of the vessels. The absence of bleeding during the operation shortens its duration; wound healing occurs very quickly—even with extensive interventions, patients remain in bed for no more than 8–10 days. The simplicity of the diathermocoagulation technique makes it possible, in case of need, to frequently repeat the operation and thereby prolong the life of patients in cases of incurable malignant tumors. The disadvantages of the method include the possibility of subsequent bleeding from the wound upon detachment of the thrombus, and damage to nearby healthy tissues, especially large nerve trunks or vessels, which must be taken into account and which is not difficult to avoid with correctly applied technique. When performing diathermocoagulation, it is necessary to have the ability to instantly turn the current on and off, for which a special pedal is connected to the apparatus, or a special interrupter is attached to the handle of the active electrode. At the moment the current is closed, a white spot forms at the site of application of the active electrode; at this same moment, it is necessary to interrupt the current and move to the next area. Coagulation should never be brought to the point of carbonizing the tissue, because in this case, the tissue sticks to the electrode, and upon removing the latter, bleeding occurs. Diathermocoagulation is very widely and successfully used for various neoplasms (benign and malignant) developing on the skin and in the cavities of the nose, pharynx, and urogenital tract. Ulcus rodens, which relates to skin cancers—a disease that progresses slowly and causes great destruction to the skin—heals quickly under the influence of diathermocoagulation. Radiologist's cancer is also treated very successfully with diathermocoagulation. Diathermocoagulation also yields good results for cancers developing in deeper parts of the skin, which very quickly spread to cartilage and bone, and give metastases to glands and other organs. In these cases, it is advantageous to combine energetic diathermocoagulation with X-ray therapy. The use of diathermocoagulation for lupus vulgaris deserves attention. The advantage of this method is the possibility of deep action on lupus foci. With diathermocoagulation, it is possible to very precisely localize the coagulating effect on the diseased focus and spare the surrounding healthy tissues. The destruction of an individual lupus focus lasts several seconds, which makes it possible to subject a significant surface area to coagulation during a single session. This operation requires some skill. Furthermore, it is painful, and therefore it is performed under general or local anesthesia. Diathermocoagulation is very widely used for the destruction of naevus pigmentosus, naevus vasculosus, angiomas, telangiectasias, and for epilation. Lit.—see lit. to the article Diathermy. L. Plotnikov.