From the Guidelines
Endocut mode on electrosurgical units (ESUs) is a controlled tissue cutting mode that alternates between cutting and coagulation phases, designed to provide precise incisions with minimal thermal damage, and its safe use is crucial to prevent complications, especially in the context of COVID-19 where aerosol-generating procedures (AGP) like electrosurgery pose a risk of viral transmission to healthcare workers 1.
Purpose of Endocut Mode
The primary purpose of Endocut is to allow for precise tissue cutting while simultaneously achieving hemostasis, making it an essential tool in various surgical procedures, including endoscopic sphincterotomy and polypectomy. This mode is particularly useful in delicate surgical interventions where control over tissue cutting and bleeding is critical.
Safe Use of Endocut Mode
For the safe use of Endocut mode, surgeons should:
- Select appropriate power settings based on the specific tissue type and procedure requirements, typically starting at lower settings (30-40 watts) and adjusting as needed.
- Keep the cutting electrode clean of tissue debris throughout the procedure to prevent impedance issues.
- Ensure proper patient grounding with a return electrode to prevent electrical burns.
- Use Endocut with brief, controlled activations rather than continuous application to minimize thermal spread to adjacent structures.
Mechanism of Action
Endocut works by delivering controlled bursts of high-frequency current that vaporize cellular water to create tissue separation, while interspersed coagulation phases seal small vessels. This pulsed delivery system reduces the risk of complications like perforation and post-procedural bleeding compared to traditional continuous cut modes.
Considerations in the Context of COVID-19
Given that electrosurgery is considered an aerosol-generating procedure (AGP) and poses a risk of viral transmission to healthcare workers, especially in the context of COVID-19 1, it is essential to take additional precautions. These include using smoke evacuation systems, minimizing energy device/electrocautery use, and ensuring all healthcare workers wear appropriate personal protective equipment (PPE) to minimize exposure to aerosolized particles.
Key Recommendations
- Use Endocut mode with caution and as part of a comprehensive strategy to minimize aerosol generation and viral transmission in surgical settings.
- Employ strategies to limit the leakage of gas during laparoscopic procedures.
- Consider the clinical benefits of a minimally invasive approach versus a laparotomy for each patient on a case-by-case basis, weighing the risks of potential viral exposure and transmission against the benefits of the procedure.
From the Research
Purpose of Endocut Mode
- The Endocut mode on electrosurgery units (ESUs) is used for cutting and coagulation in various therapeutic interventions, including endoscopic procedures such as sphincterotomy and polypectomy 2.
- The purpose of Endocut mode is to achieve a good cutting effect on tissue, which is influenced by the waveform's duty cycle and crest factor, with a high-duty cycle and lower crest factor leading to effective cutting 2.
Safe Use of Endocut Mode
- To ensure safe use of Endocut mode, it is essential to understand the proper settings and waveforms for specific endoscopic interventions, as well as the principles of electrosurgery and its application in endoscopic surgery 3, 4.
- The Endocut mode should be used in conjunction with other modes, such as Forced Coag mode, to control bleeding and achieve optimal therapeutic outcomes 2.
- The choice of Endocut mode and settings depends on the specific procedure and tissue type, and operators should be familiar with the device and its settings to minimize risks and adverse events 3, 5.
Types of Endocut Modes
- Different types of Endocut modes are available, including Endocut I and Endocut Q modes, which have specific settings and applications in endoscopic procedures 2.
- The Endocut I mode is used for endoscopic sphincterotomy, while the Endocut Q mode is used for cutting polyps 2.
- The blendcut/endocut mode has been compared to the purecut/autocut mode in terms of adverse event rates, with both methods having high rates of bleeding and pancreatitis 5.
Principles of Electrosurgery
- Electrosurgery is based on the application of high-frequency electrical alternating current to biologic tissue to cut, coagulate, desiccate, and/or fulgurate 3, 6.
- The mechanism behind electrosurgery involves heat production and thermal tissue damage, with the depth and rate of heat production determining the final tissue effects 6.
- Understanding the principles of electrosurgery is crucial for achieving optimal therapeutic outcomes and minimizing risks in endoscopic surgery 3, 4.