Electrosurgery makes use of high-frequency electrical current to cut, coagulate, desiccate, and fulgurate tissue and can be performed using either monopolar or bipolar-energy in conjunction with a specialized instrument. Each of these two modalities has specific advantages and understanding the difference between the two can help you understand the differences in how they’re used.
The simplest explanation of the differences between these two methods is that with monopolar electrosurgery, the current passes from the probe electrode, to the tissue and through the patient to a return pad to complete the electric current circuit. In bipolar electrosurgery, the current only passes through the tissue between the two arms of the forceps shaped electrode (visualize the tip of a pair of tweezers.)
Bipolar electrosurgery
Bipolar electrosurgery uses lower voltages so less energy is required. But, because it has limited ability to cut and coagulate large bleeding areas, it is more ideally used for those procedures where tissues can be easily grabbed on both sides by the forceps electrode. Electrosurgical current in the patient is restricted to just the tissue between the arms of the forceps electrode. This gives better control over the area being targeted, and helps prevent damage to other sensitive tissues. With bipolar electrosurgery, the risk of patient burns is reduced significantly.In the most common techniques, the surgeon uses forceps that are connected to the electrosurgical generator. The current moves through the tissue that is held between the forceps. Because the path of the electrical current is confined to the tissue between the two electrodes, it can be used in patients with implanted devices to prevent electrical current passing through the device causing a short-circuit or misfire. It is always recommended to review the implanted device user manual prior to preforming any electrosurgical application, to avoid complications.
Monopolar Electrosurgery
Monopolar electrosurgery can be used for several modalities including cut, blend, desiccation, and fulguration. Using a pencil instrument, the active electrode is placed in the entry site and can be used to cut tissue and coagulate bleeding. The return electrode pad is attached to the patient, so the electrical current flows from the generator to the electrode through the target tissue, to the patient return pad and back to the generator. Monopolar electrosurgery is the most commonly used because of its versatility and effectiveness.