Electrosurgery refers to the use of high-frequency alternating current (AC) to fulgurate, coagulate, desiccate or cut living tissue. In true electrosurgery, an electrical current is used to generate heat within the tissue itself. Electrosurgery is used widely in the field of dermatology to provide hemostasis in surgical procedures and is a fundamental component of electrodesiccation and curettage. Furthermore, it is also commonly used to destroy small benign superficial lesions such as angiofibromas, fibrous papules, acrochordons, seborrheic keratoses, verrucae, pyogenic granulomas, and molluscum contagiosum.1 Electrosurgical devices were developed in the early twentieth century, and remain widely used today.
In contrast, electrocautery (from Greek kauterion, branding iron), is not a true form of electrosurgery because no electrical current enters the patient.2,3 In electrocautery, electrical current is used to heat a conductor, which then directly heats the tissue.
The forerunners of electrosurgery were developed in the late nineteenth century. The Oudin coil was developed in 1899 as a transformer designed to produce high voltage arcs and discharges that could cause superficial tissue damage or destruction. In 1891, Jacques Arsène d’Arsonval, a French physician, noted that currents with frequencies higher than 10 kHz passed through human tissue without neuromuscular stimulation or tetany.4 In 1900, a Parisian physician, Joseph Rivière, described treating an ulcer on a patient’s hand using high-frequency sparks.2 Walter de Keating-Hart and Pozzi used sparks from an Oudin coil on the skin in 1907, and introduced the term fulguration to describe the superficial carbonization that resulted.5 Fulguration derives from the Latin word, fulgur, which means lightning.
The term electrocoagulation (derived from Latin coagulare, to curdle) was first used by Doyen in 1909 to describe coagulation of tissue from direct contact with an electrode.6 Doyen added an indifferent electrode to the circuit to allow electricity to flow back into the electrosurgical device. The indifferent electrode prevented shocks by providing a path for the return of the current and enhanced its penetration into tissues.5 Soon after, the term electrodesiccation entered the lexicon to describe the slow dehydration of tissues using an electrical current.
The largest advancements in the field were made by William Bovie, Ph.D. and Harvey Cushing, M.D. In 1920, Bovie, “an eccentric inventor with a doctorate in plant physiology,” developed the first electrosurgical device that offered both cutting and coagulation.2 Cushing, a neurosurgeon at Peter Bent Brigham Hospital in Boston, became interested in this device and started using electrosurgery in his surgical cases in 1926. When these devices were first used in the operating room, Bovie controlled the output of the electrosurgical device. Throughout the years, Bovie and Cushing made many modifications to the original electrosurgical units (ESUs), adding monopolar and bipolar electrodes with blended waveforms. Because of their influence, electrosurgical devices are still often colloquially called “Bovies.”5