1
Always use the lowest power setting possible to get the effect
you want. This is something that many surgeons have never
learned. To get the desired tissue effect, they almost reflexively
choose the "coag" setting and turn it all the way up. Sure, it works, at
least usually. The vessel stops bleeding.
But it's actually the least safe way to operate. If you're trying to
achieve a nice homogeneous seal with coaptive coagulation, the "cut"
setting actually does a better job.
Plus, all the things you might be inclined to worry about with elec-
trosurgery are less worrisome with lower settings. For example, lower
settings decrease the release of stray energy. And if you happen to
have an unrecognized insulation problem, it's going to be less of a
danger at a lower setting.
2
Understand the true functions of cut and coag. The first time
most surgeons use an electrosurgical pencil, they're taught on
the fly in the OR, either as a medical student or as a junior resi-
dent. The senior surgeon reduces electrosurgery to an either-or propo-
sition: If you want to cut something, use the yellow (cut) button. If
you want to have hemostasis and coagulate, use the blue (coag) but-
ton.
Unfortunately, not only is it not that simple, that's not even totally
correct. Maybe they should have different names, because cut and
coag don't always have a lot to do with the distinction between cutting
and coagulation. What they really represent are different waveforms of
energy. The cut setting delivers a continuous waveform, the coag an
interrupted waveform set at a certain duty cycle, based on how fre-
quently per minute the energy fires.
So, there's much more to it than just choosing one or the other. Many
modern instruments have a blend option — either on the handle or on
9 8 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • S E P T E M B E R 2 0 1 8
