Principles of Electrocautery-Based Techniques

  • Alexander M. Sarkisian
  • Aaron M. Bernie
  • Richard Lee


This discussion will focus on the technical aspects of electrosurgical techniques used in the surgical treatment of BPH. The core principle of electrosurgery is the application of electrical current to tissue results in heating of the tissue and desired effects on the tissue. The given effect on the tissue largely depends on the rate of temperature rise in tissue, which can be controlled by adjusting the settings of the electrosurgical generator. Tissue effects include cutting, coagulation, vaporization, desiccation, and fulguration. Monopolar techniques require a large dispersive pad located on the patient, while bipolar techniques feature both active and return electrodes built into the resectoscope. Bipolar resection can be carried out in a saline medium, which for all practical purposes removes the risks of TUR syndrome and dilutional hyponatremia observed with monopolar TURP.


International Prostate Symptom Score Return Electrode Dilutional Hyponatremia Electrosurgical Generator Roller Electrode 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    McLean A. The Bovie electrosurgical current generator: some underlying principles and results. Arch Surg. 1929;18(4):1863–73. doi: 10.1001/archsurg.1929.01140130965064.CrossRefGoogle Scholar
  2. 2.
    Taheri A, Mansoori P, Sandoval LF, Feldman SR, Pearce D, Williford PM. Electrosurgery: Part I. Basics and principles. J Am Acad Dermatol. 2014;70(4):591 e591–591 e514. doi: 10.1016/j.jaad.2013.09.056.
  3. 3.
    Morris ML. Electrosurgery in the gastroenterology suite: principles, practice, and safety. Gastroenterol Nurs. 2006;29(2):126–32. Quiz 132–124.PubMedCrossRefGoogle Scholar
  4. 4.
    Jones CM, Pierre KB, Nicoud IB, Stain SC, Melvin 3rd WV. Electrosurgery. Curr Surg. 2006;63(6):458–63. doi: 10.1016/j.cursur.2006.06.017.PubMedCrossRefGoogle Scholar
  5. 5.
    Massarweh NN, Cosgriff N, Slakey DP. Electrosurgery: history, principles, and current and future uses. J Am Coll Surg. 2006;202(3):520–30. doi: 10.1016/j.jamcollsurg.2005.11.017.PubMedCrossRefGoogle Scholar
  6. 6.
    Wang K, Advincula AP. “Current thoughts” in electrosurgery. Int J Gynecol Obstet. 2007;97(3):245–50. doi: 10.1016/j.ijgo.2007.03.001.CrossRefGoogle Scholar
  7. 7.
    Smith D, Khoubehi B, Patel A. Bipolar electrosurgery for benign prostatic hyperplasia: transurethral electrovaporization and resection of the prostate. Curr Opin Urol. 2005;15(2):95–100.PubMedCrossRefGoogle Scholar
  8. 8.
    Collins JW, MacDermott S, Bradbrook RA, Keeley FX, Timoney AG. A comparison of the effect of 1.5 % glycine and 5 % glucose irrigants on plasma serum physiology and the incidence of transurethral resection syndrome during prostate resection. BJU Int. 2005;96(3):368–72. doi: 10.1111/j.1464-410X.2005.05633.x.PubMedCrossRefGoogle Scholar
  9. 9.
    Akgul KT, Ayyildiz A, Nuhoglu B, Caydere M, Ustun H, Germiyanoglu C. Comparison of transurethral prostate resection and plasmakinetic prostate resection according to cautery artefacts in tissue specimens. Int Urol Nephrol. 2007;39(4):1091–6. doi: 10.1007/s11255-007-9174-1.PubMedCrossRefGoogle Scholar
  10. 10.
    Dawkins GPC, Miller RA. Sorbitol-mannitol solution for urological electrosurgical resection – a safer fluid than glycine 1.5 %. Eur Urol. 1999;36(2):99–102. doi: 10.1159/000067978.PubMedCrossRefGoogle Scholar
  11. 11.
    Hahn RG. Irrigating fluids in endoscopic surgery. Br J Urol. 1997;79(5):669–80. doi: 10.1046/j.1464-410X.1997.00150.x.PubMedCrossRefGoogle Scholar
  12. 12.
    Pit MJ, Tegelaar RJ, Venema PL. Isothermic irrigation during transurethral resection of the prostate: effects on peri-operative hypothermia, blood loss, resection time and patient satisfaction. Br J Urol. 1996;78(1):99–103. doi: 10.1046/j.1464-410X.1996.04819.x.PubMedCrossRefGoogle Scholar
  13. 13.
    Jin YH, Tian JH, Sun M, Yang KH. A systematic review of randomised controlled trials of the effects of warmed irrigation fluid on core body temperature during endoscopic surgeries. J Clin Nurs. 2011;20(3–4):305–16. doi: 10.1111/j.1365-2702.2010.03484.x.PubMedCrossRefGoogle Scholar
  14. 14.
    Hoekstra RJ, van Melick HHE, Kok ET, Bosch JLHR. A 10-year follow-up after transurethral resection of the prostate, contact laser prostatectomy and electrovaporization in men with benign prostatic hyperplasia; long-term results of a randomized controlled trial. BJU Int. 2010;106(6):822–6. doi: 10.1111/j.1464-410X.2010.09229.x.PubMedCrossRefGoogle Scholar
  15. 15.
    Kaplan SA, Te AE. Transurethral electrovaporization of the prostate: a novel method for treating men with benign prostatic hyperplasia. Urology. 1995;45(4):566–72. doi: 10.1016/s0090-4295(99)80044-2.PubMedCrossRefGoogle Scholar
  16. 16.
    Hammadeh MY, Madaan S, Hines J, Philp T. 5-year outcome of a prospective randomized trial to compare transurethral electrovaporization of the prostate and standard transurethral resection. Urology. 2003;61(6):1166–71.PubMedCrossRefGoogle Scholar
  17. 17.
    Hammadeh MY, Philp T. Transurethral electrovaporization of the prostate (TUVP) is effective, safe and durable. Prostate Cancer Prostatic Dis. 2003;6(2):121–6. doi: 10.1038/sj.pcan.4500654.PubMedCrossRefGoogle Scholar
  18. 18.
    Wendt-Nordahl G, Hacker A, Reich O, Djavan B, Alken P, Michel MS. The Vista system: a new bipolar resection device for endourological procedures: comparison with conventional resectoscope. Eur Urol. 2004;46(5):586–90. doi: 10.1016/j.eururo.2004.07.018.PubMedCrossRefGoogle Scholar
  19. 19.
    Rassweiler J, Teber D, Kuntz R, Hofmann R. Complications of transurethral resection of the prostate (TURP)–incidence, management, and prevention. Eur Urol. 2006;50(5):969–79. doi: 10.1016/j.eururo.2005.12.042. Discussion 980.PubMedCrossRefGoogle Scholar
  20. 20.
    Sinanoglu O, Ekici S, Tatar MN, Turan G, Keles A, Erdem Z. Postoperative outcomes of plasmakinetic transurethral resection of the prostate compared to monopolar transurethral resection of the prostate in patients with comorbidities. Urology. 2012;80(2):402–6. doi: 10.1016/j.urology.2012.02.029.PubMedCrossRefGoogle Scholar
  21. 21.
    Botto H, Lebret T, Barre P, Orsoni JL, Herve JM, Lugagne PM. Electrovaporization of the prostate with the Gyrus device. J Endourol/Endourol Soc. 2001;15(3):313–6. doi: 10.1089/089277901750161917.CrossRefGoogle Scholar
  22. 22.
    Starkman JS, Santucci RA. Comparison of bipolar transurethral resection of the prostate with standard transurethral prostatectomy: shorter stay, earlier catheter removal and fewer complications. BJU Int. 2005;95(1):69–71. doi: 10.1111/j.1464-410X.2005.05253.x.PubMedCrossRefGoogle Scholar
  23. 23.
    Bach T, Herrmann TR, Cellarius C, Geavlete B, Gross AJ, Jecu M. Bipolar resection of the bladder and prostate–initial experience with a newly developed regular sized loop resectoscope. J Med Life. 2009;2(4):443–6.PubMedPubMedCentralGoogle Scholar
  24. 24.
    Dincel C, Samli MM, Guler C, Demirbas M, Karalar M. Plasma kinetic vaporization of the prostate: clinical evaluation of a new technique. J Endourol/Endourol Soc. 2004;18(3):293–8. doi: 10.1089/089277904773582921.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Alexander M. Sarkisian
    • 1
  • Aaron M. Bernie
    • 2
  • Richard Lee
    • 3
  1. 1.Department of UrologyWeill Cornell Medical CollegeNew YorkUSA
  2. 2.Department of UrologyWeill Cornell, New York Presbyterian HospitalNew YorkUSA
  3. 3.Urology and Public Health, Weill Cornell Medical College, New York Presbyterian HospitalNew YorkUSA

Personalised recommendations