Patient Education: Radiosurgery is here to stay

Sharjah-based dermatologist Dr Minal Patwardhan puts the spotlight on "miracle" drugs and treatments every fortnight. Today: radiosurgery


Radiosurgery was developed in 1951 by Leskell and Larson. It involves usage of high frequency radiowaves which generate heat due to tissue resistance which in turn destroys or removes the tissue.

In contrast to Electrocautery, the actual electrode doesn't heat up and lateral spread of heat is less, thus the tissue destruction is well controlled. This is important for more precise surgery and the post surgical healing is faster with, more importantly, less scarring and pigmentation.

The basic principle is to boost the voltage and the frequency but reduce the amperage so as to produce oscillating radiowaves. These are further adapted in the machine so we can use a single machine for cutting, coagulating and fulgurating.

Where is it used?

Ellman — as it is more commonly known as (because they are the pioneers in the machine) — is being used more frequently in dermatology, gynaecology, facial and cosmetic surgery, vascular and podiatric surgery.

The tissues are moistened to avoid charring.

It is used for pure cutting instead of a scalpel or knife. It gives a much cleaner, more precise cut and requires no pressure. The electrodes are bendable so tissue curves and blind spots are eliminated.

Cutting and coagulating for warts, skin tags, keratosis, cysts, basal cell carcinoma and small skin cancer lesions.

Almost bloodless results and minimum post-operative scarring is achieved.

Biopsies can be taken very easily because cutting is fast, smooth and the morphology of tissues is maintained.

Ingrown toenails, spider veins, hemangiomas etc can be treated by cauterisation with the same machine.

Advantages

• Simple to operate
• No assistant is required
• Generates less lateral heat so less charring
• Pressureless surgery
• Early healing
• Self sterilising elctrode tip
• Disposable tips also available
• Very precise cutting with fine cars
• Resurfacing easy
• Portable
• Versatile machine

Disadvantages

• Slightly more expensive than routine methods
• Should be avoided in cardiac patients and those with pacemakers
• Avoidance of alcohol or oxygen in the vicinity

Side-Effects

• Pain
• Tissue swelling
• Scarring
• Keloid formation

In short, side-effects are the same as with routine cautery but are easily minimised and much less.

The most important factor is that its very fast and post operatively more cosmetic results are achieved.

It has a wider safety profile with fewer complications and allows for a better and more bloodless field for operating.

All in all radiosurgery is one evolution that's here to stay and is becoming more progressive every year.