ENDONURSE

c/o VIRGO PUBLISHING, INC.

3300 N. CENTRAL AVENUE

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PHOENIX, AZ 85012

Attn.: Ms. Kelly M. Pyrek, Editor in Chief

October 18, 2002

E-56768 KH/ii

Article entitled "Electrocautery - Sacred Cow or Valuable Asset?" by Kathy Dix published in the October/November 2002 issue of Endonurse

Dear Ms. Pyrek:

Reference is made to the subject article by Kathy Dix. The title alone deserves criticism, because nurses in endoscopic departments are professionals and dumbing down should not be the purpose of professional essays in professional journals.

The word electrocautery is also improperly applied, because it means heating up an electrode and burning with it (galvano-cautery). While such devices were used a long time ago, they are not in use in contemporary endoscopy. With the frequency of litigations against the profession, the first thing a competent lawyer would warn about is the use of proper language, so that the potentially harmful incorrect terminology does not cause an injury and expensive law suits.

"Electrocautery is the process of burning or destroying tissue by use of a small probe with an electric current running through it. It has become a routine surgical means of burning unwanted or harmful tissue and is also used to diminish or stop hemorrhaging. But rather than being applied as a universal solution for all endoscopy-related excisions, it should be weighed carefully against its alternatives to minimize patient discomfort and adverse events." This would not pass high school test requirements, because in electrosurgery the radio frequency current creates the heat and not the electrode. Actually, the whole paragraph is misleading, because electrocautery is not used in endoscopy.

Again and again the author uses the term electrocautery instead of electrosurgery, or high frequency surgery, or radio frequency surgery, or monopolar electrosurgery, or bipolar coagulation, etc. We cannot be sophisticated and reliable in action if we are sloppy, careless and misleading in our expressions.

"An oldie but goodie" is the next subheading that uses a language you would hear in a fast food store by contemporary teenagers, those below standards of etiquette and manners.

The author quotes Dr. Charles J. Lightdale and his letter to the editor of Gastrointestinal Endoscopy. The doctor uses the expression "multipolar", which is plain ignorance, because there is no such a thing. Electrosurgery is either unipolar or bipolar and for details you may request our monograph "Introduction to Electrosurgery" or download it from our web site at www.elmed.com. During the "Star War" era, which most of us have already forgotten, laser became the big panacea and electrosurgery was pushed aside. In the meantime, things have changed back to the prominence of electrosurgery (see Laser vs. Electrosurgery at www.elmed.com).

The author reviews the risks of "electrocautery" meaning electrosurgery and is quoting from a manual: "Locate the grounding pad on the buttock or thigh, remote from the ICD," - NEVER under the patient, that is on the buttock, but taped or strapped on the thigh as far away from the heart as possible.

As part of this discussion, we recommend our publication "Endoscopic Electrode Safety", available in print or on our web site www.elmed.com.

The quoted recommendations by Dr. James F. Daniell are very valuable.

The author also discusses the legal implications and, since I have been engaged in many litigations as a defendant or expert witness, I can speak from experience that most "accidents" were based on ignorance or carelessness.

In our enlightened era of sophisticated education, we certainly can do a much better job.

Very truly yours,

Karl Hausner President