Electrosurgical Pencil / Cautery Pencil and It's Uses

Cautery Pencil

 The blog highlights on 

1.What is a Cautery Pencil / Monopolar cautery / Electrosurgical Pencil ?

2. Medical Uses of Monopolar Cautery Pencil

3. Cautery pencil applications in Surgical Disciplines

4. Monopolar Cautery Pencil Types (Electrode Tips)

5. Configurations of ESU Pencils

6. Cautery Pencil Safety Tips while usage

7. Check if your Cautery Pencil is safe ?


1. What is a Cautery Pencil / Electrosurgical Pencil?

Cautery Pencil is also known as Monopolar cautery pencil / Electrosurgical Pencil, Electrocautery Pencil,  or Monopolar pencil with 2 push buttons / ESU Pencil. It is a type of medical device which is used to cut and coagulate biological tissues. 

It is mainly used in electrosurgery procedures.Through the usage of electrosurgical pencils, the surgeon can control the bleeding via Radio Frequency alternating current.

Usually, the surgeon has a freedom of adjusting the cut or coagulate setting through the Electrocautery Pencil’s push buttons.The ESU pencils suit all the universal ESU generator units.

2. Medical Uses of Electrosurgical pencil ( Cautery Pencil Uses) :

  • Cutting : The division of the tissue is generally done by the electrical sparks that directs intense heat to the surgical application site. A maximum current concentration will be generated by the surgeon through this effect.
  • The surgeon generates the electric spark by holding the electrode slightly a bit from the body tissue and thus, a large amount of current is produced in a short time period that vaporizes the tissue.


  • Electrosurgery cutting
  • Coagulation: Fulguration ( also regarded as spray) and Coagulation( Pinpoint) are the 2 types of coagulation.In the pinpoint coagulation, the surgeon usually holds the electrode in direct contact with or away from the tissue.
  • Fulguration is a type of non-contact coagulation method where electric current sparks from the active electrode to the body tissue.
  • Usually, the surgeon holds the electrode a few distance away from the body tissue, thus the delivered radio frequency current creates a spark across the airgap which is in contact with the tissue.Less heat is generated.It creates coagulum instead of cell vapourisation.


  • Coagulation , Fulguration
  • Desiccation: When the body tissue comes in touch with the electrode, the procedure is known as Desiccation. Through this contact, there is a decrease in current concentration.Drying of body cells happens, thus forming a coagulum. 


  • Desiccation

3. Cautery pencil applications in Surgical Disciplines:

These monopolar cautery pencils serve the purpose of cutting the tissue and controlling the bleeding which leads to coagulation at the body surgical site.The areas where ESU pencils are employed namely 

1. Cardiac Surgery

2. Urological procedures

3. Orthopaedic

4.Plastic / Cosmetics surgery

5. Gynaecological procedures

6.Maxillofacial surgery

7.Spine surgery



10.Few Dental Procedures

11.Certain General Surgeries

4. Cautery Pencil Types (Electrode Tips) :

The various cautery types are as follows

  • Knife electrode / Blade
  • Blunt electrode
  • Ball Electrode
  • Loop Electrode
  • Needle Electrode
  • Extended knife electrode
    Cautery Pencil Electrode Types

5. Configurations of ESU Pencils:

Various Configurations of ESU pencils are namely

  • Hand Switching (Push Buttons)
  • Foot switching 
  • Rocker Switching

6. Surgical Cautery Pencil Safety Tips while usage :

Validated ETO Sterilization: 

  • It is always safe to buy an ETO-Sterilized pencil from the cautery pencil manufacturers at competitive price. Beware of non-sterile packaged  Cautery pencils and it is highly important to check for Validated ETO sterilized packaged ESU pencils ( Sterile barrier packing systems).
  • Through the sterilization process,  the pencils are sterilized by the ethylene oxide in the cycle that kills the microbes /microorganisms / virus / bacteria present in them
  •  ETO Process parameters 
  1. Temperature- 50 deg C
  2. Pressure- 1.2 bar
  3. Humidity- 60%
  • The Electrosurgical pencils are meant for one time usage and should not be resterilized.

Instructions before use:

  • Prior to the usage of the pencil, it is better to confirm that the electrode supplied with the pencil is fully inserted.The insulating sleeve of the electrode must fit securely inside the pencil.
  • Only the operator of the active electrode should activate it by hand or foot pedal to prevent injury to sterile team members.
  • Properly provide a ground to the patient to avoid burn site.
  • Select a current frequency as per the surgeon’s suggestion.
  • If the skin presents with cuts, lesions, scars or other types of skin disorders, an alternative site for pre-placement should be selected.
  • The skin should be free of skin lotion, blood, prep solution and debris prior to applying the Patient return electrode.
  • The Patient Return Electrode must be applied to skin that is dry and clean to assure complete contact with the skin.
  • Properly inspect the correct installation and placement of the ESU pencil to the generator. Improper installation can result in injuries.
  • It is always recommended to set in low power ESU generator settings to attain the best surgical outcomes.
  • To activate either cut or coagulate mode, depress the button or end of the switch which is labeled for the desired effect.

Defects and Injuries:

  • Damaged and defective electrode electrosurgical pencils should not be used as it poses serious injuries to both patient and surgeons.
  • There are chances of electrosurgical injury as when the electrode tip comes in contact with the non-targeted tissue, the active electrodes get inadvertently energized.
  • Coupling is one of the most common defects that occurs during the surgery. Upon the current delivery, when the electrode tip is prone to contact with the metal instruments. This should be avoided.


  • Avoid placing the ESU pencils near flammable items as it catches fire when it is in an active state. Examples such as spirit, alcohol formulated skin prepping solutions and oxygen rich environment.        

So, What is the safest place for an ESU pencil when it is not in usage?

  • While the electrode is not in use, place them in an insulated holster instead of leaving it in the surgical field. Therefore, this prevents the burns to the surgeon and as well as the patient.

Cleaning :

  • It is always highly recommended to clean the electrode tips of the pencil frequently.Due to the eschar build up in the electrodes, it should be completely wiped off with a sponge. As long as the eschar builds, the impedance increases, thus contributing to flaming or sparking of the eschar. Cleaning the electrode tips with scratch pads should be avoided as the scratches pave the way for increased eschar buildup.

Proper Training and Knowledge:

  • The safe usage of the cautery pencils are mostly dependent on the factors such as  well equipped knowledge, prior proper training undertaken and the extreme care taken by the surgeons and the fellow assistants.

7. Check if your Surgical Cautery Pencil is safe ?

There are many implications involved while buying electrosurgical pencil at cheap price. Choosing the right surgical ESU / cautery pencil reduces the adverse risks. 


  •  The top and bottom portion of the Hand piece side should be uniformly hermetically sealed or welded throughout the full edges.This in turn leads to no possibility of moisture or other fluids entering into the body.
  • A Matte Finished Pencil provides a better grip during the surgical procedures.
Cautery Pencil
  • An Uniform knife width smoothens the process of surgical procedures.
    Cautery Pencil Knife Width
  • As the knife socket soldered in the PCB, paves way for no movements , however gives better connection integrity.Cautery Pencil Knife Socket
  • Best in quality Cautery Pencil will have an ETO Sterilisation Indicator with instructions in the package. It means it has been processed and sterilised in order to avoid infections. 


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