An electrosurgical end effector 26 with a rotary shaver 40 being tubular with an open distal end and having a cutting portion 38. There is an active electrode 32 on an insulative carrier 30 projecting through the tubular shaver element. An operating surface 324 of the electrode faces the same direction as the operating cutting direction of the cutting element of the rotatable tubular element. The tubular element may have a cut-out portion having one or more sharpened edges 38 to form a cutting instrument. There may be a second tubular element 36 with a cutting window 66. In use a RF electrosurgical generator supplies an RF tissue sealing or ablation signal to the electrode. This allows the electrode and blade to operate in the same direction, with may be orthogonal to the long axis of the arrangement, allowing simultaneous mechanical cutting and electrosurgical coagulation or ablation. The end effector may be used with a hand piece in a system with a suction source.
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