Principles and safety measures of electrosurgery in laparoscopy

Abstract

Background: Electrosurgical units are the most common type of electrical equipment in the operating room. A basic understanding of electricity is needed to safely apply electrosurgical technology for patient care.

Methods: We reviewed the literature concerning the essential biophysics, the incidence of electrosurgical injuries, and the possible mechanisms for injury. Various safety guidelines pertaining to avoidance of injuries were also reviewed.

Results: Electrothermal injury may result from direct application, insulation failure, direct coupling, capacitive coupling, and so forth.

Conclusion: A thorough knowledge of the fundamentals of electrosurgery by the entire team in the operating room is essential for patient safety and for recognizing potential complications. Newer hemostatic technologies can be used to decrease the incidence of complications.

Figure 1.

Direct and alternating current.

Figure 2.

Wave forms of electrosurgical units with different tissue effects.

Figure 3.

Monopolar circuit.

Figure 4.

In bipolar electrosurgery, the 2 tines of the forceps form the active and return electrode functions.

Figure 5.

Tissue charring and thermal spread are inversly related to the voltage setting.

Figure 6.

Direct coupling occurs when an active electrode makes an unintended contact with another electrode or conductive instrument.

Figure 7.

Insulation failures. Any break in the insulation may provide an alternate pathway for the flow of current.

Figure 8.

Capacitive Coupling. A capacitively coupled current typically returns through a metal trocar sheath to the grounding pad. If a plastic trocar sheath is used, the current will accumulate at the junction of the plastic and metal and seek an alternate path.

Figure 9.

Principles of ultracision technology in surgery.