1
|
Malik AA, Khan RS, Khan RN, Shakeel O, Ahmed HH, Rahid U, Fatima A, Afzal MF, Khattak S, Syed AA. Lack of awareness among surgeons regarding safe use of electrosurgery. A cross sectional survey of surgeons in Pakistan. Ann Med Surg (Lond) 2020; 50:24-27. [PMID: 31938542 PMCID: PMC6953526 DOI: 10.1016/j.amsu.2019.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/20/2019] [Accepted: 11/25/2019] [Indexed: 11/16/2022] Open
Abstract
Objective To assess our surgeons perceptive regarding the safe usage of electrosurgical devices. Method ology: This cross sectional survey was carried out at two hospitals, A cancer hospital and a public sector general hospital. Consultants, fellows and senior residents (Resident year 3rd and year 4th) on the surgical floor were requested to fill up the questionnaire. Calculations were performed with Statistical Package for the Social Sciences (SPSS 20) for Windows version 20 statistical software. Data was described using median with minimum and maximum value for quantitative variables. For categorical variables, number of observations and percentages were reported. The study is complied with hospital guidelines on research involving human subjects. Results Out of 80 questionnaires 52 were filled and returned. 12 consultants, 16 fellows/Senior registrars and 24 senior residents filled their questionnaires. For the sake of anonymity no information was obtained regarding the level of training and experience. Total 12 questions were asked. An expert level was set for a score above 10/12. A moderate level was set at 8/12. A score of less than 8 was considered unsafe for using electrosurgical devices. Only 6 (11.5%) participants had an expert level of understanding. 16 (30.7%) had moderate understanding. 30 (57.7%) were considered unsafe regarding use of electrosurgical devices. 85% participants were not aware of the correct mode of current to use for coagulating vessels. 69% of surgeons would use electrocautery to control staple line bleeds. 67% participants weren't aware of the correct placement of dispersive electrode. 60% couldn't identify a safe device for use in patients with a pacemaker. 46% of surgeons would cut a dispersive electrode to fit it on a child. 69% believed that harmonic scalpel was a bipolar cautery. 61% couldn't differentiate between RFA and Microwave Ablation. 63% didn't know how to handle an operating room fire. Conclusion In these two hospitals, high level of ignorance noticed regarding the procedure and indications of basic electrosurgical equipment which needs raising awareness and further training. The first study to show the lack of understanding of electrosurgical devices among surgeons in Pakistan. Study was performed in 2 hospitals and included consultants, fellows and residents A survey was distributed and questions pertinent to the use of electrosurgical devices were asked. Surgical residents, fellows and consultants were equally unaware of how these devices work. Study highlights the need to start training courses for these devices.
Collapse
|
2
|
Jones SB, Munro MG, Feldman LS, Robinson TN, Brunt LM, Schwaitzberg SD, Jones DB, Fuchshuber PR. Fundamental Use of Surgical Energy (FUSE): An Essential Educational Program for Operating Room Safety. Perm J 2017; 21:16-050. [PMID: 28241913 DOI: 10.7812/tpp/16-050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Operating room (OR) safety has become a major concern in patient safety since the 1990s. Improvement of team communication and behavior is a popular target for safety programming at the institutional level. Despite these efforts, essential safety gaps remain in the OR and procedure rooms. A prime example is the use of energy-based devices in ORs and procedural areas. The lack of fundamental understanding of energy device function, design, and application contributes to avoidable injury and harm at a rate of approximately 1 to 2 per 1000 patients in the US. Hundreds of OR fires occur each year in the US, some causing severe injury and even death. Most of these fires are associated with the use of energy-based surgical devices.In response to this safety issue, the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) developed the Fundamental Use of Surgical Energy (FUSE) program. This program includes a standardized curriculum targeted to surgeons, other physicians, and allied health care professionals and a psychometrically designed and validated certification test. A successful FUSE certification documents acquisition of the basic knowledge needed to safely use energy-based devices in the OR. By design FUSE fills a void in the curriculum and competency assessment for surgeons and other procedural specialists in the use of energy-based devices in patients.
Collapse
Affiliation(s)
- Stephanie B Jones
- Associate Professor of Anesthesia at Harvard Medical School and Vice Chair of Education and Faculty Development at Beth Israel Deaconess Medical Center in Boston, MA.
| | - Malcolm G Munro
- Director of Gynecologic Services for Kaiser Permanente, Los Angeles at the Los Angeles Medical Center in CA.
| | - Liane S Feldman
- Professor of Surgery and Director of General Surgery at McGill University Health Centre in Montreal, Quebec, Canada.
| | - Thomas N Robinson
- Professor of Surgery at the University of Colorado Denver School of Medicine in Aurora.
| | - L Michael Brunt
- Professor of Surgery, Chief of the Section of Minimally Invasive Surgery, Director of the Minimally Invasive Surgery Fellowship, and Director of the Washington University Institute for Minimally Invasive Surgery at the Washington University School of Medicine in St Louis, MO.
| | - Steven D Schwaitzberg
- Professor of Surgery and Chair of the Department of Surgery at the University of Buffalo Jacobs School of Medicine and Biomedical Sciences in NY.
| | - Daniel B Jones
- Professor of Surgery at Harvard Medical School, Vice Chair of Surgery in the Office of Technology and Innovation, and Chief of Minimally Invasive Surgical Services at Beth Israel Deaconess Medical Center in Boston, MA.
| | - Pascal R Fuchshuber
- Oncologic Surgeon at the Walnut Creek Medical Center, Interregional NSQIP Physician Lead for The Permanente Federation, and Associate Professor of Surgery at the University of San Francisco-East Bay in CA.
| |
Collapse
|
3
|
Sankaranarayanan G, Li B, Miller A, Wakily H, Jones SB, Schwaitzberg S, Jones DB, De S, Olasky J. Face validation of the Virtual Electrosurgery Skill Trainer (VEST©). Surg Endosc 2016; 30:730-738. [PMID: 26092003 PMCID: PMC4685014 DOI: 10.1007/s00464-015-4267-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 05/19/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Electrosurgery is a modality that is widely used in surgery, whose use has resulted in injuries, OR fires and even death. The SAGES has established the FUSE program to address the knowledge gap in the proper and safe usage of electrosurgical devices. Complementing it, we have developed the Virtual Electrosurgery Skill Trainer (VEST(©)), which is designed to train subjects in both cognitive and motor skills necessary to safely operate electrosurgical devices. The objective of this study is to asses the face validity of the VEST(©) simulator. METHODS Sixty-three subjects were recruited at the 2014 SAGES Learning Center. They all completed the monopolar electrosurgery module on the VEST(©) simulator. At the end of the study, subjects assessed the face validity with questions that were scored on a 5-point Likert scale. RESULTS The subjects were divided into two groups; FUSE experience (n = 15) and no FUSE experience (n = 48). The median score for both the groups was 4 or higher on all questions and 5 on questions on effectiveness of VEST(©) in aiding learning electrosurgery fundamentals. Questions on using the simulator in their own skills lab and recommending it to their peers also scored at 5. Mann-Whitney U test showed no significant difference (p > 0.05) indicating a general agreement. 46% of the respondents preferred VEST compared with 52% who preferred animal model and 2% preferred both for training in electrosurgery. CONCLUSION This study demonstrated the face validity of the VEST(©) simulator. High scores showed that the simulator was visually realistic and reproduced lifelike tissue effects and the features were adequate enough to provide high realism. The self-learning instructional material was also found to be very useful in learning the fundamentals of electrosurgery. Adding more modules would increase the applicability of the VEST(©) simulator.
Collapse
Affiliation(s)
- Ganesh Sankaranarayanan
- Center for Modeling, Simulation and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Baichun Li
- Center for Modeling, Simulation and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, NY, USA
- School of Mechanical Engineering and Automation, Northeastern University, Sheyang, China
| | - Amie Miller
- Boon Shaft School of Medicine, Wright State University, Dayton, OH, USA
| | - Hussna Wakily
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Stephanie B Jones
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Daniel B Jones
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Suvranu De
- Center for Modeling, Simulation and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Jaisa Olasky
- Department of Surgery, Mount Auburn Hospital, 300 Mount Auburn Street Suite 407, Cambridge, MA, 02138, USA.
| |
Collapse
|
4
|
Canadian Contraception Consensus Chapter 6 Permanent Contraception. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2015. [DOI: 10.1016/s1701-2163(16)39377-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
5
|
Madani A, Jones DB, Fuchshuber P, Robinson TN, Feldman LS. Fundamental Use of Surgical Energy™ (FUSE): a curriculum on surgical energy-based devices. Surg Endosc 2014; 28:2509-12. [PMID: 24939162 DOI: 10.1007/s00464-014-3623-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 04/26/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Amin Madani
- Department of Surgery, McGill University, 1650 Cedar Ave, D6-257, Montreal, QC, H3G 1A4, Canada,
| | | | | | | | | |
Collapse
|
6
|
|
7
|
Common uses and cited complications of energy in surgery. Surg Endosc 2013; 27:3056-72. [PMID: 23609857 DOI: 10.1007/s00464-013-2823-9] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 11/05/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND Instruments that apply energy to cut, coagulate, and dissect tissue with minimal bleeding facilitate surgery. The improper use of energy devices may increase patient morbidity and mortality. The current article reviews various energy sources in terms of their common uses and safe practices. METHODS For the purpose of this review, a general search was conducted through NCBI, SpringerLink, and Google. Articles describing laparoscopic or minimally invasive surgeries using single or multiple energy sources are considered, as are articles comparing various commercial energy devices in laboratory settings. Keywords, such as laparoscopy, energy, laser, electrosurgery, monopolar, bipolar, harmonic, ultrasonic, cryosurgery, argon beam, laser, complications, and death were used in the search. RESULTS A review of the literature shows that the performance of the energy devices depends upon the type of procedure. There is no consensus as to which device is optimal for a given procedure. The technical skill level of the surgeon and the knowledge about the devices are both important factors in deciding safe outcomes. CONCLUSIONS As new energy devices enter the market increases, surgeons should be aware of their indicated use in laparoscopic, endoscopic, and open surgery.
Collapse
|
8
|
Abu-Rafea B, Vilos GA, Al-Obeed O, AlSheikh A, Vilos AG, Al-Mandeel H. Monopolar Electrosurgery through Single-Port Laparoscopy: A Potential Hidden Hazard for Bowel Burns. J Minim Invasive Gynecol 2011; 18:734-40. [DOI: 10.1016/j.jmig.2011.07.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2011] [Revised: 07/21/2011] [Accepted: 07/28/2011] [Indexed: 11/27/2022]
|
9
|
Montero PN, Robinson TN, Weaver JS, Stiegmann GV. Insulation failure in laparoscopic instruments. Surg Endosc 2009; 24:462-5. [DOI: 10.1007/s00464-009-0601-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Revised: 05/25/2009] [Accepted: 06/16/2009] [Indexed: 01/09/2023]
|
10
|
Livaditis GJ. Comparison of monopolar and bipolar electrosurgical modes for restorative dentistry: a review of the literature. J Prosthet Dent 2001; 86:390-9. [PMID: 11677534 DOI: 10.1067/mpr.2001.118729] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This review of the literature was undertaken as part of a wider investigation of effective hemostasis in vital pulp therapy. Two general types of electrosurgical units are available: monopolar and bipolar. This review compares the features of both systems. An important hazard referred to as channeling, funneling, or current crowding is described and associated with pulp therapy injury for the first time. Important safety features of bipolar electrocoagulation are identified and applied to dental procedures. Articles were selected by means of a search of MEDLINE, the U.S. National Library of Medicine's bibliographic database, for literature published between 1966 and 2001 on the topics of electrosurgery, electrocautery, electrolysis, and lasers. A search also was completed from a pulp therapy perspective to determine the use of electrosurgery on the pulp. Numerous articles and texts published between 1900 and 1965 had been reviewed previously; their bibliographies were explored and cross-referenced for pertinent reports. Laparoscopic applications of electrosurgery were reviewed for general background information and for clarification of safety and hazard issues; no exclusionary criteria or date limitations were imposed. Beyond the literature review, numerous authors and developers in the field of electrosurgery were contacted for clarification of concepts and controversies. More than 120 articles and texts related to electrosurgery were reviewed, and another 100+ articles were reviewed in the area of pulp therapy.
Collapse
Affiliation(s)
- G J Livaditis
- Dental School, Baltimore College of Dental Surgery, University of Maryland, Baltimore, MD, USA.
| |
Collapse
|
11
|
Wu MP, Lin YS, Chou CY. Major complications of operative gynecologic laparoscopy in southern Taiwan. THE JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS 2001; 8:61-7. [PMID: 11172116 DOI: 10.1016/s1074-3804(05)60550-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
STUDY OBJECTIVE To describe our experience with major complications in gynecologic laparoscopy compared with literature reports. DESIGN Retrospective study (Canadian Task Force classification II-3). SETTING Two regional teaching hospitals in southern Taiwan. Patients. One thousand five hundred seven women. INTERVENTION Gynecologic laparoscopy. MEASUREMENTS AND MAIN RESULTS The overall number of major complications in 1507 laparoscopies was 24 (1.6%): 6 bladder injuries, 5 bowel injuries, 4 ureteral injuries, 3 cases of delayed vaginal stump bleeding, 2 cases of postoperative ileus, 2 abscesses, 1 vessel injury, and 1 umbilical hernia. Complication rates were analyzed by type of surgery-laparoscopic-assisted vaginal hysterectomy (LAVH) versus non-LAVH. We correlated clinical outcome with time of recognition and treatment of complications. Our complication rates were similar to those reported in the literature and were not significantly different between LAVH and non-LAVH. CONCLUSION Early recognition of injuries, preferably intraoperatively, with immediate appropriate treatment is crucial. It is also important to be alert to early manifestations of complications in the postoperative observation period. (J Am Assoc Gynecol Laparosc 8(1):61-67, 2001)
Collapse
Affiliation(s)
- M P Wu
- Department of Obstetrics and Gynecology, Chi Mei Foundation Hospital, No. 901, Chung Hwa Road, Yung Kang City, Tainan, Taiwan
| | | | | |
Collapse
|
12
|
Abstract
The literature review herein reveals substantial information regarding the safety, efficacy, short-term complications, long-term complications, and noncontraceptive benefits of sterilization. This information should be helpful for providers and potential sterilization candidates. The review also reveals areas where the data are unclear. Points to keep in mind during counseling include the following: The vast majority of women are satisfied with the decision to undergo sterilization. The fact that regret occurs underscores the importance of counseling and adequate individual deliberation before the procedure. In addition to the difficulty and expense associated with sterilization reversal, the woman should thoroughly understand the permanence of the procedure. Although failure is a rare event, it can occur many years after the procedure. Although evidence suggests that hysterectomy rates are higher in sterilized women aged less than 30 to 35 years, it is unlikely that there is a plausible biologic effect of sterilization on hysterectomy risk. An association between tubal sterilization and menstrual cycle changes does not seem valid for changes noted up to 2 years after the procedure. Data are unclear and inconsistent among studies observing women more than 2 years after the procedure. Evidence consistently shows that sterilization is associated with a reduced incidence of ovarian cancer and pelvic inflammatory diseases. Most studies show no effect or improvement of sexual satisfaction after sterilization. Complications during and postprocedure are rare. Sterilization provides no protection against the acquisition of sexually transmitted disease. Patients and their physicians should recognize that sterilized women may need more targeted preventive efforts for health screening and to reduce high-risk behavior than women who use other contraceptive methods. The surgeon's experience and the woman's preferences should govern the ultimate decision regarding the approach and occlusion method. Level II-2 evidence indicates comparable safety between interval laparoscopy and minilaparotomy. Data consistently show that in experienced trained hands, tubal sterilization is safe and highly effective regardless of the approach or occlusive method. Attention to the subtleties of technique seems to be most important in ensuring procedure safety and efficacy. Reanalysis of the CREST data shows that the cumulative failure rate of bipolar coagulation is comparable with the failure rate of unipolar coagulation if a substantial length of tube is adequately coagulated. The data discussed herein can be used to guide management decisions that may increase accessibility and reduce cost of the procedure. Low-resource settings and office settings have maintained an excellent safety record for this procedure through performance of sterilization under local anesthesia. The use of local anesthesia enables a change in procedure location from an inpatient operating room to a free-standing surgical clinic or adequately equipped office. Local anesthesia, with or without preoperative medication, is an excellent option associated with a lower complication risk, reduced cost, and shorter, easier recovery. The surgeon should have specific training in the effective use of local anesthetics, preoperative medications, and management of rare complications in low-resource settings. Little additional research is needed regarding the safety and efficacy of standard sterilization approaches and occlusion methods. There is a need for continued development of nonsurgical methods of sterilization, microlaparoscopic approaches performed in the office setting, and the feasibility and acceptance of service provision by nonspecialist health care providers. The evidence indicates that female sterilization can be performed safely in a variety of resource settings ranging from rural sterilization camps in developing countries to high-tech, resource-rich operating rooms in developed c
Collapse
Affiliation(s)
- S Pati
- AVSC International, New York, New York, USA
| | | |
Collapse
|
13
|
Abstract
OBJECTIVE To review the frequency, effectiveness, and clinical sequelae of tubal sterilization with a focus on the U.S. experience. DESIGN A review of U.S. health care statistics and English-language literature using a MEDLINE search, bibliographies of key references, and U.S. government publications. PATIENT(S) Women seeking tubal sterilization. INTERVENTION Tubal sterilization. MAIN OUTCOME MEASURE(S) Effectiveness and long-term risks and benefits. RESULT(S) Half of the 700,000 annual bilateral tubal sterilizations (TS) are performed postpartum and half as ambulatory interval procedures. Eleven million U.S. women 15-44 years of age rely on TS for contraception. Failure rates vary by method with one third or more resulting in ectopic pregnancy. Reversal is most successful after use of methods that destroy the least tube. Evidence of menstrual or hormonal disturbance after TS is weak, although some studies find higher rates of hysterectomy among previously sterilized women. Decreased risk of subsequent ovarian cancer has been observed among sterilized women. CONCLUSION(S) Tubal sterilization is highly effective and safe. Failures, although uncommon, occur at higher rates than previously appreciated. Evidence for hormonal or menstrual changes due to TS is weak. Tubal sterilization is associated with decreased risk of ovarian cancer.
Collapse
Affiliation(s)
- C Westhoff
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, New York, USA.
| | | |
Collapse
|
14
|
Capelluto E, Champault G. [Variations in intraperitoneal temperature during laparoscopic cholecystectomy]. ANNALES DE CHIRURGIE 2000; 125:259-62. [PMID: 10829506 DOI: 10.1016/s0001-4001(00)00130-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
STUDY AIM The aim of this study was to measure thermal variation during laparoscopy in the vicinity of heat sources such as monopolar (MC), bipolar (BC) and ultrasound coagulation (USC) and to evaluate their possible negative consequences for the patient. METHODS This study included 67 patients who underwent laparoscopic cholecystectomy. The temperature measurements were taken with a sterile thermal probe introduced through a 5 mm trocar, coupled with a recording monitor reading variations between 20 degrees and 80 degrees C. The variation in temperature was measured as a function of the power applied to the electrodes (20 or 30 W) and in relation to the distance (1, 2, 3, 4, and 5 cm) from the electrodes. RESULTS The temperature varied by 3 degrees for BC, 29 degrees for MC and only 0.2 degree for USC when the distance increased for 1 to 5 cm. Depending on the power delivered, (20 or 30 W or 1 to 5 for USC), the variations were 1 degree for BC, 17 degrees for MC and there was still no variation for USC. CONCLUSION The use of bipolar coagulation and ultrasonic coagulation associated with minimal temperature variations is the option of choice for operating near structures such as the common bile duct or the gastrointestinal tract.
Collapse
Affiliation(s)
- E Capelluto
- Université Paris XIII, UFR de médecine de Bobigny-Bondy, service de chirurgie générale et digestive, CHU Jean-Verdier, France
| | | |
Collapse
|
15
|
Wu MP, Ou CS, Chen SL, Yen EY, Rowbotham R. Complications and recommended practices for electrosurgery in laparoscopy. Am J Surg 2000; 179:67-73. [PMID: 10737583 DOI: 10.1016/s0002-9610(99)00267-6] [Citation(s) in RCA: 124] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Electrosurgery is one of the most commonly used energy systems in laparoscopic surgery. Two major categories of potential complications related to electrosurgery in laparoscopy are mechanical trauma and electrothermal injury. The latter can result from unrecognized energy transfer in the operational field or, less commonly, to unnoticed stray current outside the laparoscopic field of view. Stray current can result from insulation failure, direct coupling, or capacitive coupling. METHODS We reviewed the literature concerning essential biophysics of electrosurgery, including electrosurgical waveform differentiation, tissue effect, and variables that determine tissue effect. The incidence of electrosurgical injuries and possible mechanisms responsible for the injuries are discussed. Different types of injuries may result in different clinical manifestations and histopathological findings. Gross and microscopic pathological check-ups of the injury sites may distinguish between different mechanisms, and thus provide further clues postoperatively. RESULTS Several recommended practices are proposed to avoid electrosurgical injury laparoscopically. To achieve electrosurgical safety and to prevent electrosurgical injuries, the surgical team should have a good understanding of the biophysics of electrosurgery, the basis of equipment and general tissue effects, as well as the surgeon's spatial orientation and hand-eye coordination. Some intraoperative adjuvant procedures and newly developed safety devices have become available may aid to improve electrosurgical safety. CONCLUSIONS Knowledge of the biophysics of electrosurgery and the mechanisms of electrosurgical injury is important in recognizing potential complications of electrosurgery in laparoscopy. Procedures for prevention, intraoperative adjuvant maneuvers, early recognition of the injury with in-time salvage treatment, and alertness to postoperative warning signs can help reduce such complications.
Collapse
Affiliation(s)
- M P Wu
- Department of Obstetrics and Gynecology, Tainan Municipal Hospital, Taiwan
| | | | | | | | | |
Collapse
|
16
|
Trindade MRM, Grazziotin RU, Grazziotin RU. Eletrocirurgia: sistemas mono e bipolar em cirurgia videolaparoscópica. Acta Cir Bras 1998. [DOI: 10.1590/s0102-86501998000300010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O conhecimento das leis físicas e dos mecanismos de funcionamento da eletrocirurgia são de grande importância para o cirurgião. Lesões por eletrocirurgia em laparoscopia têm sido observadas, e estão associadas ao uso do eletrodo monopolar, com freqüência de 1 a 2 lesões a cada 1000 procedimentos.Com relação ao desenvolvimento de lesão, existem vários fatores que influenciam: densidade da corrente; o tipo de onda e de coagulação usadas, com suas respectivas voltagens; as condições de isolamento dos dispositivos; a ocorrência do fenômeno de capacitância; e os riscos oferecidos pelo uso em pacientes com marcapasso. No sistema bipolar, a densidade de corrente encontrada ao redor de seus eletrodos é bem menor, levando a menos lesões e, ainda, elimina vários dos outros mecanismos lesivos, como a placa de retorno e os citados acima. Vários estudos demonstram, em colecistectomias, apendicectomias, polipectomias e outros, que o índice de complicações com o eletrodo bipolar é significativamente menor.
Collapse
|
17
|
Chandler JG, Voyles CR, Floore TL, Bartholomew LA. Litigious consequences of open and laparoscopic biliary surgical mishaps. J Gastrointest Surg 1997; 1:138-45; discussion 145. [PMID: 9834340 DOI: 10.1016/s1091-255x(97)80101-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Three hundred six injuries or complications coincident to 296 laparoscopic cholecystectomies were analyzed for the nature and extent of injuries and litigious outcomes that followed. The data were drawn from 31 member companies of the Physician Insurers Association of America, a trade association that initiated the study. The outcomes were compared to 261 contemporaneous open cholecystectomy claims. Biliary tract injuries were the most common, accounting for almost two thirds of all injuries. The spectrum of cases, originally selected for indemnity potential, reflected relative incidences in the medical literature. Laparoscopic injuries were significantly more severe, more likely to result in indemnity, and more apt to involve higher mean +/- standard deviation dollar values (160 dollars +/- 154 x 10(3)) to surviving claimants than injuries resulting from open procedures (106 dollars +/- 122 x 10(3), P = 0.01). Injury recognition at the time of the original procedure had no discernible mitigating effect because 80% of recognized injuries required an additional operative procedure. Risk-aversive behavior should include paying particular attention to placement of the first port, more liberal use of the Hasson technique, placement of all other ports under direct vision, elimination of intraoperative anatomic uncertainty, programmed inspection of the abdomen before withdrawing the laparoscope, and acquiring sufficient knowledge of electrosurgical principles to ensure the safe use of this potentially dangerous modality.
Collapse
Affiliation(s)
- J G Chandler
- Department of Surgery, Colorado University, Denver, CO 80301, USA
| | | | | | | |
Collapse
|
18
|
Penney GC, Souter V, Glasier A, Templeton AA. Laparoscopic sterilisation: opinion and practice among gynaecologists in Scotland. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1997; 104:71-7. [PMID: 8988700 DOI: 10.1111/j.1471-0528.1997.tb10652.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES 1. To produce a list of evidence-based criteria for good quality care relating to female laparoscopic sterilisation. 2. To assess the level of agreement with each criterion among gynaecologists in Scotland. 3. To obtain an overview of current sterilisation practice for comparison with the agreed criteria. DESIGN 1. Agreement with criteria assessed by questionnaire survey; 2. Overview of current practice obtained by questionnaire survey and by casenote review. SETTING Scotland. SAMPLE 1. Questionnaire survey: all 132 consultant gynaecologists in NHS practice. 2. casenote review: 988 consecutive women sterilised in 12 representative hospitals. RESULTS The response rate to the questionnaire survey was 94%. A list of 15 evidence-based criteria was produced, covering patient selection, information and counselling, techniques of tubal occlusion and timing of sterilisation. All 15 suggested criteria gained an overall balance of support among responding gynaecologists. Similar impressions of current practice were gained from the questionnaire survey and from the casenote review. Aspects of practice which measured up well to the agreed criteria included: only 6% of women sterilised were younger than 25 years of age; over 85% of casenotes included clear documentation that women had been counselled regarding failure rate and intended permanency; 88% of sterilisations were performed, or directly supervised by, a gynaecologist of consultant or senior registrar status; and only 2% of sterilisations were undertaken in combination with induced abortion. Aspects of practice which compared poorly with the agreed criteria, and for which recommendations for change have been made, included: only 22% of casenotes mentioned that the option of vasectomy had been discussed; only 30% of gynaecologists indicated that they provide locally produced information leaflets as an adjunct to counselling; four methods of tubal occlusion (including unipolar diathermy) were in use; and there were wide variations among hospitals in the use of day-case care, ranging from 19% to 99%. CONCLUSIONS A list of criteria for good quality care in relation to sterilisation has been validated by agreement among Scottish gynaecologists. Current practice (as assessed by questionnaire survey and casenote review) has been compared with the criteria and some recommendations for change in practice have been made. Following dissemination of these results and recommendations, re-audit will be undertaken in order to identify any changes.
Collapse
Affiliation(s)
- G C Penney
- Department of Obstetrics and Gynaecology, Maternity Hospital, Aberdeen, UK
| | | | | | | |
Collapse
|
19
|
|
20
|
Tucker RD, Voyles CR. Laparoscopic electrosurgical complications and their prevention. AORN J 1995; 62:51-3, 55, 58-9 passim; quiz 74-7. [PMID: 7574564 DOI: 10.1016/s0001-2092(06)63683-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Insulation failures, direct coupling, and capacitive coupling around active electrodes may cause serious burns and tissue damage to patients undergoing laparoscopic procedures. A coordinated team effort between perioperative nurses and surgeons can prevent life-threatening complications from laparoscopic electrosurgical procedures. Knowledge of the biophysics of electrosurgery, the mechanisms of electrosurgery complications, and prevention of patient injuries will empower surgical team members to provide quality outcomes for patients undergoing laparoscopic procedures.
Collapse
Affiliation(s)
- R D Tucker
- Department of Pathology, University of Iowa Hospitals & Clinics, Iowa City, USA
| | | |
Collapse
|
21
|
Berry SM, Ose KJ, Bell RH, Fink AS. Thermal injury of the posterior duodenum during laparoscopic cholecystectomy. Surg Endosc 1994; 8:197-200. [PMID: 8191358 DOI: 10.1007/bf00591829] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
While complications of laparoscopic cholecystectomy occur in 3-7% of cases, bowel injuries are uncommonly reported. Bowel injuries appear to be of two types: penetrating bowel injury from either the Veress needle or trocar, and thermal bowel injury from either contact or conductive burn. The duodenum is usually spared from Veress needle or trocar injury because of its posterior location. However, during dissection in the triangle of Calot, the duodenum is at risk for direct contact burn or energy conduction burn. In this report we describe a presumed conductive burn injury of the posterior second portion of the duodenum which followed laparoscopic cholecystectomy. This unrecognized injury resulted in full-thickness necrosis of the duodenal wall with delayed perforation. This injury was successfully managed with pyloric exclusion. The diagnosis and management of this previously unreported injury are described.
Collapse
Affiliation(s)
- S M Berry
- Department of Surgery, University of Cincinnati Medical Center, OH 45267
| | | | | | | |
Collapse
|
22
|
Abstract
The potential complications of a laparoscopic procedure include those related to laparoscopy and those related to the specific operative procedure. The majority of these complications occur during the early learning phase for laparoscopy. They also may occur, however, during procedures performed by surgeons who have considerable laparoscopic experience. As new applications for laparoscopy continue to emerge, it is important for the surgeon to be familiar with the possible complications associated with the various laparoscopic procedures. Only through an appreciation of the potential complications of a procedure can their overall incidence be reduced to a minimum.
Collapse
Affiliation(s)
- D W Crist
- Department of Surgery, Medical College of Georgia, Augusta
| | | |
Collapse
|
23
|
Voyles CR, Tucker RD. Education and engineering solutions for potential problems with laparoscopic monopolar electrosurgery. Am J Surg 1992; 164:57-62. [PMID: 1385675 DOI: 10.1016/s0002-9610(05)80648-8] [Citation(s) in RCA: 101] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The potential problems of monopolar electrosurgery relate to unrecognized energy transfer ("stray current") outside the view of the laparoscope. Mechanisms of stray current and unrecognized tissue injury include: (1) insulation breaks in electrodes; (2) capacitive coupling, or induced currents through the intact insulation of the active electrode to surrounding cannulas or other instruments; and (3) direct coupling (or unintended contact) between the active electrode and other metal instruments or cannulas within the abdomen. Capacitive coupling poses the greatest risk for injury when the outer conductor (trocar cannula or irrigation cannula) is electrically isolated from the abdominal wall by a plastic nonconductor. Capacitive coupling is increased by the coagulation mode (versus cut), open circuit (versus tissue contact with the electrode), 5-mm cannulas (versus 11 mm), and higher voltage generators. The safety of electrosurgery can be enhanced by surgical education regarding the biophysics of radio frequency electrical energy, technical choices in instruments using all-metal cannula systems, and engineering developments with a dynamically monitored system for insulation failure and capacitive coupling.
Collapse
Affiliation(s)
- C R Voyles
- Surgical Clinic Associates, Jackson, Mississippi 39202
| | | |
Collapse
|
24
|
Abstract
Laparoscopic cholecystectomy is a newly developed technique for removing the gallbladder. Its future is very promising and this operation will probably become the preferred method of cholecystectomy for most patients. However, the limitations of laparoscopic cholecystectomy should be realized and great care must be taken to avoid technical complications. If laparoscopic cholecystectomy is associated with a much higher incidence of injuries to the bile duct than is traditional open cholecystectomy, its promise of decreasing pain, disability, and costs to patients undergoing cholecystectomy will be unfulfilled. The practicing general surgeon should learn laparoscopic techniques, since much of the future of abdominal surgery will ultimately reside in applying "less invasive" methods to perform standard operations. When embarking on a new procedure such as laparoscopic cholecystectomy, it is imperative that the surgeon remember the basis of his or her craft, primum non nocere.
Collapse
Affiliation(s)
- N J Soper
- Washington University School of Medicine, St. Louis, Missouri
| |
Collapse
|
25
|
Female sterilization and its reversal. Contraception 1989. [DOI: 10.1016/b978-0-407-01720-7.50019-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
|
26
|
Chi IC, Feldblum PJ. Methodologic considerations in studies on female sterilization--a review for clinicians. Contraception 1983; 28:437-54. [PMID: 6370584 DOI: 10.1016/0010-7824(83)90076-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Despite the large number of female sterilization (FS) studies and their relatively straightforward nature (compared to oral contraceptive studies for instance), results are often conflicting and a number of unanswered questions remain. Methodologic shortcomings can explain at least a portion of this confusion. This paper provides guidelines so that clinicians may better conduct and evaluate studies of FS techniques. Some important study topics for the future are reviewed, and the authors briefly describe the three main study designs for FS studies--clinical trial, cohort and case-control.
Collapse
|
27
|
Peterson HB, DeStefano F, Rubin GL, Greenspan JR, Lee NC, Ory HW. Deaths attributable to tubal sterilization in the United States, 1977 to 1981. Am J Obstet Gynecol 1983; 146:131-6. [PMID: 6846428 DOI: 10.1016/0002-9378(83)91040-2] [Citation(s) in RCA: 79] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
In 1979, the Centers for Disease Control began surveillance of deaths attributable to tubal sterilization in order to determine why they occur and what may be done to prevent them. Since that time, 29 such deaths have been identified as occurring in the United States from 1977 through 1981. Of these 29 deaths, 11 followed complications of general anesthesia, seven were due to sepsis, four were due to hemorrhage, three were due to myocardial infarction, and four deaths were related to other causes. Some of these deaths might have been prevented by use of endotracheal intubation for general anesthesia, particularly for laparoscopic sterilization, safer use of unipolar coagulation or use of alternative techniques, careful insertion of the needle and trocar for laparoscopy, and discontinuation of oral contraceptives before sterilization. Further surveillance may help to make tubal sterilization even safer.
Collapse
|
28
|
Peterson HB, Lubell I, DeStefano F, Ory HW. The safety and efficacy of tubal sterilization: an international overview. Int J Gynaecol Obstet 1983; 21:139-44. [PMID: 6136433 DOI: 10.1016/0020-7292(83)90051-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This article presents a synthesis of some of the major published studies on the efficacy and safety of tubal sterilization. The conclusions of this overview are that tubal sterilization is a safe operation, long-term sequelae of tubal sterilization have not been well documented, and the risk of pregnancy following tubal sterilization is less than 1 in 100. Continued study is needed to determine how to make a safe and effective procedure even safer and more effective.
Collapse
|
29
|
|
30
|
Peterson HB, DeStefano F, Greenspan JR, Ory HW. Mortality risk associated with tubal sterilization in United States hospitals. Am J Obstet Gynecol 1982; 143:125-9. [PMID: 7081321 DOI: 10.1016/0002-9378(82)90639-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Despite the millions of women who have undergone tubal sterilization in United States hospitals, little has been published about the risk of death from these procedures. To estimate a case-fatality rate of tubal sterilization, we combined data from the Commission on Professional and Hospital Activities and the National Center for Health Statistics with a review of the clinical circumstances for each woman whose death was identified as being potentially sterilization attributable. Considering all deaths temporally associated with tubal sterilization, we estimate that the case-fatality rate is nearly 8/100,000 procedures. When only deaths determined to be attributable to the sterilization operation per se are considered, the case-fatality rate is approximately 4/100,000 procedures, making death attributable to tubal sterilization a rear event.
Collapse
|
31
|
|