Electrosurgical injuries during laparoscopy are potentially serious. The vast majority occur following the use of monopolar diathermy.
The overall incidence is between ๐ผ๐ป๐ฒ & ๐๐๐ผ cases per ๐ผ๐ป๐ฒ ๐๐ต๐ผ๐๐๐ฎ๐ป๐ฑ operations.
โขElectrical injuries are usually unrecognised at the time that they occur, with patients commonly presenting 3โ7 days after injury with complaints of fever and abdominal pain.
โขAs these injuries usually present late, the ๐ฟ๐ฒ๐ฎ๐๐ผ๐ป๐ for their occurrence are largely speculative. The main theories are:
๐ ๏ธ Inadvertent touching or grasping of tissue during current application;
๐ ๏ธ Direct coupling between a portion of bowel and a metal instrument that is touching the activated probe (Figure).
๐ ๏ธ Insulation breaks in the electrodes.
๐ ๏ธ Direct sparking to bowel from the diathermy probe.
๐ ๏ธ Current passage to the bowel from recently coagulated, electrically isolated tissue.
โข๐๐ถ๐ฝ๐ผ๐น๐ฎ๐ฟ diathermy is safer and should be used in preference to monopolar diathermy, especially in anatomically crowded areas.
โขIf ๐บ๐ผ๐ป๐ผ๐ฝ๐ผ๐น๐ฎ๐ฟ diathermy is to be used, important safety measures include attainment of a perfect visual image, avoiding excessive current application and meticulous attention to insulation. Alternative methods of performing dissection, such as the use of ultrasonic devices, may improve safety.