Electrosurgical injuries during laparoscopy are potentially serious

Electrosurgical injuries during laparoscopy are potentially serious. The vast majority occur following the use of monopolar diathermy.

๐Ÿ‘‰The overall incidence is between ๐—ผ๐—ป๐—ฒ & ๐˜๐˜„๐—ผ cases per ๐—ผ๐—ป๐—ฒ ๐˜๐—ต๐—ผ๐˜‚๐˜€๐—ฎ๐—ป๐—ฑ operations.

โ€ขElectrical injuries are usually unrecognised at the time that they occur, with patients commonly presenting 3โ€“7 days after injury with complaints of fever and abdominal pain.

โ€ขAs these injuries usually present late, the ๐—ฟ๐—ฒ๐—ฎ๐˜€๐—ผ๐—ป๐˜€ for their occurrence are largely speculative. The main theories are:

๐Ÿ…๏ธŽ Inadvertent touching or grasping of tissue during current application;

๐Ÿ…‘๏ธŽ Direct coupling between a portion of bowel and a metal instrument that is touching the activated probe (Figure).

๐Ÿ…’๏ธŽ Insulation breaks in the electrodes.

๐Ÿ…“๏ธŽ Direct sparking to bowel from the diathermy probe.

๐Ÿ…”๏ธŽ Current passage to the bowel from recently coagulated, electrically isolated tissue.

โ€ข๐—•๐—ถ๐—ฝ๐—ผ๐—น๐—ฎ๐—ฟ diathermy is safer and should be used in preference to monopolar diathermy, especially in anatomically crowded areas.

โ€ขIf ๐—บ๐—ผ๐—ป๐—ผ๐—ฝ๐—ผ๐—น๐—ฎ๐—ฟ 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.