injuries. It starts with
understanding the
properties of individ-
ual instruments,
including the distance
of the device's lateral
spread of energy.
Surgeons should use
this knowledge to
ensure there's ade-
quate space between
the tip of the activated
device and vulnerable
tissue. Surgeons should also use the lowest possible effective power
setting and employ short activation bursts whenever possible.
3. Residual heat
The tips of electrosurgery instruments remain very hot, even after the
devices are deactivated, so burns can occur if the surgeon isn't aware
of this risk factor and accidentally touches the tip to a non-targeted
area. Surgeons should be careful with the residual heat associated
with all electrosurgical devices, but also aware that ultrasonic devices
have higher residual heat than mono- or bipolar equipment.
Again, an understanding of electrosurgery instruments is para-
mount. When using ultrasonic devices, surgeons should avoid touch-
ing the tip of the device to vulnerable tissue immediately after the
energy activation. To avoid collateral damage when moving ultrasonic
instruments into and out of the abdomen, surgeons must always be
aware that the devices stay hot for a long time. Ideally, they should
have direct visualization of the instrument's blade to avoid inadver-
7 6 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • N O V E M B E R 2 0 1 9
• CLOSE INSPECTION Research shows 1 in 5 reusable laparoscopic instruments
have an insultation failure.
Jaisa
Olasky,
MD,
FACS
