• Direct application injuries. The top complication in the study,
these burn injuries occur when thehot tip of the device is placed too
close to a vulnerable structure. "For example, surgeons who use the
tip of an electrosurgery pencil in close proximity to the bowel can
burn the edge and make a hole in it," says Dr. Robinson.
Preventing this injury often comes down to understanding the dis-
tance of the device's lateral spread of energy. Surgeons should make
sure there's adequate space between the tip of the activated device
and adjacent tissue, use the lowest possible effective power setting
and, whenever possible, employ short activation bursts.
• Insulation defects. Another common issue with electrosurgical
devices is the small amounts of current that can leak through tiny
breaks and minute cracks in the instrument's shaft. Current strays
from the intended energy path, causing small electrical burns to non-
targeted tissue that can result in internal bleeding, lesions and infec-
tion.
"There's research that says 20% of all laparoscopic instruments have
one or more defects along the shaft," says Dr. Robinson. "The rate of
defects on instruments used during robotic surgery can be as high as
50%."
Preventing injuries caused by instrument defects requires having a
consistent process in place to routinely examine the insulation along
electrosurgical devices, says Dr. Robinson.
• OR fires. While flash fires in the surgical field may not be as com-
mon as direct application injuries, they still happen more often than
they should. "As long as we still have OR fires, there's knowledge gaps
to fill," says Dr. Renton.
His facility fills those gaps with fire safety education at least twice a
year with a focus on understanding the fire triangle — ignition source,
oxygen, fuel — is always in play whenever electrosurgery is involved.
5 8 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • A P R I L 2 0 2 0
