"
The OR is on fire!"
Did we get your attention? Approximately 500
surgical fires occur every year in the U.S., says
Daniel B. Jones, MD, MS, FACS, a professor of sur-
gery at Harvard Medical School who practices at
Beth Israel Deaconess Medical Center in Boston.
"Accidental thermal burns and OR fires can cause
disfigurement and life-threatening injuries," he says.
Fire is just one of numerous safety concerns sur-
rounding the use of electrosurgery instruments,
venerable tools whose power and corresponding
danger is not always fully understood or appreciat-
ed by surgeons, nurses, anesthesiologists and techs.
Near-misses attributable to electrosurgery instru-
ments go unreported, says Dr. Jones. Why? "You
catch them early enough," he explains. "Someone
takes a laparoscope, points it at the drapes for a
few seconds, and poof, there's a fire. You pat it out,
you look down at the drapes, there's a hole, you put
a piece of plastic on it to cover it up and no one
ever gets around to reporting it."
Tom Robinson, MD, chief of surgery at Rocky
Mountain Regional VA Medical Center in Aurora,
Colo., once was part of a team that examined 6,000
reported electrosurgery injuries. They found laparo-
scopic surgeries particularly perilous. "When the
shaft of a laparoscopic instrument is laying against
the bowel inside the abdomen, even though the tip
of the instrument is involved in the dissection, ener-
gy can escape through the insulation and burn the
tissue," he says. "Activating the tip of the instrument
too close to vulnerable tissue can also cause harm.
If you're too close to the ureter, for example, and
you activate the energy, it heats up the tissue and
O
C T O B E R 2 0 2 0 • O U T P A T I E N T S U R G E R Y . N E T • 3 3
Joe Paone | Senior Associate Editor
When Electrosurgery Becomes Too Hot to Handle
Energy-carrying instruments are powerful tools, but awareness
remains low about how to prevent catastrophic errors while using them.
BESIDE THE POINT Even when electrosurgery instruments are expertly focused on a specific target, insulation leaks in the shaft can cause stray energy to damage tissue that
the surgeon might not even see.
