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M I N I M A L L Y
I N V A S I V E
S U R G E R Y
will soon be next to no difference in thermal spread between electrosurgery and ultrasonic devices."
Harmonic scalpels may cause minimal spread, but leaving the instruments on tissue too long after coagulation has occurred will still cause
thermal spread to extend to 5mm or beyond. "Surgeons who understand
how the different modalities work will cause minimal thermal injury, no
matter which energy source is used," says Dr. Giesler. "It's the unknowledgeable surgeon who will have issues with thermal damage. That's why
learning and understanding the application of energy modalities is essential."
The focus of surgical safety is understandably aimed at what occurs at
the tip of an instrument, but the well-being of who's holding the other end
shouldn't be ignored. Posture and ergonomics are critical to the physical
health of minimally invasive surgeons. Laparoscopic instruments are
extensions of their arms, so the best tools let them stand with elbows in a
neutral, relaxed position.
Handpieces must be balanced and comfortable for hands of various size,
especially with the growing number of female surgeons performing laparoscopic procedures, says Dr. Giesler. He's noticing that residents with smaller hands don't have the same abilities to manipulate standard instruments.
"We haven't reached the endpoint where we have optimal instrumentation
designed for all surgeons. That's an area of needed evolution." OSM
E-mail dcook @outpatientsurgery.net.
On the Web:
The Fundamental Use of
Surgical Energy (fuseprogram.org)
is an educational program offered
by the Society of American
Gastrointestinal and
Endoscopic Surgeons.
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O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E | S E P T E M B E R 2013
