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S U R G I C A L E N E R G I E S
I
t's not an overstatement to argue that energy-based cutting and sealing devices revo-
lutionized the performance and outcomes of open and laparoscopic abdominal surger-
ies. "That area is extremely vascular, and tends to bleed a lot when we cut out tissue,"
says Stephen Cohen, MD, MBA, FACS, FASCRS, a general surgeon who operates at
Atlanta (Ga.) Colon and Rectal Surgery and chairs the department of surgery at Southern
Regional Medical Center in Riverdale, Ga. "We have a vested interest not only in operat-
ing and removing tissue, but also in decreasing blood loss and pain."
"With the advent of new technology, it is crucial to understand the mechanics of how
instruments work to fully be able to utilize them and prevent injury," wrote Resad Pasic,
MD, PhD, in an article on the science and safety of laparoscopic cutting and sealing
devices in a 2008 issue of the journal Surgical Technology International.
Dr. Pasic, a professor of obstetrics, gynecology and women's health at the University of
Louisville School of Medicine in Kentucky, has recommended that physicians and their
assistants undergo in-service training sessions — led by manufacturers' representatives
— when trialing or implementing new energy-based instruments to ensure that they don't
"start cutting and burning without a full understanding of the mechanics" of the seeming-
ly accessible and easy-to-use devices.
It doesn't take an advanced degree in physics to understand one of their major han-
dling risks, though. "You've always got to be aware that the device is hot," and remains
so after use, says William L. Barrett, MD, a general surgeon at CaroMont Surgical
Associates in Gastonia, N.C. Laparoscopic tools are an extension of a physician's hand,
but these devices should not be used to sweep aside tissue. "If a hot harmonic scalpel
touches bowel, you won't see the thermal effect immediately, but once you've done it, the
damage is done."
He also points out that different energies are likely to create different amounts of surgi-
cal smoke or vapor as by-products of their cutting and sealing effects, which may impair
a laparoscopic surgeon's view of the site, so suction or continuous evacuation systems
should be in use when energies are.
SURGICAL SAFETY
Cut and Seal With Caution
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