O C T O B E R 2 0 1 6 O U T P A T I E N TS U R G E R Y. N E T 5 5
all the answers correct. That was understandable, but inexcusable, considering
that an electrosurgery tip can burn a patient's bowel or ureter and cause poten-
tially fatal internal injuries. It's clear that surgical energy training is critical to
maintaining patient safety.
Much of that training should include how currents travel through electro-
surgery tools to cut and coagulate tissue. The insulation that's integrated into
the devices is designed to prevent electrical current from escaping the hard-
ware. Routine handling and device reprocessing can, over time, break down the
integrity of this insulation and such defects, even if they're microscopically
small, can enable the escape of stray current, which can thermally burn patient
tissue. Because it isn't directed by the electrosurgery tip, the injury that it caus-
es may not occur where the surgeon is working. It may not even be within the
field of laparoscopic view, leaving the physician unaware of the complication
the patient has suffered.
That's why it is essential for your OR staff to visually inspect the electro-
surgery equipment to be used in a case. A technological safeguard can lend a
hand, too. Insulation defect detectors scan for porosity to determine the risk of
failure and the need for repair. While the handheld detectors are widely avail-
able, approximately half of all surgical facilities do not have them on site.
2. How much energy is needed?
Any training on how cutting and sealing devices work should address the size of
blood vessels that a device can reliably seal. This information can be obtained in
the pre-market approval the FDA issues a manufacturer after it's submitted its
device.
Since electrosurgery works through the direct application of energy, your sur-
geons should use extreme caution in device insertion and placement. They will
most likely be aware that a burned or nicked organ during a laparoscopic chole-
cystectomy could cause a leak and subsequent infection. But they should also
