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Archive Staff & Patient Safety 2016

Stay Current on Electrosurgery

Don't let your patients get burned by energy-based technology.

Thomas Robinson, MD, MS, FACS


surgical smoke OCCUPATIONAL HAZARD Surgical smoke is inevitable, but smoke evacuation technology should not be optional.

Energy-based devices are used every day in every case by every general surgeon, and yet much of what surgical teams understand about surgical energy is limited to knowing that tissue is cut or coagulated whenever electrosurgery instruments are activated. That widespread lack of knowledge is why your surgeons, nurses and techs must answer these 4 questions before each procedure to protect themselves and their patients from the very real dangers of stray burns, surgical smoke inhalation and OR fires.

1. Is insulation intact?
As co-chair of the Society of American Gastrointestinal and Endoscopic Surgeons' FUSE (Fundamental Use of Surgical Energy) program, I helped quiz the surgeon leaders of SAGES about basic surgical energy science. Only 20% got all the answers correct. That was understandable, but inexcusable, considering that an electrosurgery tip can burn a patient's bowel or ureter and cause potentially 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 electrosurgery tools to cut and coagulate tissue. The insulation that's integrated into the devices is designed to prevent electrical current from escaping the hardware. 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 causes 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 electrosurgery 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 available, approximately half of all surgical facilities do not have them on site.

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