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Archive November 2019 XX, No. 11

Understanding Electrosurgery Safety

Practical pointers for protecting patients from stray current and hot instruments.

Leena Khaitan

Leena Khaitan, MD, MPH, FACS


Pamela Bevelhymer, RN, BSN, CNOR
KNOWLEDGE GAP Surgeons often think they understand surgical energy, but many don't have the formal training needed to truly know how the devices work.

Electrosurgical injuries are estimated to occur in 1 to 2 out of every 1,000 laparoscopic procedures. That doesn't seem like many, but when you consider about 2 million cases involving surgical energy instruments are performed in the U.S. each year, these figures are cause for alarm — and re-education. After all, electrosurgical injuries are preventable. With that in mind, let's look at the most common electrosurgery failures that lead to patient injuries as well as the practical steps you can take to prevent these negative outcomes from taking place at your facility.

1. Insulation breaches

Small amounts of current can leak through minute breaks and small cracks in the shaft of an electrosurgical instrument and stray from the intended energy path to cause small electrical burns to non-targeted areas of tissue. These burns can lead to internal bleeding, lesions and infection. Insulation breaks can be caused by mistreatment of instruments during reprocessing or wear and tear from routine use.

Insulation failure is one of the top reasons for electrosurgery injuries during laparoscopic procedures; research has found that 1 in 5 reusable laparoscopic instruments have an insulation failure. The smaller the break, the higher the amount of current that flows through it. While breaks in the distal third of the laparoscopic instrument are the most common cause of insulation failures, the most dangerous breaks occur in the mid-shaft area, which surgeons can't see during procedures.

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