Preventing Electrosurgical Energy–Related Injuries

Electro-Surgery Practices and Complications in Laparoscopy

“…In bipolar electrosurgery, both active and return electrodes are located at the surgical field, typically within the instrument tip [21]. The electrodes are only millimeters apart, therefore relatively low power of bipolar systems are needed to desiccate the tissue [23]. The power output of bipolar instruments is one-third to one-tenth that of monopolar systems.…”

“…Generator power output is most often indicated via a digital readout on the face of the generator. Others may have a logarithmic scale from 1 (lowest) to 10 (highest), making exact settings and adjustments more difficult [20], [18], [23]. Surgeons should understand what kind of generator they use and in what scale the power is presented.…”

“…Alternating current waveforms include cut waveform (continuous, non-modulated, undamped), blended waveform (different percentage duty cycle), and coagulation waveform (interrupted, modulated, damped), which are used for different surgical aims [20], [18], [23]. However, these labels are misleading because they do not necessarily produce the tissue effects that are associated with the terms "cut" and "coagulation" [23]. In fact, "cut" waveform can coagulate, and "coagulation" waveform can cut.…”

“…In fact, "cut" waveform can coagulate, and "coagulation" waveform can cut. Moreover, "cut" waveform is often the most appropriate current to use for tissue coagulation [23]. A cut waveform incorporates higher current but lower voltage than coagulation waveforms at the same power setting.…”

“…Higher voltages are more likely to produce unwanted effects and injuries than lower voltages. In more simple terms, for the same power levels, cut waveform produce less charring and tissue damage [23]. 4.…”