Safe use of electrosurgery in gynaecological laparoscopic surgery

Abstract

It is crucial to understand the basics of electrosurgery to deliver safe and effective laparoscopic surgery. Electrosurgical tissue effects include vaporisation, desiccation and coagulation, which help to achieve cutting, dissection, ablation and haemostasis during surgery. Electrosurgery is delivered through monopolar and bipolar instruments. Surgeons can avoid complications of electrosurgery by understanding the mechanisms underlying them. Establishment of a formal training programme in surgical energy is needed for surgeons and theatre staff to provide safe laparoscopic surgery. Learning objectivesTo understand the applied physics of electrosurgery.To describe the various electrosurgical tissue effects and the variables controlling them. To identify the differences between monopolar and bipolar instruments. To know the mechanisms of various electrosurgical complications and safety measures to avoid them. Ethical issuesIs it ethical to use energy devices in laparoscopic surgery with little or no formal training about their appropriate use and safety? Do surgeons need to know about all energy devices they use in operating theatres? Should all allied healthcare professionals working in operating theatres undergo formal training on the use of electrosurgery?

Authors’ reply

“…We thank Drs. Dharmasena and Govind for their interest in our article 1 . The case they described affirms one of the learning objectives of our article relating to understanding the mechanisms of electrosurgical complications for safe use of electrosurgery.…”

Review of advanced energy devices for the minimal access gynaecologist

“…The next step for trainees is to undertake simulator‐based laparoscopic training to reinforce this knowledge and embed the practical elements 27 . A curriculum that delivers theoretical and practical components is required to cultivate surgeons capable of safe and successful MAS 1 …”

“…Tissue damage occurs at temperatures above 42°C (see Table 2). Heat can spread deep and lateral to the intended target, known as LTS 1 . ABDs can result in LTS up to 7 mm from the intended target 10 .…”

“…A considerable benefit of UDs over bipolar devices is the avoidance of the inherent complications of electrosurgery, such as coupling effects 1 . Furthermore, ultrasound energy does not result in neuromuscular stimulation.…”

“…This poses an exciting challenge for trainees in gynaecology, who can expect to encounter various devices within their training. The article published in The Obstetrician & Gynaecologist by El‐Sayed et al 1 . presents a thorough review of safety issues associated with electrosurgery, specifically in relation to conventional devices (CD).…”