Electrical testing of laparoscopic instruments
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Electrical testing of laparoscopic instruments. A surgeon’s perspective. The clinical problem. Electrical currents during electrosurgery damaging intra-abdominal structures Injury to intra-abdominal organs Bile duct Bowel If the electrocautery unit doesn’t work, turn it up until it does!

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Presentation Transcript

The clinical problem
The clinical problem

  • Electrical currents during electrosurgery damaging intra-abdominal structures

  • Injury to intra-abdominal organs

    • Bile duct

    • Bowel

  • If the electrocautery unit doesn’t work, turn it up until it does!

    • Problem - the current is not flowing where it should



Mechanism
Mechanism

  • Faulty insulation

  • Inadequate insulation

  • Direct coupling

  • Capacitative coupling

  • Pedicle effects

  • Surgeon problems




Bile duct injury
Bile duct injury

  • Delayed bile duct stricture formation

  • Consequences

    • Late onset jaundice

    • Reconstructive surgery

    • Reduced life expectancy

  • Other mechanisms

    • Poor dissection technique / devascularise duct

    • Narrow duct when applying clips


Bowel injury
Bowel injury

  • Consequences

    • Delayed perforation

    • Peritonitis approx 1 week after surgery

  • Other mechanisms

    • Direct bowel injury with instrument


How do we interpret these injuries
How do we interpret these injuries?

  • Bile duct injury and bowel injury is attributed to a mechanical injury

  • Electrical injury is virtually never acknowledged as a problem as it is usually not witnessed and its consequences are delayed



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