electrical testing of laparoscopic instruments
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Electrical testing of laparoscopic instruments - PowerPoint PPT Presentation


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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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