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Injuries associated to Laparoscopic Monopolar Electrosurgery

Monopolar Electrosurgical Probes
Monopolar Electrosurgical Probes
 What are types of injuries while using Laparoscopic Monopolar Electrosurgery? 
Two types: Direct Thermal Injury and Indirect Thermal Injury 
What is direct thermal injury? 
Direct thermal injury occurs when the surgeon misidentifies anatomic structures or accidentally applies the tip of the active electrode to non-targeted tissue (i.e., surgical “pilot error”) 
What is Indirect thermal injury? 
Indirect thermal injury can result when electrical current is conducted along unintended pathways and burns or vaporizes a non-targeted tissue. Such indirect injuries occur during laparoscopic monopolar electrosurgery as a result of insulation failure, direct coupling, and/or capacitive coupling. 
What is Insulation failure? 
Insulation failure occurs when the layer of insulation covering the shaft of the active electrode breaks down. 




What is Direct coupling? 
Direct coupling can occur if the tip of the active electrode comes in direct contact with another metal instrument or conductor within the surgical field 
What is capacitive coupling? 
Capacitive coupling is the induction of stray current to a surrounding conductor through the intact insulation of an active electrode (e.g., active electrode—insulation—metal trocar sheath). The magnitude of the coupled charge is proportional to the amount of voltage and trocar diameter.     
Check out this video tutorial on Injuries associated with Laparoscopic Monopolar Electrosurgery: 
http://youtu.be/EVIEnNP4qdA
 
References
Brill AI, Feste JR, Hamilton TL, et al. Patient Safety During Laparoscopic Monopolar Electrosurgery - Principles and Guidelines. JSLS : Journal of the Society of Laparoendoscopic Surgeons. 1998;2(3):221-225.



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