Principles of electrosurgery during laparoscopic surgery

Principles of electrosurgery during laparoscopic surgery

Inadvertent electrosurgical injuries during minimal access surgery are potentially serious and are often unrecognised at the time. The vast majority occur following the use of monopolar diathermy . For conventional laparoscopy , the overall incidence is thought to be between one and two cases per 1000 operations. Injuries can occur through inadvertent touching or grasping of tissue during current application; direct coupling between tissue and a metal instrument that is touching the activated probe; insulation breaks in the laparoscopic or robotic instru ments; direct sparking from the diathermy probe; or current Bipolar diathermy is safer and should be used in preference to monopolar diathermy , especially in anatomically crowded - areas. If monopolar diathermy is to be used, important safety measures include attainment of a perfect visual image, avoid - ing excessive current application and meticulous attention to insulation. Alternative methods of performing dissection, such as the use of ultrasonic devices, may improve safety .

Figure 10.5 Management of bleeding from a surgical trocar site.