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! –Problem - the current is not flowing where it should

Damaged bowel

Mechanism Faulty insulation Inadequate insulation Direct coupling Capacitative coupling Pedicle effects Surgeon problems

Inadequate insulation

Direct coupling

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 Consequences –Delayed perforation –Peritonitis approx 1 week after surgery Other mechanisms –Direct bowel injury with instrument

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

Evidence for a problem ?