This document discusses potential complications from the use of electrosurgery in laparoscopic procedures. It notes that minimally invasive surgeries have benefits like less tissue disruption and faster recovery, but electrosurgery can cause unintended tissue damage if currents stray. The document outlines factors that influence the tissue effects of electrosurgery like frequency, area of contact, and duration of application. It describes different types of electrosurgery and how to reduce risks of direct coupling, capacitive coupling, and insulation failures causing burns. Maintaining equipment and using lowest possible settings can help avoid complications.

1. Complications of laparoscopic
electro surgery
Dr. Mohammed Abdallah
Domiat general hospital

2. why we are rushing towards
minimally invasive surgery?
less disruptive to tissues.
patients generally recover faster
with less pain.
fewer wound problems.
less scarring .

3. In operative laparoscopies
we often use electricity
either to cut, desiccate or
coagulate.
But major catastrophes my
arise if non targeted
tissue is injured.

4. Most of the complication
in Laparoscopic surgery
is due to use of
energized instrument

5. So before we use this
tool it is wise to know
some basics about
electro- cauterization
… and how to avoid its
dangers.

6. Electricity
almost always search for a
conductor to reach the ground

7. Alternating current
60 HZ House hold
current
Faradic effect
resulting in cardiac
arrest
Below
100 KHz
Neuromuscular
stimulation
Above
350 KHz
Radio
frequency and
used in ESU
thermal
effect

8. convert standard electrical frequencies from the
wall outlet, which are 50 to 60 Hz, to much
higher frequencies, 500,000 to 3,000,000 Hz
Electrosurgical unit

9. Monopolar Electrosurgery
dispersive pad

10. Current path is confined to tissue grasped between
forceps blades.
Bipolar Electrosurgery

11. currentR
heat
Increased resistance
TISSUE IMPEDANCE
Eschar buildup
Any current with this frequency
meet resistance produce heat
0
20
40
60
80
100

12. current
Patient Return Electrodes

13. current
Patient Return Electrodes

14. Patient Return Electrodes
•It should be applied to a wide
area of electrically more
conductive tissues like muscles.
•Don't use Metal plates
•Use Large Silicon rubber plates

15.  
The large surface area of the
dispersive pad results in low current
density at the attachment site
if the dispersive pad becomes loose
with only partial skin attachment, or
of surface area the current density
increases at the attachment site

16. • the patient plate should be placed such
that the longer edge points to the active
electrode.
 
Patient Return Electrodes

17. To avoid Burn at Pad site
• Well vascularized muscle
mass
Choose
• Vascular insufficiency
Irregular body contours
Bony prominences
Avoid
• Incision site
Patient position
Other equipment on patient
Consider

18. • The use of the hook can be
summarized as
HOOK LOOK COOK

19. By varying the voltage, current or waveform
tissue can be cut cleanly (“pure cut”),
 coagulated to achieve haemostasis (“coag
mode”) or
 a “blend cut” that combines these two
functions can also be produced.
Finally, a dispersed coagulation mode
known as fulguration, allows coagulation of
diffuse bleeding.

20. Variables changing
the tissue effects of
electro-surgery

21. Frequency:
• a low voltage and a high continuous
frequency produce cut effect.
• high voltages applied with an intermittent
frequency produce coagulation effect.
Area:
• a thin, needle-shaped electrode will produce a
high power density (cut effect).
• a wider electrode (spatula-shaped),with same
energy in contact with the tissue, will dilute
the electron density on its end, temperature
will increase more slowly and gradually,
obtaining coagulation effect.

22. • some tissues (i.e., veins) explode, giving
an effect opposite to the desired one. In
these cases it is necessary to use a lower
power and to grip with the forceps a
bigger tissue mass.
• the longer the energy application time,
the greater the risks at a distance from
the coagulation or cut point .

26. Three factors lead to stray
energy burns
direct coupling.
capacitive coupling .
insulation failure.

27. direct coupling

28. the higher the peak voltage, the greater the chance for capacitive discharge
A capacitor creates an electrostatic field between the two conductors
capacitive coupling

31. • The low voltage “cut” mode exhibits less
capacitive coupling than coag. does.
• Surgeons must recognize that open
circuit activation (electrode not touching
tissue) dramatically increases voltage and
the possibility of capacitive coupling .
• It is desirable to use as low wattage as
possible and to limit noncontact
activation of the generator.

32. insulation failure
insulation defects can range from normal wear and tear, to stress placed on the
electrode from high voltages.
the smaller the defect, the higher the current density transferred

36. • When possible, place the long edge
of the dispersive pad closest to the
surgical site and on the same side of
the body as the incision if it is a sided
procedure .
• Choose a well vascularized muscle
mass .
• Avoid areas of vascular insufficiency,
irregular body contours, bony
prominences .

37. • Remove excessive hair .
• Check equipment before
each use
• Patient skin is not in contact
with metal or, if so, these
areas are Insulated .

38. • Solutions are not stored on top of
power unit .
• Power cord, dispersive pad cord, and
cautery pencil cord are carefully
placed to avoid possibility of being
tripped .
• It is recommended that Cords not be
wrapped around metal instruments Cords
not be bundled together

39. •Foot pedal is dry .
•Power unit is operated at
lowest possible setting .
•Flammable substances
are used with care when
power unit is in
operation .

40. • Inspect insulation carefully
• Use a low voltage waveform
(cut (
• Use brief intermittent
activation vs. prolonged
activation

41. • Do not activate in open
circuit .
• Do not activate in close
proximity or direct contact
with another instrument .

42. • Use bipolar electrosurgery when
appropriate
• Select an all metal cannula system as
the safest choice. Do not use hybrid
cannula systems that mix metal with
plastic .


43. •Activate the electrode only when
touching tissue.
•Clean the active tip routinely during
surgery to prevent eschar buildup,
which can cause tissue to stick and
set up resistance to current flow.
•Visually inspect instruments
throughout each procedure.

44. • Utilize available technology, such as a
tissue response generator to reduce
capacitive coupling or an active
electrode monitoring system.

45. • Terminate current at the end of
vapor phase
• Apply current in pulsatile fashion
• Alternate between desiccation
and incision
Bipolar surgery

46. TAKE HOME point
Injuries related to stray currents
(insulation failure, capacitive
coupling, and direct coupling)
are most effectively eliminated
with actively monitored
electrodes,
metal cannulas,
and an informed surgeon .

55. Thank you