Electrosurgical safety

Question 1

Types pf current

Answer 1

• Monopolar
  o Current through electrode to tissue then via patient to diathermy pad where the energy is dispersed over a large area to avoid burns
  o Cut setting
• Low voltage current with high density
• Low thermal spread
  o Coagulation setting
• High voltage current with low density
• High thermal spread
• Bipolar
  o Current passes between two electrodes via the tissue

Question 2

Electrosurgical complications at laparotomy

Answer 2

o Unintended activation of active electrode on other tissue
o Current diversion
-Electrical energy will find path of least resistance
- Modern systems will alarm if current not returned via return electrode
o Return electrode
- Poorly applied or partially detached electrodes may cause burns as energy dispersed over smaller area
- Modern systems have split-plate technology to reduce this risk

Question 3

Electrosurgical complications at laparoscopy

Answer 3

o Direct coupling
- Current conducted through two non-insulated instruments that are in contact or non-insulated instrument and metal port
o Capacitive coupling
- Transfer of a current through an insulating medium
- Ie monopolar scissors in metal port (separated by monopolar scissors insulation)
o Thermal injury
o Insulation failure