Electrical testing of laparoscopic instruments

1. Electrical testing of laparoscopic instruments A surgeon’s perspective

2. 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

3. Damaged bowel

4. Mechanism • Faulty insulation • Inadequate insulation • Direct coupling • Capacitative coupling • Pedicle effects • Surgeon problems

5. Inadequate insulation

6. Direct coupling

7. 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

8. Bowel injury • Consequences • Delayed perforation • Peritonitis approx 1 week after surgery • Other mechanisms • Direct bowel injury with instrument

9. 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

10. Evidence for a problem ?