Evaluation the amount of capacitive coupling energy occurring with the use of monopolar electrosurgery during laparoscopy

Background and Objective: Electrosurgical injuries occur during laparoscopic operations and are potentially serious. Electrothermal injury may result from direct application, insulation failure, direct coupling, and capacitive coupling. Capacitive coupling is defined as the current transferred from the active electrode, through intact insulation, into the adjacent conductive material without direct contact. The overall incidence of recognized Electrosurgical injuries is between one and two patients per 1,000 operations. The majority go unrecognized at the time of the electrical insult and commonly present three to seven days afterward with fever and pain in the abdomen. The purpose of this study was to measure the capacitive coupling energy using different generator power settings, mode settings (cut vs. coagulation), and surgical techniques (desiccation vs. fulguration vs. open air activation).Materials and Methods: This nonhuman experimental study was done with two monopolar electrosurgery generators. Monopolar generator sent current to a laparoscopic L-hook. The L-hook was inserted through a trocar placed through bovine flank muscle (used to simulate the abdominal wall). The tip or active electrode of the L-hook (the active electrode) was used to create the usual clinical effect on bovine liver tissue (used to simulate the gallbladder fossa). Separate grounding pads (the return electrodes) returned current from the simulated abdominal wall and gallbladder fossa. Capacitive coupling was measured by placing a piece of bovine liver tissue adjacent to the midshaft of the L-hook with intact insulation with a separate grounding pad with an oscilloscope measuring the capacitive coupling energy generated. Results were reported as the mean±standard deviation. Analysis of variance was used to determine the statistical significance which was set at P<0.05 by spss 18.Findings: Higher power settings increased capacitive coupling energy (Joules): 25 Watts (1.2±0.3) versus 50 Watts (2.2±0.7; P<0.05). Coagulation mode created greater capacitive coupling energy (2.2± 1.0) in comparison with cut mode (1.1±0.5; P<0.05). Open air activation (4.3±0.3) and fulguration (3.3±1.0) had higher capacitive coupling energy in comparison with desiccation (0.8±0.2; P<0.05).Conclusion: In conclusion, capacitive coupling occurs with the use of monopolar electrosurgery during laparoscopy. Improving a surgeon’s understanding of the factors that promote capacitive coupling electrosurgical injuries could help reduce laparoscopic electrosurgical complications. Surgeons should lower the power setting, use cut mode, use the surgical technique of desiccation, and use shorter activation times to reduce Electrosurgical injuries.

Keywords:

Electrosurgery injuries , capacitive coupling , laparoscopy