Understanding and Practising Safe Electrosurgery in the Operating Room

Future of Endoscopic Spine Surgery: Insights from Cutting-Edge Technology in the Industrial Field

In the evolving landscape of spinal surgery, technological advancements play a pivotal role in enhancing surgical outcomes and patient experiences. This paper delves into the cutting-edge technologies underpinning endoscopic spine surgery (ESS), specifically highlighting the innovations in scope cameras, RF equipment, and drills. The modern scope camera, with its capability for high-resolution imaging, offers surgeons unparalleled visualization, enabling precise interventions. Radiofrequency (RF) equipment has emerged as a crucial tool, providing efficient energy delivery for tissue modulation without significant collateral damage. Drills, with their enhanced torque and adaptability, allow for meticulous bone work, ensuring structural integrity. As minimally invasive spine surgery (MISS) becomes the standard, the integration and optimization of these technologies are paramount. This review captures the current state of these tools and anticipates their continued evolution, setting the stage for the next frontier in spinal surgery.

A Novel Bipolar Cautery Tool for Minimally-Invasive Neuroendoscopic Procedures

Electrosurgery is used in the operating room on a daily basis as a means to cut tissue and maintain hemostasis. The principle of this technology lies in the transfer of electricity from an electrosurgical unit to the operating site on a patient's body and modifying the waveform of that electricity to achieve the desired surgical effect. Bipolar cautery uses two electrodes, an active and a return, both at the surgical site to perform electrosurgery. Bipolar cautery can be very useful in helping surgeons to operate; however, current designs are not well suited to a 2.1 mm working channel in endoscopic procedures due to their rigid structure, limited range of motion, and bulky design. This paper describes a novel approach to designing a minimally- invasive bipolar cautery tool suitable for flexible neuroendoscopy. The system features 1.9 mm diameter bipolar tips which resemble grasping forceps, making it easier for surgeons to hold tissue while performing electrosurgery. The electrode wires also function as the actuating cables used to open and close the tips, which require 2.10 mm to open the tips to 30.9 °. The results show that the tool can safely cauterize a porcine brain specimen at various settings on the electrosurgical unit, and increasing the setting increases the area of tissue affected by the electricity. Repeatability was demonstrated and exhaustion was reached after the tool was opened and closed 73 times. Future work will involve improving the current design to increase the number of cycles the tool can survive before losing function.

Prevention and management of bowel injury during gynecologic laparoscopy: an update

PURPOSE OF REVIEW

The current article aims to briefly review recent literature on bowel injury in gynecologic surgery with a focus on minimally invasive techniques, strategies for prevention, and management of injury.

RECENT FINDINGS

Recent reviews describe a low incidence of bowel injury that is likely affected by low rates of reporting and inconsistent definitions. The major risk factor for bowel injury is adhesive disease, and assessment and prevention techniques for the presence of adhesive disease are evolving. When bowel injury occurs, prompt diagnosis and intraoperative repair yields more favorable outcomes than delayed diagnosis. Repair can be performed by a gynecologic surgeon, with or without the help of a consultant depending on the extent of the injury and surgeon comfort.

SUMMARY

Bowel injury is a potentially catastrophic complication in gynecologic surgery, but its rarity presents a challenge in research. A high index of suspicion and meticulous surgical technique are the cornerstones of managing a bowel injury.