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Zhang XR, Trinh TTT, Chien PN, Giang NN, Zhou SY, Nam SY, Heo CY. Safety assessment of electrosurgical electrodes by using mini pig tissue. Heliyon 2024; 10:e35266. [PMID: 39161807 PMCID: PMC11332808 DOI: 10.1016/j.heliyon.2024.e35266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 07/24/2024] [Accepted: 07/25/2024] [Indexed: 08/21/2024] Open
Abstract
Electrosurgical electrodes are the main dissecting devices widely used for surgeries throughout the world. The present study aimed to evaluate the thermal injury and safety within animals' organs following a minimally invasive electrosurgery technique with electrosurgical electrode AE40-300 (LIPO) and AE20-80 (LIFT). To ensure the effective application of electrosurgery in a clinical environment, it is crucial to minimize heat-induced injury to nearby tissues. In this study, the skin, liver, kidney, and femoral muscle dissected from 9 minipigs were used in tissue thermal spread experiments. Thermal imaging area analysis, maximum temperature, and time to reach basal temperature were evaluated. Thermography results revealed that the surgical temperature was significantly lower in the minimally invasive electrosurgery with AE40-300 (LIPO) and AE20-80 (LIFT) compared to the predicate device. In addition, AE40-300 (LIPO) and AE20-80 (LIFT) created a relatively small thermal injury area and thermal diffusion. Our results indicated that the tested devices named AE40-300 (LIPO) and AE20-80 (LIFT) reduced excessive thermal injury and could be applied to clinical use safely.
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Affiliation(s)
- Xin Rui Zhang
- Department of Plastic and Reconstructive Surgery, College of Medicine, Seoul National University, Seoul, Republic of Korea
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Thuy-Tien Thi Trinh
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Korean Institute of Nonclinical Study Center, Seongnam, Republic of Korea
- H&BIO Corporation/R&D Center, Seongnam, Republic of Korea
| | - Pham Ngoc Chien
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Korean Institute of Nonclinical Study Center, Seongnam, Republic of Korea
- H&BIO Corporation/R&D Center, Seongnam, Republic of Korea
| | - Nguyen Ngan Giang
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Medical Device Development, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Shu Yi Zhou
- Department of Plastic and Reconstructive Surgery, College of Medicine, Seoul National University, Seoul, Republic of Korea
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sun Young Nam
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Chan Yeong Heo
- Department of Plastic and Reconstructive Surgery, College of Medicine, Seoul National University, Seoul, Republic of Korea
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Korean Institute of Nonclinical Study Center, Seongnam, Republic of Korea
- H&BIO Corporation/R&D Center, Seongnam, Republic of Korea
- Department of Medical Device Development, College of Medicine, Seoul National University, Seoul, Republic of Korea
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Iwai S, Kobayashi S, Torai S, Kobayashi E. Development and application of a spray tip that enables electrocoagulation of a variety of tissues. Heliyon 2023; 9:e17771. [PMID: 37560677 PMCID: PMC10407041 DOI: 10.1016/j.heliyon.2023.e17771] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Spray hemostasis is possible using a high-frequency power source from the tip of an electric scalpel; however, the difficulties regarding the uniformity and rapidity of the hemostasis surface remain. This study reports the development of a novel electrocoagulation device tip that can be used in endoscopic and robotic surgeries and can quickly coagulate and hemostat and easily adjust the extent of cauterization and hemostasis while minimizing the depth of thermal injury. METHODS The safety and efficacy of the hemostatic device were verified in a porcine model. A liver surface transection was conducted in vivo and the rapidity of the hemostatic effect of the device was observed. An extracted stomach, kidney, and liver were cauterized ex vivo by three operators with different surgical skills and the effects were analyzed pathologically. In addition, a sacrificed pig cadaver was used to achieve hemostasis at a renal transection site using the multi-spray endoscope tip. RESULTS An increase in the number of tip terminals expanded the cauterization surface and shortened the cauterization time. In parenchymatous organs, uniform cauterization was possible without increasing the depth of thermal injury. The cauterization depth did not depend on the operator's skill, and the spray coagulation was safe. The variable spray tip allowed for simple hemostasis during open and laparoscopic surgeries. CONCLUSIONS This novel electrocoagulation device tip can be developed as a forceps that can change the spray range and can be used during laparoscopic and robotic surgeries.
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Affiliation(s)
- Satomi Iwai
- Kitasato University School of Veterinary Medicine, Endowed Chair for the Promotion of Minipig Research, 35-1, Higashi 23, Towada City, Aomori, 034-8628, Japan
| | - Shou Kobayashi
- Kobayashi Regenerative Research Institute, LLC, 1 Chayanochou, Wakayama-shi, Wakayama-ken, 640-8263, Japan
| | - Shinji Torai
- Department of Kidney Regenerative Medicine, Industry-Academia Collaborative Department, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Eiji Kobayashi
- Kitasato University School of Veterinary Medicine, Endowed Chair for the Promotion of Minipig Research, 35-1, Higashi 23, Towada City, Aomori, 034-8628, Japan
- Kobayashi Regenerative Research Institute, LLC, 1 Chayanochou, Wakayama-shi, Wakayama-ken, 640-8263, Japan
- Department of Kidney Regenerative Medicine, Industry-Academia Collaborative Department, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
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Vyacheslavovich NT, Mikhailovich LK, Romanovich CE, Evgenievich TA, Vyacheslavovich SA. Surgeons know that they don't know about the safe use of surgical energy: an international study reveals that the knowledge gap persists. Surg Endosc 2023:10.1007/s00464-023-09936-5. [PMID: 36879166 DOI: 10.1007/s00464-023-09936-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/05/2023] [Indexed: 03/08/2023]
Abstract
INTRODUCTION The rate of electrosurgery complications is 0.1-2.1%. More than 10 years ago, SAGES pioneered a well-structured educational program (FUSE) aimed to teach about the safe use of electrosurgery. This inspired the development of similar training programs around the globe. Still, the knowledge gap persists among surgeons, possibly due to the lack of judgment. AIM To investigate factors affecting the level of expertise in electrosurgical safety and their correlation with self-assessment scores among surgeons and surgical residents. MATERIALS AND METHODS We conducted an online survey consisting of 15 questions that could be thematically broken down into 5 blocks. We analyzed how the objective scores were correlated with the self-assessment scores, professional experience, past participation in training programs, and work at a teaching hospital. RESULTS A total of 145 specialists took part in the survey, including 111 general surgeons and 34 s-year surgical residents from Russia, Belarus, Ukraine, and Kirgizia. Only 9 (8.1%) surgeons scored "excellent," 32 (28.8%) scored "good," and 56 (50.4%) scored "fair." Of all surgical residents participating in the study, only 1 (2.9%) scored "excellent," 9 (26.5%) scored "good," and 11 (32.4%) scored "fair." The test was failed by 14 surgeons (12.6%) and 13 (38.2%) residents. The difference between the trainees and the surgeons was statistically significant. Our multivariate logistic model identified 3 significant factors predisposing to successful performance on the test: past training in the safe use of electrosurgery, professional experience, and work at a teaching hospital. Of all study participants, those with no past training in the safe use of electrosurgery, and non-teaching surgeons were the most realistic about their competencies. CONCLUSION We have identified alarming gaps in the knowledge of electrosurgical safety among surgeons. Faculty staff and experienced surgeons scored higher, but past training was the most influential factor in improving knowledge of electrosurgical safety.
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Wright R. Clinical Issues-August 2022. AORN J 2022; 116:185-192. [PMID: 35880919 DOI: 10.1002/aorn.13750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 11/07/2022]
Abstract
Use of sterile vests Key words: sterile technique, surgical attire, gown, contaminated, back. Bare arms for unscrubbed personnel Key words: long sleeves, cover jacket, disposable jacket, patient skin antisepsis, surgical site infection (SSI). Preventing thermal injury from electrosurgical devices Key words: electrosurgical unit (ESU), monopolar electrosurgical device, electrode, alternate site thermal injury, burn. Preoperative site marking for minimally invasive procedures Key words: surgical site, wrong-site surgery, alternative site marking, point of access, preprocedure verification.
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Cahn J. Electrosurgical Safety. AORN J 2022; 115:469-476. [PMID: 35476205 DOI: 10.1002/aorn.13670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 11/08/2022]
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Brinkmann F, Hüttner R, Mehner PJ, Henkel K, Paschew G, Herzog M, Martens N, Richter A, Hinz S, Groß J, Schafmayer C, Hampe J, Hendricks A, Schwandner F. Temperature profile and residual heat of monopolar laparoscopic and endoscopic dissection instruments. Surg Endosc 2022; 36:4507-4517. [PMID: 34708296 PMCID: PMC9085678 DOI: 10.1007/s00464-021-08804-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 10/17/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Endoscopic and laparoscopic electrosurgical devices (ED) are of great importance in modern medicine but can cause adverse events such as tissue injuries and burns from residual heat. While laparoscopic tools are well investigated, detailed insights about the temperature profile of endoscopic knives are lacking. Our aim is to investigate the temperature and the residual heat of laparoscopic and endoscopic monopolar instruments to increase the safety in handling ED. METHODS An infrared camera was used to measure the temperature of laparoscopic and endoscopic instruments during energy application and to determine the cooling time to below 50 °C at a porcine stomach. Different power levels and cutting intervals were studied to investigate their impact on the temperature profile. RESULTS During activation, the laparoscopic hook exceeded 120 °C regularly for an up to 10 mm shaft length. With regards to endoknives, only the Dual Tip Knife showed a shaft temperature of above 50 °C. The residual heat of the laparoscopic hook remained above 50 °C for at least 15 s after activation. Endoknives cooled to below 50 °C in 4 s. A higher power level and longer cutting duration significantly increased the shaft temperature and prolonged the cooling time (p < 0.001). CONCLUSION Residual heat and maximum temperature during energy application depend strongly on the chosen effect and cutting duration. To avoid potential injuries, the user should not touch any tissue with the laparoscopic hook for at least 15 s and with the endoknives for at least 4 s after energy application. As the shaft also heats up to over 120 °C, the user should be careful to avoid tissue contact during activation with the shaft. These results should be strongly considered for safety reasons when handling monopolar ED.
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Affiliation(s)
- Franz Brinkmann
- Department of Medicine I, University Hospital Dresden, Technische Universität Dresden (TU Dresden), Dresden, Germany ,Chair of Microsystems, Faculty of Electrical and Computer Engineering, Technische Universität Dresden (TU Dresden), Dresden, Germany ,Else Kröner Fresenius Center for Digital Health, Technische Universität Dresden (TU Dresden), Dresden, Germany ,Department of Medicine I, University Hospital Carl Gustav Carus, Technische Universität Dresden (TU Dresden), Fetscherstr. 74, 01307 Dresden, Germany
| | - Ronny Hüttner
- Chair of Microsystems, Faculty of Electrical and Computer Engineering, Technische Universität Dresden (TU Dresden), Dresden, Germany
| | - Philipp J. Mehner
- Chair of Microsystems, Faculty of Electrical and Computer Engineering, Technische Universität Dresden (TU Dresden), Dresden, Germany
| | - Konrad Henkel
- Chair of Microsystems, Faculty of Electrical and Computer Engineering, Technische Universität Dresden (TU Dresden), Dresden, Germany
| | - Georgi Paschew
- Chair of Microsystems, Faculty of Electrical and Computer Engineering, Technische Universität Dresden (TU Dresden), Dresden, Germany
| | - Moritz Herzog
- Department of Medicine I, University Hospital Dresden, Technische Universität Dresden (TU Dresden), Dresden, Germany ,Else Kröner Fresenius Center for Digital Health, Technische Universität Dresden (TU Dresden), Dresden, Germany
| | - Nora Martens
- Department of Medicine I, University Hospital Dresden, Technische Universität Dresden (TU Dresden), Dresden, Germany ,Else Kröner Fresenius Center for Digital Health, Technische Universität Dresden (TU Dresden), Dresden, Germany
| | - Andreas Richter
- Chair of Microsystems, Faculty of Electrical and Computer Engineering, Technische Universität Dresden (TU Dresden), Dresden, Germany ,Else Kröner Fresenius Center for Digital Health, Technische Universität Dresden (TU Dresden), Dresden, Germany
| | - Sebastian Hinz
- Department of General, Visceral, Vascular and Transplantation Surgery, University Medical Center Rostock, Rostock, Germany
| | - Justus Groß
- Department of General, Visceral, Vascular and Transplantation Surgery, University Medical Center Rostock, Rostock, Germany
| | - Clemens Schafmayer
- Department of General, Visceral, Vascular and Transplantation Surgery, University Medical Center Rostock, Rostock, Germany
| | - Jochen Hampe
- Department of Medicine I, University Hospital Dresden, Technische Universität Dresden (TU Dresden), Dresden, Germany ,Else Kröner Fresenius Center for Digital Health, Technische Universität Dresden (TU Dresden), Dresden, Germany
| | - Alexander Hendricks
- Department of General, Visceral, Vascular and Transplantation Surgery, University Medical Center Rostock, Rostock, Germany
| | - Frank Schwandner
- Department of General, Visceral, Vascular and Transplantation Surgery, University Medical Center Rostock, Rostock, Germany
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Link T. Guidelines in Practice: Electrosurgical Safety. AORN J 2021; 114:60-72. [PMID: 34181252 DOI: 10.1002/aorn.13421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 11/05/2022]
Abstract
Surgeons routinely use electrosurgical devices to cut and coagulate tissue during surgical procedures. However, hazards associated with electrosurgery (eg, burns, electrical shock, fire) can place patients or personnel at risk. Perioperative nurses should standardize processes, preoperatively assess the risks for electrosurgical injuries, and participate in education activities on electrosurgical safety to help prevent injuries from occurring. The AORN "Guideline for electrosurgical safety" provides guidance to perioperative personnel for safe use of electrosurgical units, electrocautery devices, and argon-enhanced coagulators. This article discusses prevention of electrosurgical unit injuries, including those that can be caused by electrosurgical accessories. A scenario describes how a team investigating two incidents related to use of electrosurgery uses an assessment tool to identify risks for injury and includes a report of these risks in the surgical briefing. Perioperative RNs should review the entire guideline for additional information when creating and updating policies and procedures for electrosurgical safety.
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Knowledge Assessment among Surgeons about Energy Devices safe use: A Multicenter Cross Sectional Study. Int Surg 2021. [DOI: 10.9738/intsurg-d-21-00016.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: To assess General Surgery trainee’s knowledge about safe use of energy devices in two tertiary hospitals in Riyadh, Saudi Arabia Background: Electro surgery is the use of high-frequency electrical energy to achieve cutting, and coagulation. This method has become ubiquitous worldwide for the purpose of achieving rapid hemostasis and rapid dissection of tissues Methods: Participants completed a 35-item multiple choice question examination, testing critical knowledge of ES. The examination was developed according to the objectives and blueprints of SAGES’ Fundamental Use of Surgical Energy curriculum. Sections of the examination included: principles of ES, ES-related adverse events, monopolar and bipolar devices, and pediatric considerations and interference with implantable devices.’’ Scores were compared between juniors and seniors participants. Results: A total of 51 general surgical trainees from two academic hospitals completed the assessment. 15.69% of the participants correctly answered 30 questions out of 35 questions, 39.22% of the participants responded correctly to 20 questions out of 35 answers, and 45.09 who responded correctly to less than 20 questions. It was found that 52.2% of the individuals with a low level of understanding were junior residents as opposed to 87.5% of the participants with the highest level of understanding were senior residents with a significant P-value of 0.04. Conclusions: majority of general surgery residents enrolled in the Saudi Arabian board of surgery lack adequate knowledge about the safe and efficient use of surgical energy devices. The level of understanding is lower among the junior residents than seniors.
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Reinke CE, Lim RB. Minimally Invasive Acute Care Surgery. Curr Probl Surg 2021. [DOI: 10.1016/j.cpsurg.2021.101033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
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10
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Reinke CE, Lim RB. Minimally invasive acute care surgery. Curr Probl Surg 2021; 59:101031. [DOI: 10.1016/j.cpsurg.2021.101031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/16/2021] [Indexed: 12/07/2022]
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Junaidi MAR, Kalluri RCM, Rao YVD, Gokhale AGK, Patel A. Design and fluid flow simulation of modified laparoscopic forceps. Comput Methods Biomech Biomed Engin 2020; 24:844-863. [PMID: 33305607 DOI: 10.1080/10255842.2020.1855331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Laparoscopic surgery has gained prominence in recent decades and employed in minimally invasive surgeries to avoid massive cuts resulting in a reduction in pain, the chance of infection, and duration of stay in the hospital. Maryland forceps, which belongs to the category of grasper instruments, are often used in minimally invasive surgeries to hold, pull, push, manipulate, and perform dissection operations. During laparoscopic surgeries, often blood and other body fluids ooze from the site of surgery. Typically, suction-irrigation (SI) devices are used to periodically clear these fluids to get a better view of the site of surgery. To achieve this, the removal and insertion of multiple instruments are required. This process has to be repeated numerous times, which significantly increases the time needed for surgery. Literature survey and feedback from practicing surgeons suggest that this can be avoided by improving the current design of forceps. In this article, a modified design is proposed by combining the SI feature with the existing form of Maryland forceps. The modified design is first modeled in SolidWorks and then analyzed for fluid flow using ANSYS Fluent. Parametric analysis is performed to obtain the optimal design for the proposed multi-functional instrument, which can potentially improve the overall efficiency of the laparoscopic surgical process.
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Affiliation(s)
| | | | - Y V Daseswara Rao
- Mechanical Engineering Department, BITS Pilani, Hyderabad, Telangana, India
| | | | - Aakrit Patel
- Mechanical Engineering Department, BITS Pilani, Hyderabad, Telangana, India
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Nechay TV, Titkova SM, Anurov MV, Mikhalchik EV, Melnikov-Makarchyk KY, Ivanova EA, Tyagunov AE, Fingerhut A, Sazhin AV. Thermal effects of monopolar electrosurgery detected by real-time infrared thermography: an experimental appendectomy study. BMC Surg 2020; 20:116. [PMID: 32460827 PMCID: PMC7251678 DOI: 10.1186/s12893-020-00735-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 04/05/2020] [Indexed: 01/09/2023] Open
Abstract
Background Monopolar energy (ME) is routinely used in appendectomy. This study aimed to investigate the degree of lateral thermal spread generated by ME and to evaluate the thermal injury sustained by the close-lying tissues. Methods Appendectomy with a monopolar Maryland dissector was performed in 8 rabbits (at 30 and 60 W power settings). A high-resolution infrared camera was used to record tissue heating during the intervention. After autopsy macroscopic changes were evaluated and tissue samples were subjected to myeloperoxidase (MPO) assay and histological examination. Results No significant differences in the extent of thermal spread, MPO activity and histological signs of inflammation were observed between groups. Regardless of the power settings, the heat spread exceeded 2 cm laterally along the mesoappendix when application time exceeded 3 s. The spread of heat through tubular structures in both groups caused a significant temperature rise in the nearby intestinal loop, resulting in perforation (n = 3) and necrosis (n = 1). Conclusions Application time is critical in thermal spread during appendectomy aided by ME. Tubular anatomic structures can enhance thermal injury on distant tissues. The observed effects of ME bear clinical relevance that need further investigation.
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Affiliation(s)
- Taras V Nechay
- Pirogov Russian National Research Medical University, Ostrovitianov str. 1, Moscow, 117997, Russia.
| | - Svetlana M Titkova
- Pirogov Russian National Research Medical University, Ostrovitianov str. 1, Moscow, 117997, Russia
| | - Mikhail V Anurov
- Pirogov Russian National Research Medical University, Ostrovitianov str. 1, Moscow, 117997, Russia
| | - Elena V Mikhalchik
- Research and Clinical Center for Physical-Chemical Medicine, Malaya Pirogovskaya 1a, Moscow, 119435, Russia
| | | | - Ekaterina A Ivanova
- Pirogov Russian National Research Medical University, Ostrovitianov str. 1, Moscow, 117997, Russia
| | - Alexander E Tyagunov
- Pirogov Russian National Research Medical University, Ostrovitianov str. 1, Moscow, 117997, Russia
| | - Abe Fingerhut
- Section for Surgical Research, Department of Surgery, Medical University of Graz, 8036, Graz, Austria.,Department of Gastrointestinal Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 20025, China
| | - Alexander V Sazhin
- Pirogov Russian National Research Medical University, Ostrovitianov str. 1, Moscow, 117997, Russia
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Meeuwsen F, Guédon A, Klein J, Elst MVD, Dankelman J, Van Den Dobbelsteen J. Electrosurgery: short-circuit between education and practice. MINIM INVASIV THER 2018; 28:247-253. [PMID: 30311831 DOI: 10.1080/13645706.2018.1513945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Introduction: Electrosurgery is used in 80% of surgical procedures. The technique allows surgeons to skilfully dissect tissues and achieve haemostasis. Since improper use of electrosurgery can lead to serious adverse events, training is required to potentially reduce the number and severity of these events. In this study we evaluate education and training in electrosurgery for surgical residents. Material and methods: Residents from six surgical subspecialties in the Netherlands were invited to anonymously complete a digital questionnaire about training, supervision and adverse events regarding electrosurgery. Results: Of the 197 respondents, 69% had received some form of training; mostly a single theoretical lecture. The feeling of competence in theory and practical skills was positively rated by 39% and 71%, respectively. Moreover, 35% judged the theoretical knowledge of their supervisors as insufficient and 65% changed their electrosurgical application technique to the preference of the supervisor. 30% of the residents had encountered a serious adverse event (e.g., burn wounds) related to the application of electrosurgery. Conclusions: The training of residents in theoretical aspects of electrosurgery is limited. Residents are not satisfied with the acquired theoretical knowledge of themselves and of their supervisors. Since adverse events related to electrosurgery occur frequently, more extensive education for both residents and their supervisors is needed to enhance patient safety.
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Affiliation(s)
- Frédérique Meeuwsen
- a Department of BioMechanical Engineering , Delft University of Technology , Delft , The Netherlands
| | - Annetje Guédon
- a Department of BioMechanical Engineering , Delft University of Technology , Delft , The Netherlands
| | - Jan Klein
- a Department of BioMechanical Engineering , Delft University of Technology , Delft , The Netherlands
| | | | - Jenny Dankelman
- a Department of BioMechanical Engineering , Delft University of Technology , Delft , The Netherlands
| | - John Van Den Dobbelsteen
- a Department of BioMechanical Engineering , Delft University of Technology , Delft , The Netherlands
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Kezze I, Zoremba N, Rossaint R, Rieg A, Coburn M, Schälte G. Risks and prevention of surgical fires : A systematic review. Anaesthesist 2018; 67:426-447. [PMID: 29766207 DOI: 10.1007/s00101-018-0445-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/08/2018] [Accepted: 04/11/2018] [Indexed: 12/18/2022]
Abstract
Surgically induced fire is a life-threatening hazard; this topic has received little attention, although only 3 factors, the so-called fire triad, are needed for surgical fires to occur: an oxidizer, fuel and an ignition source. This systematic review aims to determine the impact of each component and to delegate every staff member an area of responsibility, thus ensuring patient health through prevention or protection. The trial was registered in Prospero CRD42018082656. A database search of eligible, preferably evidence-based studies was conducted. The Robins-I tool for assessing the risk of bias revealed a moderate risk of bias. Due to insufficient data, the main findings of these studies could not be summarized through a quantitative synthesis; therefore, a qualitative synthesis is outlined. The results are summarized according to the roles of the fire triad and discussed. (1) Role of the oxidizer: oxygen is the key component of the triad. Safe oxygen delivery is important. An oxygen-enriched environment (ORE) is caused by draping and is preferably prevented by suctioning. Fuel characteristics are affected by varying oxygen concentrations. (2) Role of the ignition source: electrocauterization is the most common ignition source, followed by lasers. Less common ignition sources include fiberoptic cables and preparative solutions, petrol or acetone. (3) Role of the fuel: surgical drapes are one of the most common fuels for surgical fires followed by the patient's hair and skin. Skin preparation solutions are among the less common fuels. Many fire-resistant materials have been tested that do not remain fire resistant in ORE. It was concluded that the main problem is defining the real extent of this hazard. Exact numbers and exact condition protocols are needed; therefore, standardized registration of every fire and future studies with much evidence are needed. Immediate prevention consists of close attention to patient safety to prevent surgical fires from happening.
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Affiliation(s)
- I Kezze
- Department of Anesthesiology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - N Zoremba
- Department of Anesthesiology, Critical Care and Emergency Medicine, St. Elisabeth Hospital Gütersloh, Gütersloh, Germany
| | - R Rossaint
- Department of Anesthesiology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - A Rieg
- Department of Anesthesiology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - M Coburn
- Department of Anesthesiology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - G Schälte
- Department of Anesthesiology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
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Borie F, Mathonnet M, Deleuze A, Millat B, Gravié JF, Johanet H, Lesage JP, Gugenheim J. Risk management for surgical energy-driven devices used in the operating room. J Visc Surg 2018; 155:259-264. [PMID: 29289460 DOI: 10.1016/j.jviscsurg.2017.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Complications related to energy sources in the operating room are not well-recognized or published, despite occasionally dramatic consequences for the patient and the responsible surgeon. The goal of this study was to evaluate the risks and consequences related to use of energy sources in the operating room. PATIENTS AND METHODS Between 2009 and 2015, 876 adverse events related to health care (AERHC) linked to energy sources in the operating room were declared in the French experience feedback data base "REX". We performed a descriptive analysis of these AERHC and analyzed the root causes of these events and of the indications for non-elective repeat operations, for each energy source. RESULTS Five different energy sources were used, producing 876 declared AERHC: monopolar electrocoagulation: 614 (70%) AERHC, advanced bipolar coagulation (thermofusion): 137 (16%) AERHC, ultrasonic devices: 69 (8%) AERHC, traditional bipolar electrocoagulation: 32 AERHC, and cold light: 24 AERHC. The adverse events reported were skin burns (27.5% of AERHC), insulation defects (16% of AERHC), visceral burns or perforation (30% of AERHC), fires (11% of AERHC), bleeding (7.5% of AERHC) and misuse or miscellaneous causes (8% of AERHC). For the five energy sources, the root causes were essentially misuse, imperfect training and/or cost-related reasons regarding equipment purchase or maintenance. One hundred and forty-six non-elective procedures (17% of AERHC) were performed for complications related to the use of energy sources in the operating room. CONCLUSION This study illustrates the risks related to the use of energy sources on the OR and their consequences. Most cases were related to persistent misunderstanding of appropriate usage within the medical and paramedical teams, but complications are also related to administrative decisions concerning the purchase and maintenance of these devices.
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Affiliation(s)
- F Borie
- Fédération de chirurgie viscérale et digestive (FCVD), 6, rue Pétrarque, 31000 Toulouse, France.
| | - M Mathonnet
- Fédération de chirurgie viscérale et digestive (FCVD), 6, rue Pétrarque, 31000 Toulouse, France
| | - A Deleuze
- Fédération de chirurgie viscérale et digestive (FCVD), 6, rue Pétrarque, 31000 Toulouse, France
| | - B Millat
- Fédération de chirurgie viscérale et digestive (FCVD), 6, rue Pétrarque, 31000 Toulouse, France
| | - J-F Gravié
- Fédération de chirurgie viscérale et digestive (FCVD), 6, rue Pétrarque, 31000 Toulouse, France
| | - H Johanet
- Fédération de chirurgie viscérale et digestive (FCVD), 6, rue Pétrarque, 31000 Toulouse, France
| | - J-P Lesage
- Fédération de chirurgie viscérale et digestive (FCVD), 6, rue Pétrarque, 31000 Toulouse, France
| | - J Gugenheim
- Fédération de chirurgie viscérale et digestive (FCVD), 6, rue Pétrarque, 31000 Toulouse, France
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16
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Fuchshuber P, Schwaitzberg S, Jones D, Jones SB, Feldman L, Munro M, Robinson T, Purcell-Jackson G, Mikami D, Madani A, Brunt M, Dunkin B, Gugliemi C, Groah L, Lim R, Mischna J, Voyles CR. The SAGES Fundamental Use of Surgical Energy program (FUSE): history, development, and purpose. Surg Endosc 2017; 32:2583-2602. [PMID: 29218661 DOI: 10.1007/s00464-017-5933-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 10/09/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Adverse events due to energy device use in surgical operating rooms are a daily occurrence. These occur at a rate of approximately 1-2 per 1000 operations. Hundreds of operating room fires occur each year in the United States, some causing severe injury and even mortality. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) therefore created the first comprehensive educational curriculum on the safe use of surgical energy devices, called Fundamental Use of Surgical Energy (FUSE). This paper describes the history, development, and purpose of this important training program for all members of the operating room team. METHODS The databases of SAGES and the FUSE committee as well as personal photographs and documents of members of the FUSE task force were used to establish a brief history of the FUSE program from its inception to its current status. RESULTS The authors were able to detail all aspects of the history, development, and national as well as global implementation of the third SAGES Fundamentals Program FUSE. CONCLUSIONS The written documentation of the making of FUSE is an important contribution to the history and mission of SAGES and allows the reader to understand the idea, concept, realization, and implementation of the only free online educational tool for physicians on energy devices available today. FUSE is the culmination of the SAGES efforts to recognize gaps in patient safety and develop state-of-the-art educational programs to address those gaps. It is the goal of the FUSE task force to ensure that general FUSE implementation becomes multinational, involving as many countries as possible.
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Affiliation(s)
- P Fuchshuber
- Department of Surgery, Kaiser Walnut Creek Medical Center, The Permanente Medical Group, Inc., 1425 South Main Street, Walnut Creek, CA, 94596, USA.
| | - S Schwaitzberg
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, The State University of New York, Buffalo General Hospital, 100 High Street, D-352, Buffalo, NY, 14203, USA
| | - D Jones
- Harvard Medical School, Boston, MA, USA.,Office of Technology and Innovation, Boston, MA, USA.,Division of Minimally Invasive Surgical Services, Boston, MA, USA.,Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA
| | - S B Jones
- Department of Anesthesiology, Harvard Medical School, Boston, MA, USA.,Department of Anesthesia/Crit Care/Pain, BIDMC, Boston, MA, USA
| | - L Feldman
- Department of Surgery, McGill University Health Centre, 1650 Cedar Ave L9-309, Montreal, QC, H3G 1A4, Canada
| | - M Munro
- Department of Obstetrics & Gynecology, David Geffen School of Medicine at UCLA and Kaiser Permanenete Los Angeles Medical Center, Los Angeles, CA, USA
| | - T Robinson
- Rocky Mountain VA Medical Center, University of Colorado, Aurora, Colorado, USA
| | - G Purcell-Jackson
- Vanderbilt University Medical Center, 2200 Children's Way, Doctor's Office Tower Suite 7100, Nashville, TN, 37232, USA
| | - D Mikami
- John A. Burn School of Medicine, University of Hawaii, 1356 Lusitania Street, 6th Floor, Honolulu, HI, 96813, USA
| | - A Madani
- Department of Surgery, McGill University, 1650 Cedar Ave, Rm D6-257, Montreal, QC, H3G 1A4, Canada
| | - M Brunt
- Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - B Dunkin
- Houston Methodist Institute for Technology, Innovation & Education, Institute for Academic Medicine, Houston Methodist, Weill Cornell Medical College, 6550 Fannin St #1601, Houston, TX, 77030, USA
| | - C Gugliemi
- Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA
| | - L Groah
- AORN, 2170 South Parker Road. Suite 400, Denver, CO, 80231, USA
| | - R Lim
- Uniformed Services University of Health Sciences, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI, 95869, USA
| | - J Mischna
- Fundamentals Department SAGES, 11300 West Olympic Blvd Suite 600, Los Angeles, CA, 90064, USA
| | - C R Voyles
- , 3838 Eastover Drive, Jackson, MS, 39211, USA
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17
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Ypsilantis P, Lambropoulou M, Milicevic M, Bulajic P, Karayiannakis A, Zacharoulis D, Simopoulos C. Microscopic assessment of the tissue-sparing potential of radiofrequency-assisted liver resection techniques in a porcine model. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2017; 24:657-666. [PMID: 29032589 DOI: 10.1002/jhbp.513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The aim of the present study was to microscopically assess the tissue-sparing potential of contemporary radiofrequency-assisted liver resection (RF-LR) techniques. METHODS Twenty-four pigs were subjected to either (1) partial hepatectomy (PH) using the sequential-coagulate-cut (SCC) technique (group SCC, n = 6) using a monopolar electrode, the technique using the bipolar electrode Habib-4X (group H, n = 6) or the "crush-clamp" technique (group CC, n = 6); or (2) sham operation (group Sham, n = 6). At 48 h post-operation, liver parenchyma proximal to the ablation rim was excised for histopathologic examination and immunohistochemical assessment of apoptosis (antibody M30) and inflammatory response (antibodies IL-6, TNFα and NFκB). RESULTS Histopathologic index increased from the 1st to the 4th , the 1st to the 2nd or only the 1st cm from the inner margin of the ablation rim in group SCC, H or CC, respectively. The index was higher in group SCC compared to the other groups. Tissue expression of M30, IL-6, TNFα and NFκB increased in all PH groups, being higher and more expanded in group SCC, H, SCC and SCC, respectively. CONCLUSIONS RF-LR techniques had variable microscopically assessed tissue-sparing effect. The Habib-4X proved to be less injurious compared to the SCC Belgrade technique regarding the severity and extent of tissue damage proximal to the ablation rim.
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Affiliation(s)
- Petros Ypsilantis
- Laboratory of Experimental Surgery and Surgical Research, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Maria Lambropoulou
- Laboratory of Histology and Embryology, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Miroslav Milicevic
- First Surgical Clinic, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Predrag Bulajic
- First Surgical Clinic, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Anastasios Karayiannakis
- Laboratory of Experimental Surgery and Surgical Research, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dimitrios Zacharoulis
- Clinic of Surgery, School of Medicine, University of Thessaly, University Hospital of Larissa, Larissa, Greece
| | - Constantinos Simopoulos
- Laboratory of Experimental Surgery and Surgical Research, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
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Suthar R, Viswanath O, Wittels SH, Rosen GP. An uncommon intraoperative implantable cardiac device complication and subsequent troubleshooting. Ann Card Anaesth 2017; 20:483-484. [PMID: 28994696 PMCID: PMC5661330 DOI: 10.4103/aca.aca_86_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Rekha Suthar
- Department of Anesthesiology, Mount Sinai Medical Center, Miami Beach Anesthesiology Associates, Inc., Miami Beach, Florida, USA
| | - Omar Viswanath
- Department of Anesthesiology, Mount Sinai Medical Center, Miami Beach Anesthesiology Associates, Inc., Miami Beach, Florida, USA
| | - S Howard Wittels
- Department of Anesthesiology, Mount Sinai Medical Center, Miami Beach Anesthesiology Associates, Inc., Miami Beach, Florida, USA
| | - Gerald P Rosen
- Department of Anesthesiology, Mount Sinai Medical Center, Miami Beach Anesthesiology Associates, Inc., Miami Beach, Florida, USA
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Meeuwsen FC, Guédon ACP, Arkenbout EA, van der Elst M, Dankelman J, van den Dobbelsteen JJ. The Art of Electrosurgery: Trainees and Experts. Surg Innov 2017; 24:373-378. [PMID: 28438057 PMCID: PMC5505226 DOI: 10.1177/1553350617705207] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The benefits of electrosurgery have been acknowledged since the early 1920s, and nowadays more than 80% of surgical procedures involve devices that apply energy to tissues. Despite its widespread use, it is currently unknown how the operator’s choices with regard to instrument selection and application technique are related to complications. As such, the manner in which electrosurgery is applied can have a serious influence on the outcome of the procedure and the well-being of patients. The aim of this study is to investigate the variety of differences in usage of electrosurgical devices. Our approach is to measure these parameters to provide insight into application techniques. A sensor was developed that records the magnitude of electric current delivered to an electrosurgical device at a frequency of 10 Hz. The sensor is able to detect device activation times and a reliable estimate of the power-level settings. Data were recorded for 91 laparoscopic cholecystectomies performed by different surgeons and residents. Results of the current measurement data show differences in the way electrosurgery is applied by surgeons and residents during a laparoscopic cholecystectomy. Variations are seen in the number of activations, the activation time, and the approach for removal of the gallbladder. Analysis showed that experienced surgeons have a longer activation time than residents (3.01 vs 1.41 seconds, P < .001) and a lower number of activations (102 vs 123). This method offers the opportunity to relate application techniques to clinical outcome and to provide input for the development of a best practice model.
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