Intraoperative burn from a grounding pad of electrosurgical device during breast surgery: A CARE-compliant case report

Inadvertent Intraoperative Defibrillation Secondary to Electrocautery Grounding Pad Placement

Intraoperative defibrillation secondary to the usage of electrocautery in a patient with a cardiovascular implantable electronic device is a rare occurrence, and below-the-umbilicus electrocautery use causing inadvertent defibrillation is a near-zero risk. Defibrillation secondary to electrodispersive pad (EDP) radiofrequency dispersion has only ever been theorized. In this report, we describe the case of a 67-year-old male with an automatic implantable cardioverter defibrillator (AICD) undergoing a robotic-assisted left anterior total hip arthroplasty for left hip osteoarthritis who experienced inadvertent intraoperative defibrillation concurrent with electrocautery usage. The defibrillations ceased following contralateral EDP repositioning and application of a donut magnet overlying the patient's AICD.

Advances and safe use of energy devices in lung cancer surgery

Objectives

A clear understanding of energy devices would help achieve high effectiveness and safety and guide the selection of devices. The present review aimed to elucidate the efficacy and adverse events of energy devices in lung cancer to guide the selection of appropriate devices depending on the situation.

Methods

Four major databases were searched electronically for relevant articles published until 16 April 2021. The reference lists of the identified papers were examined. We excluded (1) irrelevant studies, (2) manuscripts published in languages other than English and Japanese, (3) duplicates, and (4) studies for which the full text was not available in the databases. The results and key information obtained were summarized by means of a narrative approach.

Results

A total of 78 papers were included in the review and these were categorized according to the main topic of investigation as follows: (1) electrosurgery-related injuries, (2) fundamentals of electrosurgery, (3) monopolar devices, (4) bipolar electrosurgical devices, (5) ultrasonic energy devices, (6) energy devices in lung cancer surgery, (7) operating room fire risks, and (8) basic principles of surgery.

Conclusions

Understanding energy devices could help us use them in a more effective and safer manner. Knowledge of their selection criteria (suitability), merits, risks, and safety precautions relevant to each process of lung cancer surgery could guide appropriate selection.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11748-022-01775-w.

Application of multi-component fluid model in studies of the origin of skin burns during electrosurgical procedures

This paper reports on safety challenges regarding spark created when the applied electric field exceeds the dielectric breakdown strength as a source of complication during electrosurgery. Despite the unquestionable benefits of electrosurgery, such as minimal chances of infection and fast recovery time, the interaction of the electrosurgical tool with the tissue may result in tissue damage and force feedback to the tool. Some risks of complications often depend on a surgeon's knowledge of instruments and safety aspects of technical equipment that can be eliminated by clarifying the causation and conditions of their development. Current trends in electrosurgery include computational algorithms and methods to control the effect of delivered energy to the patient. For this study, calculations were performed by using the COMSOL simulation package based on a multi-component plasma fluid model. The emphasis is put on conditions that lead to the breakdown of the dielectric medium. It was found that breakdown occurs most easily when both electrodes are cylindrical. For configurations with one or two spherical electrodes, breakdown voltages are higher up to 25% and 48%, respectively. With decreasing the cathode radius, the breakdown voltage may decrease even to 41%. On the other hand, the temperature increase lowers the breakdown voltage. Also, electrical asymmetries appear to be a response to the non-symmetry of the electric field between the electrodes causing differences in the breakdown voltage between 36% and 70%. The results presented here could be very useful for the design of surgical devices to prevent potential complications of electrosurgical procedures.

Thermal and thermal damage responses during switching bipolar radiofrequency ablation employing bipolar needles: A computational study on the effects of different electrode configuration, input voltage and ablation duration

Recent studies have demonstrated the effectiveness of switching bipolar radiofrequency ablation (bRFA) in treating liver cancer. Nevertheless, the clinical use of the treatment remains less common than conventional monopolar RFA - likely due to the lack of understanding of how the tissues respond thermally to the switching effect. The problem is exacerbated by the numerous possible switching combinations when bRFA is performed using bipolar needles, thus making theoretical deduction and experimental studies difficult. This article addresses this issue via computational modelling by examining if significant variation in the treatment outcome exists amongst six different electrode configurations defined by the X-, C-, U-, N-, Z- and O-models. Results indicated that the tissue thermal and thermal damage responses varied depending on the electrode configuration and the operating conditions (input voltage and ablation duration). For a spherical tumour, 30 mm in diameter, complete ablation could not be attained in all configurations with 70 V input voltage and 5 minutes ablation duration. Increasing the input voltage to 90 V enlarged the coagulation zone in the X-model only. With the other configurations, extending the ablation duration to 10 minutes was found to be the better at enlarging the coagulation zone.

A computational model to investigate the influence of electrode lengths on the single probe bipolar radiofrequency ablation of the liver

BACKGROUND AND OBJECTIVES

Recently, there have been calls for RFA to be implemented in the bipolar mode for cancer treatment due to the benefits it offers over the monopolar mode. These include the ability to prevent skin burns at the grounding pad and to avoid tumour track seeding. The usage of bipolar RFA in clinical practice remains uncommon however, as not many research studies have been carried out on bipolar RFA. As such, there is still uncertainty in understanding the effects of the different RF probe configurations on the treatment outcome of RFA. This paper demonstrates that the electrode lengths have a strong influence on the mechanics of bipolar RFA. The information obtained here may lead to further optimization of the system for subsequent uses in the hospitals.

METHODS

A 2D model in the axisymmetric coordinates was developed to simulate the electro-thermophysiological responses of the tissue during a single probe bipolar RFA. Two different probe configurations were considered, namely the configuration where the active electrode is longer than the ground and the configuration where the ground electrode is longer than the active. The mathematical model was first verified with an existing experimental study found in the literature.

RESULTS

Results from the simulations showed that heating is confined only to the region around the shorter electrode, regardless of whether the shorter electrode is the active or the ground. Consequently, thermal coagulation also occurs in the region surrounding the shorter electrode. This opened up the possibility for a better customized treatment through the development of RF probes with adjustable electrode lengths.

CONCLUSIONS

The electrode length was found to play a significant role on the outcome of single probe bipolar RFA. In particular, the length of the shorter electrode becomes the limiting factor that influences the mechanics of single probe bipolar RFA. Results from this study can be used to further develop and optimize bipolar RFA as an effective and reliable cancer treatment technique.