EN‐22
MA510a
_EN
Instruction’s
Manual
HF
Electrosurgical
in
Laparoscopy
Since
its
introduction
minimally
invasive
surgery
has
revolutionized
surgical
operation
offering
any
significant
benefits
to
the
patient
of
faster
healing
and
less
postoperative
pain.
In
laparoscopy
the
monopolar
HF
electro
surgery
is
the
most
used
because
it
is
highly
versatile
(pure
cut,
coagulation,
blended
cut
that
combines
these
two
functions),
but
this
modality
can
compromise
patient
safety
by
burns.
The
constricted
view
of
the
surgical
field,
the
poor
maintenance
of
the
laparoscopic
instrumentation,
interference
on
the
video
monitor,
the
insufficient
training
of
the
surgeon
or
his
inattention,
the
smoke,
the
insulation
failure,
the
capacitive
currents,
the
contact
of
the
tip
of
the
active
electrode
with
the
surrounding
tissue,
these
are
all
factors
that
increase
the
hazard
of
burns,
intra
‐
abdomen
lesions,
necrosis
of
the
tissue,
perforation
of
internal
organs.
The
nature
of
the
surgical
environment
–
in
which
the
active
electrode
is
in
close
proximity
to
other
conductive
instruments
and
to
tissue
‐
may
make
the
electrical
currents
transmission
to
unseen
tissue
off
the
laparoscope,
causing
unintentional
tissue
burns
at
non
‐
targeted
sites,
by:
-
direct
coupling
-
insulation
failure
-
capacitive
coupling
Direct
coupling
occurs
when
the
active
electrode
touches
another
metal
instrument,
transferring
electrical
current
to
it
and
possibly
injuring
tissue
with
which
it
comes
in
contact
(for
example
bowel
or
other
organs).
Insulation
failure
occurs
when
there
is
an
excessive
voltage,
abuse,
wear
and
tear,
poor
handling,
or
mechanical
accident
of
the
electrode
shaft
that
happens
during
a
single
laparoscopic
procedure
or
during
disinfection
and
sterilization
procedures.
The
breakdown
along
the
unseen
shaft
of
an
activated
electrode
can
allow
electrical
current
to
leak
into
surrounding
non
‐
targeted
tissues,
causing
unobserved
damage.
Paradoxically,
small
cracks
are
more
dangerous
than
large
breaks
because
the
current
is
more
focused,
and
is
therefore
more
likely
to
produce
burns.
Capacitive
coupling
occurs
when
electrical
current
is
induced
from
the
active
electrode
to
nearby
conductive
material,
despite
intact
insulation.
During
HF
electrosurgical
operations
the
rapidly
varying
electrical
field
around
the
active
electrode
is
only
partially
impeded
by
electrical
insulation
and
creates
stray
electrical
currents
by
alternately
attracting
and
repelling
ions
in
surrounding
body
tissue.
Currents
transferred
in
this
way
