Don’t Get Burned! Electrosurgery in the OR

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The document, presented by Dr. Benjamin D. Beran, focuses on the crucial aspects of electrosurgery in the operating room (OR) under the auspices of the American Urogynecologic Society (AUGS). It aims to enhance understanding and safe practices related to electrosurgery among medical professionals, emphasizing proper terminology, electrical concepts, different waveforms, and applications of electrosurgical techniques.<br /><br />Key takeaways include:<br /><br />1. <strong>Electrosurgery Basics</strong>: Addresses the common misunderstandings among surgeons and potential complications, including injury and litigation. It stresses the importance of clear communication and correct terminology, citing guidelines from Munro M et al.<br /><br />2. <strong>Electrical Fundamentals</strong>: Basic concepts like electric flow and Ohm's Law are explained, with demonstrations of circuits relevant to the OR.<br /><br />3. <strong>Electrosurgical Generators</strong>: Critical tasks such as frequency amplification and duty cycle control are highlighted. The typical electrosurgical range is between 200kHz and 3.3MHz, with the term "radiofrequency" being essential.<br /><br />4. <strong>Instruments and Circuits</strong>: Differences between monopolar and bipolar instruments are detailed, including their respective circuits. Proper use of these tools can significantly impact tissue and procedural outcomes.<br /><br />5. <strong>Safety and Best Practices</strong>: Strategies for the safe placement of dispersive electrodes and activation options are outlined. Patient safety features like Return Electrode Monitoring (REM) and isolated circuit checks are emphasized to avoid stray currents and ensure effective procedures.<br /><br />6. <strong>Case Studies and Practical Examples</strong>: Real-world cases, particularly those involving colpotomies during robotic-assisted procedures, illustrate the consequences of improper electrosurgical use. Recommendations for practices like bipolar tubal sterilization are based on these findings.<br /><br />7. <strong>Troubleshooting</strong>: Common issues like no tissue effect are addressed with a step-by-step troubleshooting guide, ensuring practitioners can quickly identify and rectify problems.<br /><br />The document underscores the necessity of mastering electrosurgical techniques to improve patient safety and surgical outcomes effectively.
Keywords
Electrosurgery
Operating Room
American Urogynecologic Society
Terminology
Electrical Concepts
Electrosurgical Generators
Monopolar Instruments
Bipolar Instruments
Patient Safety
Troubleshooting