Essential principles of electrosurgery in operative laparoscopy

Abstract

Summary The three principal parts of electrosurgical instrumentation are the generator and the active and passive electrodes; it is important that they be matched properly to obtain the desired tissue effects. The generator supplies the current flow, which is adjustable to enable the surgeon to deliver the correct energy levels for the condition at hand. The minimum effective voltage should be used to reduce the chance of “electron jumping,” or sparking to nearby unintended structures such as bowel and blood vessels. Fortunately, the physics of sparking (fulguration) preclude deep penetration, reducing the probability of a serious, deep injury. Several types of microelectrodes are available. Some are insulated, with only the tips exposed to decrease the chance of inadvertent damage to lateral tissue. Microelectrodes should be used for rapid vaporization of avascular planes, using the noncontact technique as described. Where coagulation effects are desired, for example, endometriosis implants on the broad ligament, electrodes of large diameter should be used to achieve superficial coagulation and to avoid deep penetration of current. Microelectrode surgery is equivalent to CO2 laser surgery used at superpulse or ultrapulse mode. 5, 6 Macroelectrosurgery with wide-tipped electrodes is similar to low power density CO2 laser surgery or fiber laser surgery. Tissue cutting must be precise and atraumatic to limit thermal and electrical damage to surrounding tissue. Electrosurgery provides the surgeon with a wide range of options: type of current, power level, unipolar and bipolar systems, and electrodes of various shapes and sizes. Also essential are proper equipment and basic understanding of, and meticulous adherence to, the related principles. Faulty or improper equipment, and lack of knowledge and careful attention on the part of the surgeon, may result in poor surgical outcomes and an increased possibility of unnecessary complications.