Wu M P, Ou C S, Chen S L, Yen E Y, Rowbotham R
Department of Obstetrics and Gynecology, Tainan Municipal Hospital, Taiwan.
Am J Surg. 2000 Jan;179(1):67-73. doi: 10.1016/s0002-9610(99)00267-6.
Electrosurgery is one of the most commonly used energy systems in laparoscopic surgery. Two major categories of potential complications related to electrosurgery in laparoscopy are mechanical trauma and electrothermal injury. The latter can result from unrecognized energy transfer in the operational field or, less commonly, to unnoticed stray current outside the laparoscopic field of view. Stray current can result from insulation failure, direct coupling, or capacitive coupling.
We reviewed the literature concerning essential biophysics of electrosurgery, including electrosurgical waveform differentiation, tissue effect, and variables that determine tissue effect. The incidence of electrosurgical injuries and possible mechanisms responsible for the injuries are discussed. Different types of injuries may result in different clinical manifestations and histopathological findings. Gross and microscopic pathological check-ups of the injury sites may distinguish between different mechanisms, and thus provide further clues postoperatively.
Several recommended practices are proposed to avoid electrosurgical injury laparoscopically. To achieve electrosurgical safety and to prevent electrosurgical injuries, the surgical team should have a good understanding of the biophysics of electrosurgery, the basis of equipment and general tissue effects, as well as the surgeon's spatial orientation and hand-eye coordination. Some intraoperative adjuvant procedures and newly developed safety devices have become available may aid to improve electrosurgical safety.
Knowledge of the biophysics of electrosurgery and the mechanisms of electrosurgical injury is important in recognizing potential complications of electrosurgery in laparoscopy. Procedures for prevention, intraoperative adjuvant maneuvers, early recognition of the injury with in-time salvage treatment, and alertness to postoperative warning signs can help reduce such complications.
电外科手术是腹腔镜手术中最常用的能量系统之一。腹腔镜电外科手术相关的两大类潜在并发症是机械创伤和电热损伤。后者可能源于手术区域未被识别的能量转移，或者较少见的是腹腔镜视野外未被注意到的杂散电流。杂散电流可能由绝缘故障、直接耦合或电容耦合引起。
我们回顾了有关电外科手术基本生物物理学的文献，包括电外科波形分化、组织效应以及决定组织效应的变量。讨论了电外科损伤的发生率及造成损伤的可能机制。不同类型的损伤可能导致不同的临床表现和组织病理学发现。对损伤部位进行大体和显微镜病理检查可区分不同机制，从而在术后提供进一步线索。
提出了几种推荐的操作方法以避免腹腔镜电外科手术损伤。为实现电外科安全并预防电外科损伤，手术团队应充分了解电外科手术的生物物理学、设备基础和一般组织效应，以及外科医生的空间定向和手眼协调能力。一些术中辅助程序和新开发的安全装置可能有助于提高电外科安全性。
了解电外科手术的生物物理学和电外科损伤机制对于识别腹腔镜电外科手术的潜在并发症很重要。预防措施、术中辅助操作、早期识别损伤并及时进行挽救治疗以及对术后警示信号保持警惕有助于减少此类并发症。
