Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Western University, London, Ontario, Canada.
J Minim Invasive Gynecol. 2013 May-Jun;20(3):279-87. doi: 10.1016/j.jmig.2013.02.013.
Electrosurgery is the most commonly used and misunderstood technology by all surgical and medical disciplines. A lack of basic knowledge or ignorance of principles of electrosurgery and equipment among obstetricians and gynecologists is reported. As a result, thermal injuries during laparoscopic electrosurgery occur, which frequently lead to significant morbidity and mortality and medicolegal actions. Surveys indicate that up to 90% of general surgeons and gynecologists use monopolar radiofrequency (RF) during laparoscopy, 18% have experienced visceral burns, and 13% admitted 1 or more ongoing cases of litigations associated with such burns. This article describes the basics of electrosurgery beginning with the generation of electrons and their physical characteristics and governing laws before their arrival in the operating room where they are fed to an electrosurgical unit (ESU) to boost their frequency with step-up transformers from 60 Hz to >500 000 Hz. This RF creates heat, resulting in dissection, desiccation, coagulation, and fulguration of tissues without neuromuscular stimulation, pain, or burn to the patient. The ESU delivers power (wattage = volts × amps) in monopolar or bipolar (1 vs 2 high-density electrodes) configuration. Because of RF, monopolar electrosurgery compared with other energy sources is associated with unique characteristics, inherent risks, and complications caused by the requirement of a return/dispersive electrode, inadvertent direct and/or capacitive coupling, or insulation failure of instruments. These dangers become particularly important with the popular and frequent use of monopolar electrodes (hook, needle, and scissors) during cholecystectomy; robot-assisted surgeries; and the re-emergence of single-port laparoscopy, which requires close proximity and crossing of multiple intraabdominal instruments outside the surgeon's field of view. Presently, we identify all these potential risks and complications associated with the use of electrosurgery and provide suggestions and solutions to mitigate/minimize these risks based on good clinical practice and sound biophysical principles.
电外科是所有外科和医学领域最常用但也最容易被误解的技术。据报道，妇产科医生对电外科的基础知识或原理缺乏了解。因此，在腹腔镜电外科手术中会发生热损伤，这经常导致严重的发病率和死亡率以及医疗法律诉讼。调查表明，高达 90%的普通外科医生和妇科医生在腹腔镜手术中使用单极射频 (RF)，18%的人经历过内脏烧伤，13%的人承认有 1 例或多例与这种烧伤有关的法律诉讼。本文介绍了电外科的基础知识，从电子的产生及其物理特性和基本定律开始，然后介绍它们到达手术室的情况，在手术室中，电子被输送到一个电外科单元 (ESU)，通过升压变压器将其频率从 60 Hz 提升到 >500 000 Hz。这种射频会产生热量，从而导致组织的分离、干燥、凝固和熔断，而不会引起神经肌肉刺激、疼痛或灼伤患者。ESU 以单极或双极 (1 对 2 高密度电极) 配置提供功率 (功率 = 电压 × 电流)。由于射频的存在，与其他能源相比，单极电外科与独特的特性、固有风险以及由于需要返回/分散电极、无意的直接和/或电容耦合或仪器绝缘故障而引起的并发症相关。当在胆囊切除术期间频繁使用单极电极（钩、针和剪刀）、机器人辅助手术以及单端口腹腔镜手术重新出现时，这些危险变得尤为重要，因为单端口腹腔镜手术需要在外科医生的视野之外，使多个腹腔内器械紧密靠近并交叉。目前，我们根据良好的临床实践和合理的生物物理原理，确定了与电外科使用相关的所有这些潜在风险和并发症，并提出了减轻/最小化这些风险的建议和解决方案。
