Encision Inc., Louisville, CO, USA.
J Minim Invasive Gynecol. 2013 May-Jun;20(3):288-98. doi: 10.1016/j.jmig.2013.01.015.
Monopolar electrosurgical energy is the most commonly used energy source during laparotomic and laparoscopic surgery. The clinical application of monopolar energy is not without risk. Monopolar electrosurgical energy was introduced into surgical practice at the turn of the 20th century. Alternate site burns during laparotomic application were the most common complication for the first half century (i.e., ground point burns and dispersive electrode burns [1920-1970]). The aims of this article were to discuss historic design flaws associated with the most common alternate site burns, ground point burns, and dispersive electrode burns and the technological advancements introduced to mitigate these risks to the patient and to discuss current design flaws associated with stray energy burns during laparoscopy because of insulation failure and capacitive coupling and the technological advancements introduced to eliminate these risks to the patient. Today, insulation failure and capacitive coupling are the most common reasons for electrosurgical injury during laparocopic procedures. There is a need for advanced technology such as active electrode monitoring to address these invisible risks to the surgeon and their patients. In addition, the laparoscopic surgeon should be encouraged to study the basic biophysics involved in electrosurgery.
单极电外科能量是腹腔镜和剖腹手术中最常用的能量源。单极能量的临床应用并非没有风险。单极电外科能量在 20 世纪之交被引入外科实践。在剖腹应用中，替代部位烧伤是前半个世纪最常见的并发症（即接地点烧伤和分散电极烧伤[1920-1970]）。本文旨在讨论与最常见的替代部位烧伤、接地点烧伤和分散电极烧伤相关的历史设计缺陷，以及为降低这些对患者的风险而引入的技术进步，并讨论由于绝缘故障和容性耦合而导致腹腔镜手术中出现散逸能量烧伤的当前设计缺陷，以及为消除这些对患者的风险而引入的技术进步。如今，绝缘故障和容性耦合是腹腔镜手术中电外科损伤的最常见原因。需要先进的技术，如主动电极监测，以解决外科医生及其患者面临的这些无形风险。此外，应鼓励腹腔镜外科医生研究电外科涉及的基本生物物理学。
