Surgical complications specific to monopolar electrosurgical energy: engineering changes that have made electrosurgery safer.

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.