Electrosurgery

In high-frequency electrosurgery, electrothermal energy is used for tissue destruction. Frequencies between 500 kHz and 2 NHz do not interference with physiologic electric events, such as, cardiac activity. Different instruments for monopolar and bipolar coagulation, with a diameter between 2 and 10 mm are available. Electrocautery should be applied cautiously and accurately. Excessive use of electro-cautery to control haemorrhage is recognised as an important pitfall in laparoscopic surgery. The ease of raising the temperature of tissue many centimetres from the operative site, using monopolar electrocautery, has been shown by several groups.9,10 Saye et al. reported that if a temperature differential of 30° C was reached for only two seconds, tissue damage occurred.10 Breaks in the integrity of the insulated coating and the capacitive coupling can occur along the shaft of the instrument or through a metal trocar. When this happens thermal injury to bowel, out of view of the surgeon, may occur as only a small portion of the laparoscopic instrument is visualised during surgery. Up to 50% of laparoscopic bowel injury is caused by electrocautery11. Therefore, electrocautery-induced thermal injury leads to significant morbidity and mortality after laparoscopic surgery.12,13 Another disadvantage of using electrocautery, especially unipolar, is that smoke is produced. This reduces the overview.

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