What is “stray energy?”
During minimally invasive surgery, the combination of electrical current, heat generation, the wide variety of surgical devices, and the complex environments in which they are used can occasionally result in a complication known as “stray energy”. This occurs during surgical procedures when there is a leakage through the outer insulation of conventional laparoscopic surgical instruments. This stray energy can burn a patient intraoperatively and can, in some instances, be catastrophic.[i]
Why is it an issue with laparoscopic surgery?
Although laparoscopic surgery is generally very safe, there are special circumstances surrounding the performance of laparoscopic surgery. It is performed through small key holes, the instruments are very long and thin, and require insulation around their long metallic shaft. This sets up a situation of potential insulation breaks, inability of the surgeon to concurrently visualize the position of all instruments, and thus the creation of stray energy. This occurs when energy jumps from an electrically active instrument shaft, to the shaft of a non-active instrument that is holding a piece of tissue or organ that should not be exposed to electrical energy. This can create injuries to tissue or organs not directly involved in the surgical procedure and under the control of the surgeon.
How does stray energy harm patients?
It creates thermal, or burn, injuries on tissue and organs uninvolved in the surgical procedure being performed. This can produce dangerous complications during or after surgery.
What are some examples of how stray energy may result in a problem for a patient?
– Electrical shock
– Minor skin burns
– Bleeding or leakage
– Tissue injury
– Fire outbreak in the procedure area
– The necessity of additional procedures unrelated to the initial procedure
– The need for readmission to the hospital
– Severe illness, or in some cases death
How often do such incidents occur?
In the United States, several million surgical procedures are done each year. Surgical fires occur several hundred times annually in the US. Two-thirds of these OR fires involve electrosurgical equipment. Electrosurgical injuries to tissue are thought to occur at a rate of 1-2 per 1000 procedures.
What is SAGES doing to address this risk?
SAGES launched the Fundamental Use of Surgical Energy™, or FUSE, program in 2014 to educate surgeons and affiliated OR staff about the safe use of surgical energy-based devices in the operating room, endoscopic suite and other procedural areas. The multidisciplinary FUSE program meets a crucial gap in surgical education as, previously, no formal training program had existed that promoted safety in the operating room (OR) when using surgical devices. The program includes a didactic curriculum and covers a number of topics including the fundamental principles of electrosurgical devices, practical aspects of commonly used energy devices in various settings, integration of energy systems with other devices, as well as prevention of operating room fires. A FUSE certification exam is offered that ensures successful learners have acquired the needed knowledge. SAGES encourages mastering fundamental skills in order to ensure a safe standard of care for all patients undergoing surgery.
Are physicians receiving enough training? What do they need to know?
There has been a dramatic rise in the number and complexity of energy devices for procedural applications, including radio-frequency based systems (e.g., bipolar devices, argon beam, radiofrequency-ablation) and ultrasonic energy systems. These devices often facilitate or even enable complex procedures and they are at the core of many innovations in the field of minimally invasive surgery, general surgery, hepatobiliary surgery, urologic and gynecologic surgery as well as endoscopic and image-guided interventions.
The FUSE program was designed so that any health care professional (Surgeons, Nurses and Anesthesiologists) who uses an energy device in the OR will better understand how it works, when to apply it, and what possible hazards and errors can occur.[ii]
SAGES was founded more than 30 years ago with the mission of improving quality patient care through education, research, innovation and leadership, principally in gastrointestinal and endoscopic surgery. Representing a worldwide community of over 6,000 surgeons, SAGES seeks to bring excellence in and access to minimally invasive surgery (MIS) and emerging techniques to patients around the globe.