Hand-to-hand coupling and strategies to minimize unintentional energy transfer during laparoscopic surgery.

Background: Energy-based devices are used in nearly every laparoscopic operation. Radiofrequency energy can transfer to nearby instruments via antenna and capacitive coupling without direct contact. Previous studies have described inadvertent energy transfer through bundled cords and nonelectrically active wires.

Single-incision laparoscopic surgery increases the risk of unintentional thermal injury from the monopolar "Bovie" instrument in comparison with traditional laparoscopy.

Background: Single-incision laparoscopic surgery (SILS) places multiple instruments in close, parallel proximity, an orientation that may have implications in the production of stray current from the monopolar "Bovie" instrument. The purpose of this study was to compare the energy transferred during SILS compared to traditional four-port laparoscopic surgery (TRD).

Method: In a laparoscopic simulator, instruments were inserted via SILS or TRD setup.

An Effective Curriculum for Focused Assessment Diagnostic Echocardiography: Establishing the Learning Curve in Surgical Residents.

Background: Simulation training and competency-based assessment are the evolving standard for surgical education. The Focused Assessment Diagnostic Echocardiography (FADE) examination is a bedside, limited transthoracic ultrasound to assess cardiac function, anatomy, and volume status. FADE can be used to noninvasively evaluate and guide resuscitation of critically ill patients.

Surgical Risk and Comorbidity in Older Urologic Patients.

Almost two-thirds of urology operations are performed in patients 65 years and older. Older adults are at higher risk for complications and mortality compared with their younger counterparts. There are 2 primary methods to quantify surgical risk in these patients, frailty measurement and organ/comorbidity-based surgical risk calculators.

Separating the Laparoscopic Camera Cord From the Monopolar "Bovie" Cord Reduces Unintended Thermal Injury From Antenna Coupling: A Randomized Controlled Trial.

Objective(s): The monopolar "Bovie" is used in virtually every laparoscopic operation. The active electrode and its cord emit radiofrequency energy that couples (or transfers) to nearby conductive material without direct contact. This phenomenon is increased when the active electrode cord is oriented parallel to another wire/cord.

Unintended stray energy from monopolar instruments: beware the dispersive electrode cord.

Background: The monopolar instrument emits stray radiofrequency energy from its cord when activated. This is a source of unintended thermal injury to patients. Stray energy emitted from the dispersive electrode cord has not been studied.

Surgical Energy-Based Device Injuries and Fatalities Reported to the Food and Drug Administration.

Background: Energy-based devices are used in virtually every operation. Our purposes were to describe causes of energy-based device complications leading to injury or death, and to determine if common mechanisms leading to injury or death can be identified.

Study Design: The FDA's Manufacturer and User Facility Device Experience (MAUDE) database was searched for surgical energy-based device injuries and deaths reported over 20 years (January 1994 to December 2013).

Antenna coupling explains unintended thermal injury caused by common operating room monitoring devices.

Introduction: Unintended thermal injury from patient monitoring devices (eg, electrocardiogram pads, neuromonitoring leads) results in third-degree burns. A mechanism for these injuries is not clear. The monopolar "bovie" emits radiofrequency energy that transfers to nearby, nonelectrically active cables or wires without direct contact by capacitive and antenna coupling.

Electromagnetic interference caused by common surgical energy-based devices on an implanted cardiac defibrillator.

Background: Surgical energy-based devices emit energy, which can interfere with other electronic devices (eg, implanted cardiac pacemakers and/or defibrillators). The purpose of this study was to quantify the amount of unintentional energy (electromagnetic interference [EMI]) transferred to an implanted cardiac defibrillator by common surgical energy-based devices.

Methods: A transvenous cardiac defibrillator was implanted in an anesthetized pig.

Effect of radiofrequency energy emitted from monopolar "Bovie" instruments on cardiac implantable electronic devices.

Background: The monopolar "Bovie" instrument emits radiofrequency energy that can disrupt the function of other implanted electronic devices through a phenomenon termed electromagnetic interference. The purpose of this study was to quantify the electromagnetic interference occurring on cardiac implantable devices (CIEDs) resulting from monopolar instrument use in common, modifiable clinical scenarios.

Study Design: Three anesthetized pigs underwent CIED placement (1 pacemaker and 2 defibrillators).

Blend mode reduces unintended thermal injury by laparoscopic monopolar instruments: a randomized controlled trial.

Background: The purpose of this study was to compare histologic evidence of thermal injury at the epigastric and umbilical incisions after elective laparoscopic cholecystectomy performed using the monopolar "Bovie" instrument set on the higher voltage coag mode versus the lower voltage blend mode. We hypothesized that the higher voltage coag mode would create more unintended thermal tissue injury at the epigastric trocar's incision.

Methods: A prospective blinded randomized controlled trial of patients undergoing elective laparoscopic cholecystectomy was performed.