http://www.jmig.org/article/S1553-4650(06)00551-6/abstract

Study objectives

To determine the prevalence of insulation failure in gynecologic laparoscopic instruments and to assess the impact of routine static insulation failure testing
Design

Cross-sectional study (Canadian Task Force classification II-2).
Setting

Public tertiary teaching hospitals.
Intervention

Routine static insulation failure testing
Measurements and main results

Dichotomous assessment of instrument insulation failure. Characterization of insulation defects. One hundred eleven instruments were tested. The overall prevalence of insulation failure was 27% with a rate of 39% in dedicated monopolar instruments. The sensitivity of visual inspection to predict a damaged instrument was 10%. Even when the site of the failure was identified, the defect was detectable only in 35% of instruments without magnification. The mean site of insulation failure was at 71 mm from the tip of the instrument, placing most insulation defects within the abdominopelvic cavity during surgery. After the introduction of routine static electrosurgical instrument testing, the overall prevalence of insulation failure dropped to 5.9%.
Conclusion

There is an unacceptably high prevalence of instrument insulation failure in gynecologic laparoscopic instruments. Visual inspection is not an appropriate screening mechanism for insulation failure but routine biomedical testing reduces the prevalence of defective laparoscopic instruments.

...visit the web site to read more

"The Basics of Sterile Processing" edited by Nancy Chobin,Sterile Processing University 2006 First Edition 2006; Page 108-109

Nancy's book can be ordered here https://www.sterileprocessing.org/bookform.htm

http://www.ncbi.nlm.nih.gov/pubmed/17368262

STUDY OBJECTIVES: To determine the prevalence of insulation failure in gynecologic laparoscopic instruments and to assess the impact of routine static insulation failure testing

DESIGN: Cross-sectional study (Canadian Task Force classification II-2). SETTING: Public tertiary teaching hospitals. INTERVENTION: Routine static insulation failure testing MEASUREMENTS AND MAIN RESULTS: Dichotomous assessment of instrument insulation failure. Characterization of insulation defects. One hundred eleven instruments were tested. The overall prevalence of insulation failure was 27% with a rate of 39% in dedicated monopolar instruments. The sensitivity of visual inspection to predict a damaged instrument was 10%. Even when the site of the failure was identified, the defect was detectable only in 35% of instruments without magnification. The mean site of insulation failure was at 71 mm from the tip of the instrument, placing most insulation defects within the abdominopelvic cavity during surgery. After the introduction of routine static electrosurgical instrument testing, the overall prevalence of insulation failure dropped to 5.9%.

CONCLUSION: There is an unacceptably high prevalence of instrument insulation failure in gynecologic laparoscopic instruments. Visual inspection is not an appropriate screening mechanism for insulation failure but routine biomedical testing reduces the prevalence of defective laparoscopic instruments.

...viist the web site to read more

http://www.psqh.com/mayjun05/aems.html

Advancing Patient Safety in Laparoscopy:
The Active Electrode Monitoring System

Vangie Dennis RN, CNOR, CMLSO

In the past, use of monopolar electrosurgery in open surgical procedures involved the risk of external skin injury due to an alternate return path or compromised return electrode. In the 1970s and 1980s, perioperative nurses championed the adoption of technologies that prevented these problems (isolated generators and return electrode monitoring). As a result of their efforts, the risk of external skin injuries was almost completely eliminated. However, the introduction in the early 1990s of laparoscopic application of monopolar electrosurgery introduced the risk of stray electrosurgical burns (internal thermal burns to non-target tissue). This is an important issue for the perioperative staff to address; unlike skin injuries, stray electrosurgical burns during laparoscopy can be fatal.

... for complete article visit web site

http://laparoscopy.blogs.com/prevention_management/chapter_02_electrosurgery/

Chapter 2. Laparoscopic Electrosurgery

by Scott Rohlf

INSULATION FAILURE

Insulation failure can occur from damage to the insulation such as breaks or holes caused by reprocessing or damage created during use. Insulation failure can also occur during surgery through the use of high voltage coagulation waveform. Breaks in the insulation caused by trauma during use or reprocessing provide an alternate pathway for the current to leave the electrode as it completes the circuit to the patient return electrode. If, while the generator is being activated, the portion of the electrode with defective insulation encounters adjacent tissue, the current can complete the circuit by arcing from the electrode through the insulation break to adjacent tissue (Figure 1). If this point of exit is small, current density can be high enough to produce significant tissue damage. Often this problem can occur outside the surgeon’s field of vision. Consequently, this occurrence can go undetected.

http://www.infectioncontroltoday.com/articles/0a1feat2.html

Managing a New Class of Electrosurgical Risk: Active Electrode Monitoring
By Vangie Dennis, RN, CNOR, and Beth Grimes, RN, BSN, CNOR

Use of monopolar electrosurgery has always carried the risk of skin injury as a result of return electrode placement. In recent years, this risk has been almost completely eliminated through intense education of perioperative personnel, and the technological developments of "isolated" generators and return electrode monitoring (REM), both of which are now standards of care. However, the serious risk of stray electrosurgical burns (internal thermal burns to non-target tissue) resulting from the laparoscopic application of monopolar electrosurgery still exists. And unlike skin injuries, stray electrosurgical burns can be fatal.

....visit the web site to read the complete article

http://www.jmig.org/article/S1553-4650(08)00653-5/abstract

Insulation Failures in Robotic and Laparoscopic Instrumentation: A Prospective Evaluation

M. Espada, R. Munoz, B. Nobile, R. Kho, P. Magtibay, E. Castle, J. Magrina

http://www.endonurse.com/articles/1c1feat3.html

Education in Electrosurgery Technology is Key for Endoscopy Team Members
Kelly M. Pyrek
12/01/2001

It is estimated that more than 3 million laparoscopic surgical procedures are performed annually in the US, with approximately 85% of surgeons utilizing electrosurgical instruments in these procedures.1 The ubiquitous nature of these procedures has the members of many endoscopic suites paying particular attention to reducing the risk of inflicting thermal burns to patients during minimally invasive surgeries. While minimally invasive surgery technology is revolutionizing healthcare--reflected in the tremendous advances made in science--it may exact a greater price for the benefits it yields. These burns can cause patient injury, serious post-operative complications, even death.

....visit the web site to read the complete article

http://www.obgyn.net/medical.asp?page=/english/pubs/features/els-104-wht

Avoiding Electrosurgical Injury During Laparoscopy:

An Emerging Patient Safety Issue

Table of Contents

Overview

Increased Use of Minimally Invasive Surgery

Monopolar Electrosurgery

Alternatives to Monopolar Electrosurgery

Unintentional Tissue Burns at Non-Targeted Sites

Complications Resulting from Unintentional Tissue Burns

Medicolegal and Economic Issues

Professional and Public Awareness

Limitations of Traditional Methods to Minimize Risk of Patient Injury

Technological Solutions for Preventing Unintentional Tissue Burns

Conclusion

Glossary

References

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