Page 32 - World Journal of Laparoscopic Surgery

Anshika Lekhi et al

Fig. 11: Direct coupling

Fig. 12: Glowing of bulb due to capacitative coupling from
monopolar hook

Return Electrode or Alternative Site Burns

If the return electrode is not completely in contact with
the patient’s skin, or is not able to disperse the current
safely, then the exiting current can have a high enough
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density to produce an unintended burn. It is important
to have good contact between the patient and a dispersive
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pad. The minimum size of return electrode should be
2
100 cm .
RESULTS
Fig. 13: Capacitance due to wrapping of monopolar code
around artery forceps The author in this review of the literature likewise accen-
tuates on the unprejudiced learning of all the energy
devices before using them. It also shows that the perfor-
Direct Coupling
mance of the energy devices depends upon the type of
Direct coupling happens when the active terminal is effect needed. There is no accord as to which device is
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unintentionally enacted or is in close nearness to another ideal for a given purpose (Table 3). Wang and Advincula
metal instrument inside the pelvis, e.g., laparoscope or have stressed on a careful comprehension of the upsides
metal grasper forceps (Fig. 11). Direct coupling can be and downsides of the innovative technical advances
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prevented by keeping the electrode in vision and keeping can enhance the operative experience for both specialist
away from whatever other conductive instruments before and patient. The specialized expertise level of the spe-
enacting the electrode. 13,15 cialist and the learning about the device are both critical
variables in choosing safe results.
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Holloran-Schwartz et al, in a randomized control
Capacitive Coupling
trial of 46 laparoscopic hysterectomy patients, compared
Capacitive coupling happens when the electric current is
exchanged from one conductor (the dynamic terminal), Table 3: Comparison of various energy sources
through in-place insulation, into nearby conductive Risk of
materials (e.g., bowel) without direct contact (Fig. 12). stray
Longer length of instruments, thinner protection, higher Device Skill current Cutting Coagulation Reusable
Monopolar hook     
voltages, and different conductivity instruments, such Bipolar
as unknown wrapping of electrosurgical codes (Fig. 13) dissector     
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and thin trocars build the danger of this kind of injury. Ligasure     
Capacitor coupling can be minimized by enacting the Enseal     
active electrode just when it is in contact with target Gyrus     
tissues and restricting the time length of high-voltage Harmonic     
peaks. 12,17 Thunderbeat     
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