Electrosurgery in laparoscopy

The two factors that probably contributed most to the bowel burns that have occurred during monopolar laparoscopy were the use of higher-than-necessary voltages and the electrical isolation of the salpinx. Preferably, low-peak voltages should be used. If the two-burn technique is used, desiccation should be from distal to proximal to avoid electrical isolation of the salpinx. Bipolar laparoscopy is unquestionably safer than monopolar, but it is also harder to perform because the salpinx must be grasped repeatedly on both sides to desiccate the required 2 to 3 cm of tissue. Moreover, electrosurgical cutting with bipolar forceps is not very practical because the spark punches through to the opposite jaw and the cutting stops. Bipolar forceps that can make a mechanical cut after desiccation are available for those who desire this feature. Metal trocar sleeves are recommended for use with the monopolar, single-puncture technique only. They are not necessary for the bipolar or double-puncture monopolar techniques.