Current electrosurgical practice: hazards

The beneficial aspects of electrosurgical cutting and coagulating techniques are nearly too numerous to list. The major contribution and electrosurgery has been to drastically reduce both blood loss and operative time resulting in reduced morbidity and mortality. There are, as well, procedures which would not be possible without electrosurgery. Nonetheless, as a source of high energy in the operating theatre, there are hazards attendant to the use of electrosurgery. Moreover, since high frequency signals are involved, the nature of the machine-patient interactions creating a potentially hazardous situation many not be easily identifiable. The significant hazards of electrosurgery in use are: explosions of combustible mixtures including anaesthesia gas and bowel gas; interference with instruments and pacemakers; stimulation of excitable tissues which on occasion has apparently caused ventricular fibrillation; and accidental radio frequency burns. Though the rate of incidents is low--in terms of the number per 100 000 procedures--individual accidents tend to be fairly catastrophic and traumatic to both the patient and surgical team. Frequently, litigation results from these accidents. Though the hazards cannot be eliminated, the probability of an incident can be minimized by careful technique.