Technological Assessment of Laparoscopic Monopolar Electrosurgery Instruments at CSSS du Lac-Des-Deux-Montagnes

Abstract

Thermal injuries observed at the distal end of the insulative sheathing of monopolar laparascopes during two recent interventions at the CSSS du Lac-des-Deux-Montagnes’ surgical unit prompted this technological assessment of monopolar laparoscopes. This type of incident occurring rarely – no incident had been previously reported – the biomedical engineering department recommended, in agreement with the surgical unit manager and the chief of general surgery, the assessment of all our reusable monopolar laparoscopic instruments. Results indicate that quality of the electrode insulation sheathing, handling of instruments during surgery and non-compliant sterilization cycle parameters can compromise patient safety. The following guidelines should be followed when purchasing monopolar laparoscopes: minimal insulation thickness of 0.4 mm, compatibility with the institution’s sterilization cycles, and visual inspection. A system ensuring instrument traceability is strongly recommended to monitor their actual usage and better predict a physical damage timeline. In the absence of such a system, we recommend a periodic insulation testing in the normal validation cycle of the laparoscopic instruments and their replacement after two years on a financial amortization basis instead of using them up to their average useful life cycle.

Key words: Laparoscopy, Electrosurgery, Electrode insulation, Quality control, Thermal injury, Managing Burn Risks, Instrument insulation testing.