A LAPAROSCOPIC COMPLICATION - A MEDICAL-LEGAL CASE ANALYSIS .2.

This article presents the results of a medical legal case presented as an unknown in Volume 11, Number 2, page 113, of this journal. The cas e was concluded to be an electrosurgical burn delivered to both the il eum and the colon. A description of electrosurgical burns is given and correlated to the medical-legal case. Also discussed are methods to m inimize the likelihood of electrosurgical complications. Technology so lutions, including actively monitored shielding of monopolar electrode s and bipolar electrodes, also are discussed. The histologic variation of electrosurgical damage is discussed, varying from uniform coagulat ion necrosis with vacuolization to areas appearing essentially normal but with areas showing pale-staining cellular cytoplasm and small dark nuclei. Areas with both vascular thrombi and hemorrhage also may be s een. The potential causes for electrosurgery damage are insulation fai lure, direct coupling through instrumentation and tissue, and capaciti ve coupling.