ELECTROSURGICAL SAFETY DURING LAPAROSCOPIC SURGERY

Dissection and haemostasis using electrosurgical current has been used safely for nearly 70 years. It is used most commonly in the monopolar form in which the circuit is completed across the patient between an active instrument and a low energy density return plate and using two current waveforms (cut and coagulation) which are manipulated to produ ce a variety of tissue effects. In surgical laparoscopy the monopolar arrangement may create abnormal return paths to the patient plate by c apacitive and direct coupling. If these paths have a cross-sectional a rea sufficient to raise the power density above 7.5 watts/cm(2) tissue damage may occur. These risks can be reduced by modification of surgi cal technique and using instrumentation designed to eliminate the abno rmal return paths.