High Incidences of Insulation Failure Found in Robotic and Laparoscopic Instruments

July 12, 2011

Although uncommon, insulation failure (IF) during minimally invasive surgical procedures can cause electrosurgical injuries that can lead to significant complications. For instance, the resulting burns of these injuries involve a high risk of tissue necrosis and abscess formation that can lead to the perforation of internal organs, such as the bowel, which in turn can result in bacterial contamination of the abdominal cavity.

Although uncommon, insulation failure (IF) during minimally invasive surgical procedures can cause electrosurgical injuries that can lead to significant complications. For instance, the resulting burns of these injuries involve a high risk of tissue necrosis and abscess formation that can lead to the perforation of internal organs, such as the bowel, which in turn can result in bacterial contamination of the abdominal cavity. Furthermore, it has been estimated that 1 to 5 events per 1000 procedures occur outside the surgeon’s view.

To better understand the risks involved, Dr Mercedes Espada from the obstetrics and gynecology department at the Hospital Quirn Madrid in Madrid and colleagues conducted a prospective study to evaluate the incidence and prevalence of IF in laparoscopic and robotic instruments.

Espada and colleagues studied all the in-stock robotic and laparoscopic instruments that were used for obstetrics/gynecology surgeries during their 2-phase study. This included 78 robotic instruments (36 monopolar, 42 bipolar) and 298 laparoscopic instruments. During the first phase, instruments were tested at 20Wand 2.64 kV using a porosity detector following the company’s general recommendations. The second phase sought to eliminate the possibility that IF could have been created by a higher voltage; as such, the instruments were tested at 20W and 1 kV.

The researchers found a higher prevalence of IFs in the robotic group as compared to the laparoscopic group (32% and 13%, respectively). Specifically, they further found 4 monopolar and 21 bipolar instruments indicating positive IF, with a lower prevalence of IF in the monopolar group (11% and 50%, respectively). However, visually detectable IFs occurred more often in the laparoscopic instruments (69%) than the robotic instruments (28%). The proximal one-half of the shaft of laparoscopic instruments was the most common site (69%); this was especially true where the core joined the plastic sheath and in the distal one-half of the shaft of robotic instruments (100%).

“There is a high incidence and prevalence of IFs in robotic and laparoscopic electrosurgical instruments, even when tested according to manufacturer specifications of voltage,” the researchers concluded. “Routine testing of robotic and laparoscopic electrosurgical instruments after each use will dictate the clinical significance of IF.”

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References:

Reference
Espada M, Munoz R, Noble BN, Magrina JF. Insulation failure in robotic and laparoscopic instrumentation: a prospective evaluation. Am J Obstet Gynecol. 2011;205 [Epub].