Feature: Curbing laparoscopy burns

CHARLENE LAINO, United Press International

NEW YORK, June 21 (UPI) -- Laparoscopic surgery has become a routine medical procedure, promising a quick in and out at the hospital and easy recovery -- so the last thing patients think about is a small but significant possibility of stray electrical burns.

"The thing that's so sad is most doctors know about this problem but don't think it will happen to them," Kay Ball, a surgical nurse in Lewis Center, Ohio, who has written books on the topic, told United Press International.


Statistics show unintentional burns account for more than one in 20 injuries associated with laparoscopic surgery. Ball said what makes it even sadder is that, just like house fires resulting from poorly insulated wiring, stray electrosurgical burns are preventable.

In laparoscopic or keyhole surgery, doctors operate with a laparoscope, a tiny video camera and miniaturized surgical instruments inserted through half-inch incisions in the abdomen.

"You don't have to open the belly and cut all that tissue," so laparoscopic surgery offers less pain, fewer complications, shorter hospital stays and a quicker recovery than conventional surgery, Ball said.

More than 4.4 million laparoscopic surgeries are performed each year in the United States alone, meaning more than 200,000 procedures result in injuries.


Most laparoscopic surgeons use insulated electrosurgical instruments to cut or coagulate the injured tissue, said Dr. Alan Johns, immediate past president of the American Association of Gynecologic Laparoscopists.

"A stream of electricity goes through the instrument, out its tip and into the patient, where it has a tissue effect -- cutting or coagulating tissue exactly where you want," said Johns, who has a private practice in Fort Worth, Texas.

If the insulation covering one of the long, slender instruments contains a microscopic hole, however, electricity can escape in the wrong place and its energy spreads like lightening on a hot summer day, burning any tissue with which it comes in contact. The unintended burn, Johns said, can be life-threatening.

"If the injury is significant enough to cause a burn, you will get a hole in the bowel and fecal matter can leak. This can be a disaster, even fatal," Johns told UPI.

One study showed one in four patients who suffers internal injuries stemming from stray electrosurgical burns dies, even after aggressive antibiotic treatment.

Trudy Hamilton did survive and has since created a video to share her experiences with others. Several days after a routine laparoscopic procedure to remove her gallbladder, she started feeling nauseous and had abdominal pain. A week later, the pain was so unbearable doctors had to perform emergency surgery, during which they discovered her bowel had been punctured and its bacteria-laden contents leaked out of the gut and caused a potentially fatal infection.


Hamilton, then a registered nurse in Tampa, Fla., said her doctors blamed stray electrical burns. After more surgery, untold pain and four missed months of work, she has moved on, becoming a nurse practitioner and moving to Clayton, Wis.

"(But) it was my life," she said. "I (went) through something that a lot of patients don't survive."

Such problems could be avoided with Active Electrode Monitoring or AEM, Johns said.

AEM laparoscopic instruments, made by Encision, have a protective shield around the insulation that monitors the flow of electrical current to ensure it is exactly where the surgeon expects it to be, said Jim Bowman, president and chief executive officer of Encision, based in Boulder, Colo.

"If there is a hole in the insulation, the monitor will sense it and shut the whole system down -- a surgical circuit breaker, so to speak," said Johns, who has no tie to the company.

About nine in 10 laparoscopic surgeries use so-called monopolar electrosurgical devices that can cause unintended burns and would benefit from the AEM shield, he said. Encision currently is the only company that manufactures shielded, monitored instruments.

There are steps patients can take to help ensure they are not victims of stray burns from a laparoscopic procedure. Johns said to ask the procedure be videotaped.


"If everyone would let themselves be videotaped, that would fix all these problems. That means he or she is willing to let some else see what they are doing," Johns said.

Next, find out if the doctor uses monopolar electrosurgery and whether there is a monitoring system for the electrical current.

"While I hate to promote one company, I would not have the procedure done unless AEM technology was being used," Ball said, and added patients also should ask if their physicians has taken any special courses in electrosurgery.

"A course means nothing. It's a good idea, but I've seen people who still don't get it (after the course)," Johns countered." If you go in as a crappy surgeon, you'll come out as a crappy surgeon."


Charlene Laino covers medicine and health for UPI Science News. E-mail

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