A Laparoscopic Complication? A Medical Legal Case Analysis. Part I

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 case was concluded to be an electrosurgical burn delivered to both the ileum and the colon. A description of electrosurgical burns is given and correlated to the medical-legal case. Also discussed are methods to minimize the likelihood of electrosurgical complications. Technology solutions, including actively monitored shielding of monopolar electrodes and bipolar electrodes, also are discussed. The histologic variation of electrosurgical damage is discussed, varying from uniform coagulation 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 seen. The potential causes for electrosurgery damage are insulation failure, direct coupling through instrumentation and tissue, and capacitive coupling. (J GYNECOL SURG 11...