and Janesh Gupta2
(1)
Fetal Medicine, Rainbow Hospitals, Hyderabad, Telangana, India
(2)
University of Birmingham Birmingham Women’s Hospital, Birmingham, UK
SP1
Answer: B
Explanation
There are four causes of inadvertent laparoscopic electrosurgical injuries, namely, inadvertent tissue contact, insulation failure, direct coupling and capacitive coupling. The above apply to all visceral injuries that may occur during laparoscopic surgery.
Such injuries may be difficult to identify, as they can occur at a site distant to the surgeon’s view and/or present as delayed tissue breakdown several days following the primary insult. Safety measures to prevent laparoscopic electrosurgical complications include:
Inspect insulation carefully before use
Use the lowest possible effective power setting.
Use available technology; newer tissue response generators and active electrode monitoring technology eliminate concerns about insulation failure and capacitive coupling.
Use a low-voltage waveform for monopolar diathermy (cut).
Use bipolar electrosurgery when appropriate.
Use brief intermittent activation.
Do not activate in close proximity or direct contact with another instrument.
Ensure that both the heel and the tips of the bipolar forceps are kept under direct view when activating.
References
1.
Shirk GJ, et al. Complications of laparoscopic surgery: how to avoid them and how to repair them. J Minim Invasive Gynecol. 2006;13:352–9.
2.
Alkatout I, et al. Principles and safety measures of electrosurgery in laparoscopy. JSLS. 2012;16:130–9.
SP2
Answer: C
Explanation
The two types of current used in hysteroscopic surgery are monopolar and bipolar. The energy is transmitted through the hysteroscope at the tip of a loop, rollerball or disc. Monopolar energy needs the patient to be part of the electrical circuit; hence, a return electrode is attached to the patient. In bipolar devices, the circuit is formed within the instrument itself, avoiding the risk of burn injury to patient. Bipolar energy is used with electrolytic solutions and produces a vapour at the end of the operating instrument leading to the tissue vaporization or desiccation needed to dissect the tissue. Monopolar current need non-electrolytic solutions as they do not conduct electricity.
References
Stocker L, et al. An overview of hysteroscopy and hysteroscopic surgery. Obstet Gynaecol Rep Med. 23:5;146–53.
SP3
Answer: B
Explanation
Pre-op counselling for procedures needs a clear explanation of risks. There is no need to discuss every conceivable risk posed by the surgery, but the main risks must be covered: both those that occur frequently and those less frequent but more severe. Vague terms such as ‘low’ and ‘high’ risk should be avoided, as should complicated statistical terms. Use of phrases such as ‘a risk of 1 in 100 women’ is more appropriate.
The serious risks that need to be mentioned for a diagnostic hysteroscopy are uterine perforation, pelvic infection and failure to visualise uterine cavity, pelvic or shoulder pain. Frequent risks are vaginal bleeding and discharge. Extra procedures that may become necessary are laparotomy to repair a uterine perforation and blood transfusion.
References
Lebus CS, Shafi MI. Pre and post op care in gynaecology. Curr Obstet Gynaecol. 2006;16:84–92.
SP4
Answer: D
