Overview
Definition:
Energy devices in surgery utilize various forms of energy (electrical, ultrasonic, plasma) to achieve hemostasis, dissection, or tissue fusion
Troubleshooting refers to the systematic identification and resolution of malfunctions or suboptimal performance of these devices during surgical procedures.
Clinical Significance:
Proper functioning of energy devices is paramount for patient safety, preventing unintended burns, bleeding, or delayed recovery
Malfunctions can lead to prolonged operative times, conversion to open procedures, increased morbidity, and potential litigation
Thorough understanding of troubleshooting is a core competency for all surgeons.
Types Of Energy Devices:
Commonly used energy devices include monopolar and bipolar electrocautery, ultrasonic scalpels (e.g., Harmonic), advanced bipolar systems (e.g., LigaSure), argon plasma coagulators, and laser devices
Each operates on different principles and has unique troubleshooting considerations.
Common Malfunctions And Causes
Failure To Activate Or Deliver Energy:
Causes: Power supply issues, faulty handpiece or tip, damaged cord, incorrect settings, active electrode issues, grounding pad detachment (monopolar).
Intermittent Energy Delivery:
Causes: Loose connections, damaged cables, worn-out handpiece components, internal device faults, inadequate tissue contact.
Inadequate Hemostasis Or Cutting:
Causes: Wrong energy mode or power setting, dull or damaged tip, insufficient tissue contact, incorrect technique, excessive bleeding overwhelming device capacity, tissue charring.
Unintended Tissue Damage Or Burns:
Causes: Accidental activation, faulty insulation on cords or instruments, proximity to critical structures, incorrect use of monopolar device with poor grounding, arcing.
Smoke Production Issues:
Causes: Inadequate smoke evacuation, high power settings, thick tissue, charring.
Troubleshooting Approach
Systematic Evaluation:
Begin with the simplest potential causes and progress to more complex ones
Maintain a calm and methodical approach.
Visual Inspection:
Check all visible components: cords for damage, connections for security, handpiece for cracks or debris, instrument tip for integrity and cleanliness, grounding pad placement and adhesion.
Auditory And Tactile Feedback:
Listen for usual device sounds during activation
note any unusual noises
Feel for appropriate vibration or tactile feedback if applicable.
Setting And Mode Verification:
Confirm that the correct energy mode and power setting are selected for the intended surgical task and tissue type.
Component Swapping:
If feasible and safe, swap suspect components (e.g., handpiece, cord) with known functional ones to isolate the fault.
Communication With Support Staff:
Liaise with OR nurses, biomedical engineers, or device representatives for assistance and to obtain replacement parts or devices.
Specific Device Troubleshooting
Monopolar Electrocautery:
Ensure grounding pad is firmly adhered to a large, well-vascularized area without bony prominences
Check pad integrity
Verify handpiece activation
Check for faulty insulation on active electrode or cords
Ensure correct return electrode contact.
Bipolar Electrocautery:
Confirm both prongs of the instrument are in contact with tissue
Check for charring or debris on tips
Ensure correct power and mode are set
Verify cable integrity and connection
Inspect instrument tips for damage.
Ultrasonic Scalpels:
Ensure tip is clean and free of char
Check for correct tension on tissue
Verify appropriate power setting
Listen for characteristic hum
Inspect tip for damage or wear
Ensure proper connection to the generator.
Argon Plasma Coagulation:
Check argon gas flow
Ensure no obstruction in the handpiece or tubing
Verify correct power settings and probe distance to tissue
Ensure proper grounding if applicable.
Prevention Strategies
Preoperative Checks:
Perform functional checks of all energy devices before the start of surgery
Verify that all components are present and undamaged
Ensure appropriate settings are pre-programmed or known.
Proper Handling And Storage:
Train staff on correct use, cleaning, and storage of energy devices to minimize wear and tear
Avoid kinking or straining cords.
Clear Communication:
Establish clear communication protocols between surgeon and OR staff regarding device use, activation, and any perceived issues.
Regular Maintenance And Training:
Ensure regular servicing of energy devices by qualified personnel
Provide ongoing training for surgical teams on new devices and best practices for troubleshooting.
Key Points
Exam Focus:
Understanding the fundamental principles of energy devices is critical
Be prepared to discuss common malfunctions and their systematic troubleshooting steps, emphasizing patient safety
Know the difference between monopolar and bipolar troubleshooting.
Clinical Pearls:
When in doubt, stop using the device and troubleshoot
A loose connection is often the culprit
Always have a backup plan or instrument
Never assume a device is working correctly
verify its function.
Common Mistakes:
Rushing the troubleshooting process
Focusing on advanced issues before basic checks
Not communicating effectively with the team
Incorrectly diagnosing the problem, leading to wasted time or further harm.