Why we are rushing towards minimally invasive surgery?
Less disruptive to tissues
Patients generally recover faster with less pain
Fewer wound problems
Less scarring

In operative laparoscopies we often use electricity either to cut, desiccate or coagulate;but major catastrophes may arise if non targeted tissue is injured.

Three factors lead to stray energy burns
Direct coupling
Capacitive coupling
Insulation failure

The low voltage “cut” mode exhibits less capacitive coupling than coag does.
Surgeons must recognize that open circuit activation (electrode not touching tissue) dramatically increases voltage and the possibility of capacitive coupling.
It is desirable to use as low wattage as possible and to limit noncontact activation of the generator.

How to avoid
When possible, place the long edge of the electrode closest to the surgical site and on the same side of the body as the incision if it is a sided procedure.
Choose a well vascularized muscle mass.
Avoid areas of vascular insufficiency, irregular body contours, bony prominences.
Remove excessive hair.
Check equipment before each use
Patient skin is not in contact with metal or, if so, these areas are Insulated.
Solutions are not stored on top of power unit.
Power cord, dispersive pad cord, and cautery pencil cord are carefully placed to avoid possibility of being tripped.
It is recommended that Cords not be wrapped around metal instruments Cords not be bundled together
Use bipolar electrosurgery when appropriate
Select an all metal cannula system as the safest choice. Do not use hybrid cannula systems that mix metal with plastic.
Activate the electrode when touching tissue.
Clean the active tip routinely during surgery to prevent eschar buildup, which can cause tissue to stick and set up resistance to current flow.
Visually inspect instruments throughout each procedure.

Perioperative Management of Patients with Cardiac Rhythm Management Devices
Assure that the electrosurgical receiving plate is positioned so that the current pathway does not pass through or near the cardiac rhythm management devices  (CRMD system)
avoid proximity of the cautery's electrical field to the pulse generator or leads.
use short, intermittent, and irregular bursts at the lowest feasible energy levels.
reconsider the use of a bipolar electrocautery system or ultrasonic (harmonic) scalpel in place of a monopolar electrocautery system, if possible.

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