Fundamentals of Energy Utilization in the Operating Room

  • Amin Madani
  • Carmen L. MuellerEmail author


Energy devices are used throughout surgery and for nearly every operation. Major benefits of using energy devices include aid in dissection, achievement of hemostasis, and ablation of unwanted tissue. Numerous types of energy devices are available, including monopolar and bipolar electrosurgical devices, ultrasonic energy, and argon beam plasma coagulators. While energy devices are enormously useful for the safe completion of modern surgical procedures, risks of the use of energy devices are significant and include inadvertent tissue injury, interference with implanted devices, and operating room fires, among others. Surgeons must be familiar with the types of devices available, their appropriate setup and use, limitations of each device and type of energy used, and potential sources of patient or personal injury. This chapter summarizes these concepts.


Electrosurgery Energy Monopolar Bipolar Ultrasonic Argon Coupling Fire Pacemaker 

Suggested Readings

  1. Feldman LS, Fuchshuber P, Jones DB. The SAGES manual on the fundamental use of surgical energy (FUSE). New York: Springer; 2012.CrossRefGoogle Scholar


  1. 1.
    Lee J. Update on electrosurgery. Outpatient Surg. 2002;2:44–53.Google Scholar
  2. 2.
    Nduka CC, Super PA, Monson JR, Darzi AW. Cause and prevention of electrosurgical injuries in laparoscopy. J Am Coll Surg. 1994;179:161–70.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Tucker RD. Laparoscopic electrosurgical injuries: survey results and their implications. Surg Laparosc Endosc. 1995;5:311–7.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Perantinides PG, Tsarouhas AP, Katzman VS. The medicolegal risks of thermal injury during laparoscopic monopolar electrosurgery. J Healthc Risk Manag. 1998;18:47–55.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Chandler JG, Voyles CR, Floore TL, Bartholomew LA. Litigious consequences of open and laparoscopic biliary surgical mishaps. J Gastrointest Surg. 1997;1:138–45. discussion 145CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Feldman L, Fuchshuber P, Jones DB, editors. The SAGES manual on the fundamental use of surgical energy (FUSE). New York: Springer; 2012.Google Scholar
  7. 7.
    Sankaranarayanan G, Resapu RR, Jones DB, Schwaitzberg S, De S. Common uses and cited complications of energy in surgery. Surg Endosc. 2013;27:3056–72.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Agarwal BB, Gupta M, Agarwal S, Mahajan K. Anatomical footprint for safe laparoscopic cholecystectomy without using any energy source: a modified technique. Surg Endosc. 2007;21:2154–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Polychronidis A, Tsaroucha AK, Karayiannakis AJ, Perente S, Efstathiou E, Simopoulos C. Delayed perforation of the large bowel due to thermal injury during laparoscopic cholecystectomy. J Int Med Res. 2005;33:360–3.CrossRefPubMedGoogle Scholar
  10. 10.
    Montero PN, Robinson TN, Weaver JS, Stiegmann GV. Insulation failure in laparoscopic instruments. Surg Endosc. 2010;24:462–5.CrossRefPubMedGoogle Scholar
  11. 11.
    Tixier F, Garcon M, Rochefort F, Corvaisier S. Insulation failure in electrosurgery instrumentation: a prospective evaluation. Surg Endosc. 2016;30:4995–5001.CrossRefPubMedGoogle Scholar
  12. 12.
    Vancaillie TG. Active electrode monitoring. How to prevent unintentional thermal injury associated with monopolar electrosurgery at laparoscopy. Surg Endosc. 1998;12:1009–12.CrossRefPubMedGoogle Scholar
  13. 13.
    Jones EL, Robinson TN, McHenry JR, Dunn CL, Montero PN, Govekar HR, Stiegmann GV. Radiofrequency energy antenna coupling to common laparoscopic instruments: practical implications. Surg Endosc. 2012;26:3053–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Robinson TN, Barnes KS, Govekar HR, Stiegmann GV, Dunn CL, McGreevy FT. Antenna coupling--a novel mechanism of radiofrequency electrosurgery complication: practical implications. Ann Surg. 2012;256:213–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Townsend NT, Jones EL, Paniccia A, Vandervelde J, McHenry JR, Robinson TN. Antenna coupling explains unintended thermal injury caused by common operating room monitoring devices. Surg Laparosc Endosc Percutan Tech. 2015;25:111–3.CrossRefPubMedGoogle Scholar
  16. 16.
    Postgate A, Saunders B, Tjandra J, Vargo J. Argon plasma coagulation in chronic radiation proctitis. Endoscopy. 2007;39:361–5.CrossRefPubMedGoogle Scholar
  17. 17.
    ECRI Institute. Health devices: top 10 health technology hazards for 2011. 2010.Google Scholar
  18. 18.
    Avgerinos A, Kalantzis N, Rekoumis G, Pallikaris G, Arapakis G, Kanaghinis T. Bowel preparation and the risk of explosion during colonoscopic polypectomy. Gut. 1984;25:361–4.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Keighley MR, Taylor EW, Hares MM, Arabi Y, Youngs D, Bentley S, Burdon DW. Influence of oral mannitol bowel preparation on colonic microflora and the risk of explosion during endoscopic diathermy. Br J Surg. 1981;68:554–6.CrossRefPubMedGoogle Scholar
  20. 20.
    Brunt LM. Fundamentals of electrosurgery part II: thermal injury mechanisms and prevention. In: Feldman LS, Fuchshuber P, Jones DB, editors. The SAGES manual on the fundamental use of surgical energy (FUSE). New York: Springer; 2012. p. 61–79.CrossRefGoogle Scholar
  21. 21.
    Jones S, Rozner M. Integration of energy systems with other medical devices. In: Feldman LS, Fuchshuber P, Jones DB, editors. The SAGES manual on the fundamental use of surgical energy (FUSE). New York: Springer; 2012. p. 181–94.CrossRefGoogle Scholar
  22. 22.
    Robinson TN, Varosy PD, Guillaume G, Dunning JE, Townsend NT, Jones EL, Paniccia A, Stiegmann GV, Weyer C, Rozner MA. Effect of radiofrequency energy emitted from monopolar “Bovie” instruments on cardiac implantable electronic devices. J Am Coll Surg. 2014;219:399–406.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of SurgeryMcGill UniversityMontrealCanada

Personalised recommendations