What is a hazard of laparoscopic monopolar current diversion?

What is a hazard of laparoscopic monopolar current diversion?

• A. Current follows path of least resistance and can pass through unintended tissue.
• B. Current is always confined to the electrode site.
• C. Capacitive coupling is the main hazard.
• D. There are no hazards with monopolar devices.

Answer: (A)

When using monopolar electrosurgery, the current travels from the active instrument tip through the patient to a return pad, and it will take the path of least resistance. Because tissues have different impedances, the energy can leave the intended route and pass through nearby or distant structures, causing unintended thermal injury such as to the bowel, vessels, ureter, or nerves. In laparoscopy this risk is amplified by proximity of organs, moisture, and any insulation defects that create easier pathways for current. To reduce this risk, use the lowest effective energy for the shortest activation, ensure proper grounding pad contact and placement, inspect insulation, and consider bipolar devices when possible since their current is confined to the tissue between the two ends.

When using monopolar electrosurgery, the current travels from the active instrument tip through the patient to a return pad, and it will take the path of least resistance. Because tissues have different impedances, the energy can leave the intended route and pass through nearby or distant structures, causing unintended thermal injury such as to the bowel, vessels, ureter, or nerves. In laparoscopy this risk is amplified by proximity of organs, moisture, and any insulation defects that create easier pathways for current. To reduce this risk, use the lowest effective energy for the shortest activation, ensure proper grounding pad contact and placement, inspect insulation, and consider bipolar devices when possible since their current is confined to the tissue between the two ends.