State of Shock – Part 1

The consequences of a damaged surgical instrument can extend far beyond inconvenience, potentially putting patients at serious risk. However, when it comes to electrosurgical devices, the stakes are even higher. A faulty instrument can lead to a shocking—and dangerous—experience for both the surgeon and the patient.

Electrosurgical instruments, such as forceps, scissors, and leads, are vital for facilitating Monopolar and Bipolar surgeries. But what exactly is the difference between these two techniques, and how does it relate to the maintenance and repair of the instruments involved?

Understanding Bipolar Electrosurgery

In Bipolar electrosurgery, the electrical current flows exclusively through the instrument itself, completing the circuit at the tips of the device. Bipolar instruments, such as forceps and scissors, are generally used in delicate procedures and are considered safer due to their localised energy flow.

Key Bipolar instruments include:

• Straight Forceps: Used in general surgery, available in sizes from 100mm to 250mm, with tips ranging from 0.3mm to 1.5mm. Options include plain or non-stick silver-coated tips.
• Bayonet Forceps: Common in neuro and ENT surgery, similar in size and tip options to straight forceps.
• Bipolar Scissors with Ceramic Inserts: Favoured for fine dissection in procedures like vasectomy, breast surgery, and tonsillectomy, offering precise cut-and-seal functionality.
• Laparoscopic Bipolar Instruments: Forceps, scissors, and accessories designed for minimally invasive surgery.

Understanding Monopolar Electrosurgery

Monopolar electrosurgery (or diathermy) is the more common and higher-risk option. The electrical current flows from the instrument, through the patient’s body, and returns to the generator via a patient plate adhered to the skin.

Monopolar instruments include:

• Straight Forceps: Widely used in general surgery, with similar dimensions to their Bipolar counterparts.
• Laparoscopic Monopolar Instruments: Forceps, scissors, and graspers designed for keyhole procedures.

Because Monopolar instruments rely on the patient as part of the circuit, any damage to the instrument’s insulation or the patient plate can have serious consequences, underscoring the importance of rigorous maintenance and inspection.