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Insulation care is important with Laparoscopic and Robotic Instruments
Sat - June 18, 2011 11:39 am  |  Article Hits:5545  |  A+ | a-
Electrical insulation failures, which can cause electrosurgical injuries towards the bowel and perforations, are typical with laparoscopic and robotic surgery instruments, according to a new study. Researchers at Hospital Quirón (Madrid, Spain) evaluated the insulation reliability of 298 laparoscopic and 78 robotic instruments. They assumed that robotic instruments might have a lower potential for insulation failure since they're discarded after 10 uses, while laparoscopic instruments are reusable. In fact, the prevalence of failure was significantly higher with the robotic tools (32%) than the laparoscopy tools (13%). The failures were more often visually detectable in the laparoscopic instruments, however (69% versus 28%).

Instruments that were free from insulation failure on the first-pass evaluation were retested after each surgery for any total of 10 procedures. Failures were detected in 80% of robotic instruments however in only 36% of laparoscopic instruments. The outcomes were similar when instruments were tested at 20 W and 26.4 kV, 20 W and 1 kV, and 20 W and 4.2 kV. Insulation failures were more common in the proximal 1 / 2 of the shaft of laparoscopic instruments, appearing as small defects in the plastic sheath. Within the robotic surgery tools, however, they were more common within the distal 1 / 2 of the shaft, that's, closer to the surgical field.

Robotic instruments with a metallic tip had a higher rate of insulation failure, as did bipolar versus monopolar instruments. The research was published early online on April 8, 2011, in the American Journal of Obstetrics and Gynecology. “In our practice, when an insulation failure is detected, it's immediately repaired by recoating the plastic sheath. The entire process of recoating could repair both proximal and distal defects but manipulation from the shaft during surgical procedures or washing process could break the original plastic sheath in the proximal part of the laparoscopic instrument, because it is the weakest portion.
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