Table Of ContentLiane S. Feldman
Pascal R. Fuchshuber
Daniel B. Jones Editors
The SAGES Manual on
the Fundamental Use of
Surgical Energy (FUSE)
123
The SAGES Manual
on the Fundamental Use
of Surgical Energy (FUSE)
The SAGES Manual
on the Fundamental Use
of Surgical Energy (FUSE)
Liane S. Feldman, MD, FACS, FRCS(C)
McGill University Health Centre, Montreal, QC, Canada
Pascal R. Fuchshuber, MD, PhD, FACS
The Permanente Medical Group, Inc., Walnut Creek, CA, USA
Daniel B. Jones, MD, MS, FACS
Harvard Medical School, Beth Israel Deaconess Medical Center,
Boston, MA, USA
Editors
Editors
Liane S. Feldman, MD, FACS, FRCS(C) Pascal R. Fuchshuber, MD, PhD, FACS
McGill University Health Centre The Permanente Medical Group, Inc.
Montreal, QC, Canada Walnut Creek, CA, USA
Daniel B. Jones, MD, MS, FACS
Harvard Medical School
Beth Israel Deaconess Medical Center
Boston, MA, USA
ISBN 978-1-4614-2073-6 e-ISBN 978-1-4614-2074-3
DOI 10.1007/978-1-4614-2074-3
Springer New York Dordrecht Heidelberg London
Library of Congress Control Number: 2011944511
© Springer Science+Business Media, LLC 2012
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Foreword
Some things are not spoken about much in part because we would like to
think they are rare events or we really, truly believe, “it could never
happen to me.” Yet, device misfi res, accidental burns, and operating
rooms fi res do occur—more often than you’d think. And many times
these adverse events are totally preventable.
The vast majority of surgical procedures in every specialty performed
throughout the world involve the use of some device that applies energy
to tissue. As such, there must be a standardized curriculum for surgeons
(and perhaps allied health personnel) that addresses the physics, safe use,
and complications associated with these devices that promotes the best
outcomes for patients.
The SAGES Manual on the Fundamental Use of Surgical Energy is
intended to serve as an easy to read companion to the FUSE online
educational program/curriculum developed by the Society of American
Gastrointestinal and Endoscopic Surgeons (SAGES). The chapters review
the use of energy in the operating room and endoscopic procedure areas.
The general topics covered by the The SAGES Manual on the
Fundamental Use of Surgical Energy include the physics of electrical
energy applications, safe use of electrical, ultrasonic, and other forms of
energy and electrical tools in the OR, recognition of faulty equipment
and application of correct setting, and appropriate indications of energy
tools and technology in the OR.
The SAGES Manual on the Fundamental Use of Surgical Energy is a
comprehensive read of just about everything the practicing surgeon needs
to know about surgical energy and devices. It should help prepare
surgeons for the Self-Assessment Program for FUSE which leads to
certifi cation with a validated multiple choice test. The aim of the FUSE
certifi cate will be to assure basic profi ciency with basic didactic and
specifi c tool based components.
Cambridge, MA, USA Steven D. Schwaitzberg, MD, FACS
Boston, MA, USA Daniel B. Jones, MD, MS, FACS
v
Introduction
How many different surgical energy devices are in your operating room
today? Chances are you would have trouble coming up with a complete
list. With increasing surgical specialization the number of energy devices
has grown exponentially. Specifi cally designed devices exist for almost
every surgical need using many different types of energy sources and
designs. Often different devices compete for the same operative task.
Many of today’s surgical techniques and procedures owe their existence
to these energy devices, and many of the future surgical innovations will
depend on the development of new devices.
However, the introduction of new energy devices into surgical
practice has occurred at a dizzying speed and essentially without any
formal education about their safety and correct use. Surgeons who would
fi rmly hold on to a specifi c type of suture material for their entire career
can be seen readily switching to a new energy device with minimal or no
instructions. Without the fundamental technical and safety knowledge
about energy devices the surgeon puts himself at risk for injury to the
patient and himself. There is a clear need for a curriculum on the safe and
correct use of surgical energy devices.
This fi rst edition of The SAGES Manual on the Fundamental Use of
Surgical Energy tries to accomplish just that. It provides an educational
tool for the practicing surgeon to acquire the necessary knowledge to use
most currently available surgical energy devices. This Manual covers the
fundamentals of electrical, ultrasonic, radiofrequency and microwave
energy, their application in surgical devices and the appropriate use of
these devices in adult and pediatric patients. It provides tips and guidance
on how to manage the main safety issues related to energy devices in the
OR such as fi res, burn injuries, device failures, and interference with
other medical devices.
The authors and editors have tried to avoid discussion of individual
proprietary devices. As much as possible, we have tried to be generic and
discuss fundamental principles. For fi gures and images, efforts were
made to remove manufacturer’s names and markings. When a specifi c
device was included, attempts were made to include other devices of that
type. Discussion of a device does not imply its endorsement by the
authors, editors or SAGES.
vii
viii Introduction
The editors believe that T he SAGES Manual on the Fundamental Use
of Surgical Energy will become an indispensable tool for any surgeon or
allied health professional wishing to enhance patient safety and effi ciency
in the use of surgical energy devices. The fi rst 13 chapters of the manual
provide fundamental knowledge to the safe use of these devices. The
subsequent “enrichment” chapters allow the user to obtain a deeper
understanding of the principles through hands-on simulations. Finally, a
nomenclature for common terms related to electrosurgery and energy
devices is included at the end. While readers may at fi rst fi nd it hard not
to call for their “cautery”, they will surely appreciate that the use of
correct and consistent terminology is an important fi rst step towards
understanding the fundamental use of surgical energy. The FUSE manual
is thus designed to be an integral part of the FUSE certifi cation program
developed by SAGES.
The editors would like to thank our expert faculty for their
contributions, the outstanding SAGES staff (Jessica and Carla), and our
supportive spouses (Hillel, Anne, and Stephanie).
Montreal, QC, Canada Liane S. Feldman, MD, FACS, FRCS(C)
Walnut Creek, CA, USA Pascal R. Fuchshuber, MD, PhD, FACS
Boston, MA, USA Daniel B. Jones, MD, MS, FACS
Contents
Foreword .......................................................................................... v
Introduction ...................................................................................... vii
PART I FUNDAMENTALS OF SURGICAL ENERGY
1 Evolutions and Revolutions in Surgical Energy....................... 3
Steven D. Schwaitzberg
2 Fundamentals of Electrosurgery Part I:
Principles of Radiofrequency Energy for Surgery ................... 15
Malcolm G. Munro
3 Fundamentals of Electrosurgery Part II:
Thermal Injury Mechanisms and Prevention ........................... 61
L. Michael Brunt
4 The Art and Science of Monopolar Electrosurgery ................. 81
C. Randle Voyles
5 Bipolar Electrosurgical Devices ............................................... 93
Chan W. Park and Dana D. Portenier
6 Electrosurgical Energy in Gastrointestinal Endoscopy ............ 107
Brian J. Dunkin and Calvin D. Lyons
7 Ultrasonic Energy Systems ...................................................... 123
James G. Bittner IV, J. Esteban Varela,
and Daniel Herron
8 Cavitron Ultrasonic Surgical Aspirator .................................... 133
James S. Choi
ix
