Insulation Failure Common with Laparoscopic and Robotic Instruments

Electrical insulation failures, which can cause electrosurgical injuries to the bowel and perforations, are common with laparoscopic and robotic surgery instruments, according to a new study.

Researchers at Hospital Quirón (Madrid, Spain) evaluated the insulation durability of 298 laparoscopic and 78 robotic instruments. They assumed that robotic instruments would have a lower potential for insulation failure because they are 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 of insulation failure on the first-pass evaluation were retested after each surgery for a total of 10 procedures. Failures were detected in 80% of robotic instruments but in only 36% of laparoscopic instruments. The results 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 half of the shaft of laparoscopic instruments, appearing as small defects in the plastic sheath. In the robotic surgery tools, however, they were more common in the distal half of the shaft, that is, 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 study 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 is immediately repaired by recoating the plastic sheath. The process of recoating could repair both proximal and distal defects but manipulation of the shaft during surgery or washing process could break the original plastic sheath at the proximal part of the (laparoscopic) instrument, as it is the weakest portion," concluded lead author Mercedes Espada, MD, of the department of obstetrics and gynecology. "Routine testing of robotic and laparoscopic electrosurgical instruments following each use will dictate the clinical significance of insulation failures."

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