Surgeons must be knowledgeable about the effects of waveform, wattage and electrode size. A dangerous situafion exisls in laparoscopic cholecysectomy. The wrong waveform or excessively high power settings are being used because stainless steel does mot melt at temperatures which should prevail during electrosurgical procedures. When surgeons demanded that hook and spatula electrodes be insulated to the tip, the burn-up of such electrodes, including blistering of the coating, significantly increased. Because blistering is caused by excessive current density, excessive high power, and thus overheating occures.
Laparoscopic cholecystectomy involves a significant amount of bleeding within the surgical field.
To avoid this problem, irrigation and suction are mandatory. Non-conductive irrigants must be used in all instances where electrosurgery will be performed. The practice of using saline based irrigants increases the risk of injury and eliminates the predictability of the electrosurgical current. With the growing popularity of endoscopic surgery using electrosurgery, the risk and occurrence of injuries will continue to increase unless surgeons use electrosurgery properly. With the introduction of the wattage meter, a false security was created.