Explore the vast range of titles available.

Background Despite the widespread use of surgical energy devices and the potential for rare but serious complications, pilot data from North America suggest that surgeons and surgical trainees have knowledge gaps in their safe use. The purpose of this study was to determine baseline knowledge of general surgeons and surgical trainees regarding the safe use of electrosurgery (ES) across varying levels of experience in Japan. Methods Participants completed a 35-item multiple-choice question examination, testing critical knowledge of ES. The examination was developed according to the objectives and blueprints of SAGES’ Fundamental Use of Surgical Energy™ curriculum. Sections of the examination included: “principles of ES,” “ES-related adverse events,” “monopolar and bipolar devices,” and “pediatric considerations and interference with implantable devices.” Scores were compared between PGY > 5 and PGY 1–5 participants. Results A total of 145 general surgeons and surgical trainees of all years after medical school (PGY 1–5: 57, PGY > 5: 88) from ten academic and five community hospitals completed the assessment (mean age 35; 91 % male). The mean score in the entire cohort was 58 ± 12 % (range 23–83 %), with significantly higher scores in the PGY > 5 group compared to the PGY 1–5 group (60 ± 11 vs. 53 ± 12 %, p  < 0.01). Among all participants, 92 % were not familiar with best practices when using ES on patients with a pacemaker; 44 % believe that ES uses thermal energy from cautery; 19 % did not know how to manage an operating room fire; 16 % thought that a dispersive electrode should be cut to fit a child; and 27 % believe that insulation failure in minimally invasive surgical instruments is mostly visible under careful inspection. Conclusions General surgeons and trainees at all levels have knowledge gaps in the safe and effective use of energy devices, regardless of years of experience. There is a need for educational curricula to help address these gaps and contribute to safer surgery.

Purpose The aim of this study is to analyze a quality assurance program regarding the switch from loop electrosurgical excision procedure (LEEP) in general anesthesia (GA) to local anesthesia (LA) regarding patients’ perioperative pain levels, patients´ satisfaction, as well as resection margins. Methods We performed a single-center retrospective analysis of our quality assurance program including all patients undergoing LEEP at the Department of Obstetrics and Gynecology, Ordensklinikum Linz and Konventhospital Barmherzige Brueder Linz, from January 2021 to June 2024. 435 patients were questioned postoperatively after being treated with LEEP in LA regarding the perioperative pain as measured by a numeric rating scale (NRS) and patients’ satisfaction. Clinical data were collected from the patients’ electronic chart to investigate further parameters. Results Mean perioperative pain levels were stated as 1.3 (1.9). Five perioperative complications were reported. In seven out of 435 cases (1.6%) an inpatient readmission or a revision surgery under GA had to be performed. A R0 resection rate of 81.4% could be achieved. In 9.7% and 8.3% a R1 resection rate was reported on the ectocervix and on the endocervix, respectively. 95.3% of patients would choose LEEP in LA as their preferred method of anesthesia for a possible subsequent surgical LEEP procedure. Conclusions Our study showed that the implementation of LEEP in LA was successful at our department as a new standard of care, resulting in a high R0 resection status and a high level of patients’ satisfaction. We encourage physicians and organizations to switch from GA to LA when performing LEEP for cervical dysplasia.

More than 500,000 health care workers are exposed to surgical smoke every year. Toxic gases create an offensive odor, small particulate matter causes respiratory complications, and pathogens may be transmitted in the surgical smoke to the surgical team. Previous research notes that perioperative nurses do not consistently follow smoke evacuation recommendations. The purpose of this study was to determine key indicators that are associated with compliance with smoke evacuation recommendations. Data from a web-based survey completed by 777 nurse members of AORN were analyzed to examine the relationship between the key indicators and compliance with smoke evacuation recommendations. Major findings were that specific key indicators influencing compliance include increased knowledge and training, positive perceptions about the complexity of the recommendations, and increased specialization, interconnectedness, and leadership support in larger facilities. Education programs can be developed that directly address these key predictors so that a surgical environment free from surgical smoke is promoted.

Surgical smoke presents a serious health hazard, but perioperative nurses' compliance with smoke evacuation recommendations is not consistent. I investigated key indicators for compliance with electrosurgical smoke evacuation recommendations based on nurses' individual innovativeness characteristics, perceptions of the attributes of smoke evacuation recommendations, and organizational innovativeness characteristics. The study findings provide implications for improving nurses' compliance with smoke evacuation recommendations. Individual innovativeness characteristics, including nurses' knowledge and training, were most strongly linked to smoke evacuation compliance. The key indicators that promote surgical smoke evacuation can provide direction to guide the content of education programs and help identify the personnel and settings that are most in need of this information. Barriers to compliance included lack of equipment, physician resistance, noise, and staff member complacency. Vendor demonstrations on the ease of smoke evacuation device use can show nurses that smoke evacuation is compatible with nursing practice. Facility leaders should provide smoke evacuation policies that are easy to understand and should enforce these policies.

Technology is constantly changing, and it is important for perioperative nurses to stay current on new products and technologies in the perioperative setting. AORN's “Recommended practices for electrosurgery” addresses safety standards that all perioperative personnel should follow to minimize risks to both patients and staff members during the use of electrosurgical devices. Recommendations include how to select electrosurgical units and accessories for purchase, how to minimize the potential for patient and staff member injuries, what precautions to take during minimally invasive surgery, and how to avoid surgical smoke hazards. The recommendations also address education/competency, documentation, policies and procedures, and quality assurance/performance improvement. Perioperative nurses should consider the use of checklists and safety posters to remind staff members of the dangers of electrosurgery and the steps to take to minimize the risks for injury.

Electrosurgical smoke contains the same airborne contaminants as laser smoke. The plume contains toxic gases and vapors such as benzene, hydrogen cyanide, formaldehyde, and dead and living cellular material including blood and viruses. The contaminants have an unpleasant odor; may cause visibility problems at the surgical site, particularly during laparoscopic procedures; and may also cause upper respiratory tract and eye irritation. The contaminants have mutagenic and carcinogenic potential.

The recommended practices for electrosurgery, developed by the Association of Operating Room Nurses (AORN) Recommended Practices Committee and approved by the AORN Board of Directors, are presented. These recommended practices are intended as achievable recommendations representing what is believed to be an optimal level of practice.

Proper care and handling of electrosurgical equipment is essential to patient and personnel safety. Several recommended practices for perioperative nurses in performing electrosurgery are detailed.

Ulmer reports on OSHA's draft of the long-awaited guidelines, \"Information for Health Care workers Exposed to Laser and Electrosurgical Smoke.\" Safety issues are discussed.