Michael S. Baggish, MD Dr. Baggish is Chairman of the Department of Obstetrics and Gynecology at Good Samaritan Hospital and Director of Obstetrics and Gynecology Residency Training for TriHealth Hospitals in Cincinnati. He is also Professor of Obstetrics and Gynecology at the University of Cincinnati College of Medicine and a Course Director of the 2008 Pelvic Anatomy and Gynecologic Symposium (PAGS), to be held December 11–13 at the Wynn Las Vegas. For more information go to: www.PAGS-cme.org
Upon direct contact with the intestine, energy devices cut into the tissue in a manner similar to mechanical scissors or a knife but produce a larger wound. The reason? The transfer of heat to areas adjacent to the primary wound produces additional necrosis. Heat conduction, capacitive coupling, high-frequency leaks, and front scatter coagulate the intestinal wall with subsequent tissue devitalization and necrosis, the extent of which depends on the power density at contact and the duration of energy applied.
It is impossible to predict the depth or area of devitalization in energy-inflicted injury by visualization of the event.
In the Baggish review of 130 intestinal injuries, the number of injuries sustained during the operative procedure was 19 involving the small intestine and 29 involving the large bowel.12 Of this subset, 44% (21 cases) were secondary to the use of energy devices, with monopolar electrosurgical instruments alone accounting for 9 (43%) of the injuries.
Even best-laid plans can go awry
Despite our best intentions and precautions, accidents do sometimes happen, and bowel injury is no exception.In Part 2 of this article, I detail steps you can take to detect injuries in as timely a manner as possible.
