Emmat's 'Traffic Light System' and how this can help to reduce the risk of surgical fires and patient risk during laparoscopic surgery
Over the years a great deal of research has been conducted into patient risk involved with endoscopic surgery, especially regarding the risk of surgical fires and perioperative burns. We have composed this article to highlight some of the interesting risks associated with laparoscopes and light-cables, and how this can be minimised by using the correct combinations.
Although there are a variety of possible reasons that may cause thermal damage, research has highlighted that a great deal of patient burns are caused by heat from equipment for example surgeons using the wrong device, settings or even device malfunction.
Possible Surgical Risks:
One of the key aspects of laparoscopy includes a reliable and sustainable source of light in order to allow visualisation of surgical procedures. Unfortunately however, there is a risk of thermal damage as a result of the fibreoptic light cables
There are many possible complications associated with light sources and light cables, therefore it is very important to be aware of the risk of optical surgeries. Using the incorrect size of endoscope can cause instruments to overheat. Similarly, equipment malfunction can mean that the temperature of the end of the light cord can cause superficial tissue necrosis and extensive damage to both the patient and the equipment. In order to minimise surgical risks, manufacturers recommend that a specific traffic light system is used to encourage correct endoscope and light-cable combinations.
Using the ‘Traffic Light System’:
Combination A: Using a ‘thick’ light cable (4.9mm) with a ‘thin’ endoscope (3.5mm light entry)
This combination should not be selected under any circumstances as the endoscope connecting pieces may overheat. This may cause instrument damage and therefore increase risk to patients.
Combination B: Using a ‘thin’ light cable (3.5mm) with a ‘thick’ endoscope (4.9mm light entry)
This combination is not advisable. Generally, the light yield for thinner cables will not be sufficient for surgeries using thicker endoscopes. This will therefore compromise the visualisation of surgical procedures.
Combination C: using a ‘thin’ light-cable (3.5mm) with a ‘thin’ endoscope (3.5mm light entry)
This combination is ideal. By combining ‘thin’ cables with ‘thin’ endoscopes we maximise the light yield for surgical visualisation, as well as minimising any possible surgical risks. Similarly, only use a ‘thick’ cable with larger diameter 10mm endoscopes
Emmat’s Guide to Proper Instrument Care:
The following framework is suggested to minimise damage to laparoscopic instruments, as well as minimising possible patient risk:
- Always ensure light cables are handled carefully and avoid twisting cables.
- Ensure that the correctly sized endoscope is used with the light cable to reduce damage or overheating.
- It is very important that endoscopes with a thin light entry are used with light-cables with a fibre diameter of 3.5mm.
- Similarly, endoscopes with a thick light entry eg 10mm must be used with light-cables of a fibre diameter of 4.9mm.
- When connected to a light source the fibre-optic cable should never be placed next to the patient or near surgical drapes in order to minimise risk of surgical fires.
- Following every surgical procedure, the light cable should be removed from the endoscope and attached to the light source until it has cooled down sufficiently.
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