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Surgeons know that they don’t know about the safe use of surgical energy: an international study reveals that the knowledge gap persists

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A Correction to this article was published on 03 May 2023

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Abstract

Introduction

The rate of electrosurgery complications is 0.1–2.1%. More than 10 years ago, SAGES pioneered a well-structured educational program (FUSE) aimed to teach about the safe use of electrosurgery. This inspired the development of similar training programs around the globe. Still, the knowledge gap persists among surgeons, possibly due to the lack of judgment.

Aim

To investigate factors affecting the level of expertise in electrosurgical safety and their correlation with self-assessment scores among surgeons and surgical residents.

Materials and methods

We conducted an online survey consisting of 15 questions that could be thematically broken down into 5 blocks. We analyzed how the objective scores were correlated with the self-assessment scores, professional experience, past participation in training programs, and work at a teaching hospital.

Results

A total of 145 specialists took part in the survey, including 111 general surgeons and 34 s-year surgical residents from Russia, Belarus, Ukraine, and Kirgizia. Only 9 (8.1%) surgeons scored “excellent,” 32 (28.8%) scored “good,” and 56 (50.4%) scored “fair.” Of all surgical residents participating in the study, only 1 (2.9%) scored “excellent,” 9 (26.5%) scored “good,” and 11 (32.4%) scored “fair.” The test was failed by 14 surgeons (12.6%) and 13 (38.2%) residents. The difference between the trainees and the surgeons was statistically significant. Our multivariate logistic model identified 3 significant factors predisposing to successful performance on the test: past training in the safe use of electrosurgery, professional experience, and work at a teaching hospital. Of all study participants, those with no past training in the safe use of electrosurgery, and non-teaching surgeons were the most realistic about their competencies.

Conclusion

We have identified alarming gaps in the knowledge of electrosurgical safety among surgeons. Faculty staff and experienced surgeons scored higher, but past training was the most influential factor in improving knowledge of electrosurgical safety.

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References

  1. Jones DB, Brunt LM, Feldman LS, Mikami DJ, Robinson TN, Jones SB (2015) Safe energy use in the operating room. Curr Probl Surg 52:447–468. https://doi.org/10.1067/j.cpsurg.2015.08.004

    Article  PubMed  Google Scholar 

  2. Carvalho GL, Paquentin EM, Rao P (2016) Should high-frequency electrosurgery be discouraged during laparoscopic surgery? Surg Endosc 30:401–403. https://doi.org/10.1007/s00464-015-4536-8

    Article  PubMed  Google Scholar 

  3. Townsend NT, Nadlonek NA, Jones EL, McHenry JR, Dunne B, Stiegmann GV, Robinson TN (2016) Unintended stray energy from monopolar instruments: beware the dispersive electrode cord. Surg Endosc 30:1333–1336. https://doi.org/10.1007/s00464-015-4388-2

    Article  PubMed  Google Scholar 

  4. Sankaranarayanan G, Resapu RR, Jones DB, Schwaitzberg S, De S (2013) Common uses and cited complications of energy in surgery. Surg Endosc 27:3056–3072. https://doi.org/10.1007/s00464-013-2823-9

    Article  PubMed  PubMed Central  Google Scholar 

  5. Meeuwsen FC, Guédon ACP, Arkenbout EA, Van Der Elst M, Dankelman J, Van Den Dobbelsteen JJ (2017) The art of electrosurgery: trainees and experts. Surg Innov 24:373–378. https://doi.org/10.1177/1553350617705207

    Article  PubMed  PubMed Central  Google Scholar 

  6. Cassaro S (2015) Delayed manifestations of laparoscopic bowel injury. Am Surg 81:478–482

    Article  PubMed  Google Scholar 

  7. Demir E, O’Dey DM, Pallua N (2006) Accidental burns during surgery. J Burn Care Res 27:895–900. https://doi.org/10.1097/01.BCR.0000245650.67130.5C

    Article  PubMed  Google Scholar 

  8. Madani A, Jones DB, Fuchshuber P, Robinson TN, Feldman LS (2014) Fundamental use of surgical energy™ (FUSE): a curriculum on surgical energy-based devices. Surg Endosc 28:2509–2512. https://doi.org/10.1007/S00464-014-3623-6

    Article  PubMed  Google Scholar 

  9. Altieri MS, Carmichael H, Jones E, Robinson T, Pryor A, Madani A (2020) Educational value of telementoring for a simulation-based fundamental use of surgical energy™ (FUSE) curriculum: a randomized controlled trial in surgical trainees. Surg Endosc 34:3650–3655. https://doi.org/10.1007/S00464-020-07609-1

    Article  PubMed  Google Scholar 

  10. Overbey DM, Townsend NT, Chapman BC, Bennett DT, Foley LS, Rau AS, Yi JA, Jones EL, Stiegmann GV, Robinson TN (2015) Surgical energy-based device injuries and fatalities reported to the food and drug administration. J Am Coll Surg 221:197-205.e1. https://doi.org/10.1016/j.jamcollsurg.2015.03.031

    Article  PubMed  Google Scholar 

  11. Humes DJ, Ahmed I, Lobo DN (2010) The pedicle effect and direct coupling. Arch Surg 145:96–98

    Article  PubMed  Google Scholar 

  12. Nechay TV, Titkova SM, Anurov MV, Mikhalchik EV, Melnikov-makarchyk KY, Ivanova EA, Tyagunov AE, Fingerhut A (2020) Thermal effects of monopolar electrosurgery detected by real-time infrared thermography : an experimental appendectomy study. BMC Surg. https://doi.org/10.1186/s12893-020-00735-6

    Article  PubMed  PubMed Central  Google Scholar 

  13. Feldman LS, Fuchshuber P, Jones DB, Mischna J, Schwaitzberg SD, FUSE (Fundamental Use of Surgical Energy TM) Task Force (2012) Surgeons don’t know what they don’t know about the safe use of energy in surgery. Surg Endosc 26:2735–2739. https://doi.org/10.1007/s00464-012-2263-y

    Article  PubMed  Google Scholar 

  14. Mayooran Z, Pearce S, Tsaltas J, Rombauts L, Brown TIH, Lawrence AS, Fraser K, Healy DL (2004) Ignorance of electrosurgery among obstetricians and gynaecologists. BJOG 111:1413–1418. https://doi.org/10.1111/J.1471-0528.2004.00334.X

    Article  PubMed  Google Scholar 

  15. Watanabe Y, Kurashima Y, Madani A, Feldman LS, Ishida M, Oshita A, Naitoh T, Noma K, Yasumasa K, Nagata H, Nakamura F, Ono K, Suzuki Y, Matsuhashi N, Shichinohe T, Hirano S (2016) Surgeons have knowledge gaps in the safe use of energy devices: a multicenter cross-sectional study. Surg Endosc. https://doi.org/10.1007/s00464-015-4243-5

    Article  PubMed  Google Scholar 

  16. Van Hove PD, Verdaasdonk EGG, Dankelman J, Stassen LPS (2014) Development and evaluation of an interactive simulation module to train the use of an electrosurgical device. J Laparoendosc Adv Surg Tech A 24:628–633. https://doi.org/10.1089/LAP.2013.0579

    Article  PubMed  Google Scholar 

  17. Ulmer B (2016) What is your energy IQ? FUSE: bridging a patient safety gap. AORN J 103:333–337. https://doi.org/10.1016/j.aorn.2016.01.003

    Article  PubMed  Google Scholar 

  18. Robinson TN, Olasky J, Young P, Feldman LS, Fuchshuber PR, Jones SB, Madani A, Brunt M, Mikami D, Jackson GP, Mischna J, Schwaitzberg S, Jones DB (2016) Fundamental use of surgical energy (FUSE) certification: validation and predictors of success. Surg Endosc. https://doi.org/10.1007/s00464-015-4334-3

    Article  PubMed  Google Scholar 

  19. Assiotis A, Christofi T, Raptis DA, Engledow A, Imber C, Huang A (2009) Diathermy training and usage trends among surgical trainees–will we get our fingers burnt? Surgeon 7:132–136. https://doi.org/10.1016/S1479-666X(09)80035-8

    Article  CAS  PubMed  Google Scholar 

  20. The jamovi project (2021).[Computer Software]. Jamovi

  21. ECRI Institute (2015) Top 10 Health Technology Hazards for 2016: A Report from Health Devices. 1–16

  22. Yildirim D (2017) Do Turkish gynecologists have sufficient knowledge on the basic principles of electrosurgery? - PubMed. Hippokratia 21:8–12

    CAS  PubMed  PubMed Central  Google Scholar 

  23. Meeuwsen F, Guédon A, Klein J, Van Der Elst M, Dankelman J, Van J, Dobbelsteen D, Ed Erique MF, Gu A (2018) Electrosurgery: short-circuit between education and practice. Minim Invasive Ther Allied Technol. https://doi.org/10.1080/13645706.2018.1513945

    Article  PubMed  Google Scholar 

  24. Modaffari P, Panuccio E, Zimmiti G, Padilla Mozo L, Cordeiro Vidal G, Rabischong B, Bourdel N, Canis M, Botchorishvili R (2016) Are gynecologists sufficiently trained and educated on electro surgery and basic laparoscopic setting? Surg Endosc 30:3327–3333. https://doi.org/10.1007/S00464-015-4606-Y

    Article  PubMed  Google Scholar 

  25. Madani A, Watanabe Y, Vassiliou MC, Fuchshuber P, Jones DB, Schwaitzberg SD, Fried GM, Feldman LS (2016) Long-term knowledge retention following simulation-based training for electrosurgical safety: 1-year follow-up of a randomized controlled trial. Surg Endosc. https://doi.org/10.1007/s00464-015-4320-9

    Article  PubMed  Google Scholar 

  26. Farrugia M, McGurgan P, McMillan L, O’Donovan P (2001) Recent advances in electrosurgery—VERSAPOINT® technology. Rev Gynaecol Pract 1:12–17. https://doi.org/10.1016/S1471-7697(01)80030-7

    Article  Google Scholar 

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Acknowledgements

The authors thank engineers from EFA-MEDICA and the management of the MEDTOUCH educational portal for their help with the survey.

Funding

The funders had no role in study design, data collection, analysis, decision to publish, or preparation of the manuscript.

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Correspondence to K. M. Loban.

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Drs. T. V. Nechay, K. M. Loban, E. R. Chechin, A. E. Tyagunov, and A. V. Sazhin have no conflict of interest or financial ties to disclose.

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Nechay, T.V., Loban, K.M., Chechin, E.R. et al. Surgeons know that they don’t know about the safe use of surgical energy: an international study reveals that the knowledge gap persists. Surg Endosc 37, 4673–4680 (2023). https://doi.org/10.1007/s00464-023-09936-5

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