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.
Similar content being viewed by others
Change history
03 May 2023
A Correction to this paper has been published: https://doi.org/10.1007/s00464-023-10103-z
References
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
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
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
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
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
Cassaro S (2015) Delayed manifestations of laparoscopic bowel injury. Am Surg 81:478–482
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
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
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
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
Humes DJ, Ahmed I, Lobo DN (2010) The pedicle effect and direct coupling. Arch Surg 145:96–98
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
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
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
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
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
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
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
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
The jamovi project (2021).[Computer Software]. Jamovi
ECRI Institute (2015) Top 10 Health Technology Hazards for 2016: A Report from Health Devices. 1–16
Yildirim D (2017) Do Turkish gynecologists have sufficient knowledge on the basic principles of electrosurgery? - PubMed. Hippokratia 21:8–12
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
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
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
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
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.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
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.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-023-09936-5