The Fundamental Use of Surgical Energy – FUSE

By Dr. Daniel Jones, President-Elect, SAGES

The Fundamental Use of Surgical Energy initiative was conceived and initiated in 2010 by then SAGES president-elect Steven Schwaitzberg. He recognized that surgeons have a very rudimentary understanding of the physics behind the surgical energy devices they use every day in the operating room. As such, they were, and still are,  placing their patients at risk.  Every year there are approximately 400 OR fires and 40,000 thermal injuries, with many more that were likely go unreported.  We coined the project “FUSE.”

The Task Force, initially led by Daniel Jones, Liane Feldman, and Pascal Fuchshuber, recruited experts in surgical  energy and the associated risks across many disciplines:  anesthesia, gynecology, urology, bariatrics, colorectal surgery, general surgery, hepatobiliary surgery, flexible endoscopy and very importantly – nursing .  The mantra became “energy injuries are team failures.” One of the initial challenges was that there was no textbook to turn to.  So the Task Force authored the “SAGES Manual on the Fundamental Use of Surgical Energy (FUSE)” by Springer, 2013. This paperback has become the “go- to” reference in our field.

Predictably,  many surgeons were skeptical that FUSE was needed in the surgical community.  They cited that the FUSE program was costly and unnecessary.  It was common to hear, “Surgeons operate every day – of course we are experts,” or “We don’t need another burdensome course.”  So the first thing the Task Force did was identify 20 concepts that all surgeons would need to know to be safe in relation  to energy devices.  This mini-exam was administered to the SAGES Board of Governors.  Nearly 70% failed and did not know basic concepts. [i]   It was no longer OK to ignore the learning gap.

SAGES utilized a professional psychometrician to assist us in creating a blue print for the educational program. Through a rigorous process, we identified critical learning points, which then guided the curriculum.  We envisioned two educational products; the first was an on-line curriculum that would be free to all nurses, anesthesiologists and surgeons to learn about the safe use of energy. The second is a high stakes examination.

Today, learners can log on to and be taught the principles of energy and safe use of related devices. Punching through a series of slides however, while informative, may not lead to an in-depth understanding of the FUSE principles.  Again, using experts in test-writing and validation, we developed an exam that was relevant and distinguished between those who learned the material and others who had not studied.  All test questions were validated by a cohort of 500 surgeons.  FUSE is catching on.  The last issue of SCOPE highlighted that the country of France leased the FUSE didactic, translated it into French, and is now mandating it for surgeons and nurses, and  Germany is considering moving ahead with a similar model.  The Unites States military is also considering mandating FUSE for all military surgeons.  An increasing number of hospital credentialing boards are discussing requiring surgeons to review specific modules  to retain operating privileges. Similarly, Kaiser Permanente in Southern California is looking to develop an abbreviated FUSE course for their surgeons and nurses.

We have a learning gap;  FUSE can prevent patient harm with a formal educational curriculum that teaches safety.  Hospitals, residency programs, practicing surgeons all know it’s important and should be done.  Three years ago, Past President Michael Brunt called for all SAGES  Board members to become FUSE certified.  Current President Danny Scott emphasized that all Committee Chairs and Co-chairs should also become FUSE certified.  As President-elect, I hope that all 6000 SAGES members will log on and learn about the FUSE Program and consider learning more about the safe use of energy in their operating room.

Selected readings:

All  FUSE articles listed at

[i] Feldman LS, Fuchshuber P, Jones DB, Mischna J, Schwaitzberg SD; FUSE (Fundamental Use of Surgical Energy™) Task Force. Surgeons don’t know what they don’t know about the safe use of energy in surgery.

Surg Endosc. 2012 Oct;26(10):2735-9.