Surgeons Have Knowledge Gaps in the Safe Use of Energy Devices: a Multicenter Cross-Sectional Study

Yusuke Watanabe, MD¹, Yo Kurashima, MD¹, Amin Madani, MD², Liane S Feldman, MD², Minoru Ishida, CCE³, Akihiko Oshita, MD⁴, Takeshi Naitoh, MD⁵, Kazuhiro Noma, MD⁶, Keigo Yasumasa, MD⁷, Hiroshi Nagata, MD⁸, Fumitaka Nakamura, MD⁹, Koichi Ono, MD¹⁰, Yoshinori Suzuki, MD³, Toshiaki Shichinohe, MD¹, Satoshi Hirano¹. ¹Hokkaido University, ²McGIll University, ³KKR Tonan Hospital, ⁴JA Hiroshima General Hospital, ⁵Tohoku University, ⁶Okayama University, ⁷JCHO Osaka Hospital, ⁸Kameta Memorial Center, ⁹Teine Keijinkai Hospital, ¹⁰Obihiro Kosei General Hospital

Introduction

Despite the widespread use of surgical energy devices, pilot data from North America suggests that surgeons and surgical trainees have knowledge gaps in their safe use and this may lead to significant complications to patients. The purpose of this study was to determine general surgeons’ and trainees’ knowledge regarding the safe use of electrosurgery (ES) across varying levels of experience in Japan.

Methods

Participants completed a 35-item multiple-choice question examination, testing critical knowledge of ES. The examination was developed based on the objectives and blueprints of the SAGES Fundamental Use of Surgical Energy™ (FUSE) curriculum. Sections of the examination included: “Principles of ES”, “ES-Related Adverse Events”, “Monopolar and Bipolar Devices”, and “Pediatric Considerations and Interference with Implantable Devices”. Scores were compared between post-graduate year (PGY) >5 and PGY 1-5 participants. The percentage of correct answers is expressed as mean score ± standard deviation. Unpaired t-test and Tukey multiple comparison test determined significance.

Results

A total of 135 general surgeons and surgical trainees of all years after medical school (PGY 1-5: 52, PGY> 5: 83) from 9 academic and 5 community hospitals completed the assessment (mean age 36; 91% male). The mean score in the entire cohort was 58 ± 12% (range = 23-83%), with significantly higher scores in the PGY> 5 group compared to the PGY 1-5 group (61 ± 11% vs. 53 ± 12%, p<0.01). This difference was due to better performance on the sections “Principles of ES”, “ES-Related Adverse Events” and “Pediatric Considerations and Interference with Implantable Devices”. Amongst all participants, 92% were not familiar with best practices when using ES on patients with a pacemaker; 44% believe that ES uses thermal energy from cautery; 23% believe that the best way to stop a bleeding vessel by applying ES to forceps is using the “coag” mode; 19% did not know how to manage an operating room fire; 7% thought that ES should be used when entering the airway to minimize bleeding during an open tracheostomy; 72% did not know the role of a dispersive electrode; 16% thought that a dispersive electrode should be cut to fit a child; and 27% believe that insulation failure is mostly visible under careful inspection.

Conclusions

General surgeons and trainees at all levels have knowledge gaps in the safe and effective use of energy devices, regardless of years of experience. Educational curricula can help address these gaps and contribute to safer surgery.