Surgeons have knowledge gaps in the safe use of energy devices: a multicenter cross-sectional study

Surg Endosc. 2016 Feb;30(2):588-592. doi: 10.1007/s00464-015-4243-5. Epub 2015 May 28.


Background: Despite the widespread use of surgical energy devices and the potential for rare but serious complications, pilot data from North America suggest that surgeons and surgical trainees have knowledge gaps in their safe use. The purpose of this study was to determine baseline knowledge of general surgeons and surgical trainees 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 according to the objectives and blueprints of SAGES' Fundamental Use of Surgical Energy™ 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 PGY > 5 and PGY 1-5 participants.

Results: A total of 145 general surgeons and surgical trainees of all years after medical school (PGY 1-5: 57, PGY > 5: 88) from ten academic and five community hospitals completed the assessment (mean age 35; 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 (60 ± 11 vs. 53 ± 12%, p < 0.01). Among 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; 19% did not know how to manage an operating room fire; 16% thought that a dispersive electrode should be cut to fit a child; and 27% believe that insulation failure in minimally invasive surgical instruments 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. There is a need for educational curricula to help address these gaps and contribute to safer surgery.

Keywords: Electrosurgery; Energy device; FUSE; Operating room fire; Operating room safety; Surgical education.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Clinical Competence / standards*
  • Cross-Sectional Studies
  • Curriculum*
  • Electrosurgery / education
  • Electrosurgery / instrumentation
  • Electrosurgery / standards*
  • Female
  • General Surgery / education
  • General Surgery / standards*
  • Humans
  • Internship and Residency / standards*
  • Japan
  • Male
  • Minimally Invasive Surgical Procedures