Laparoscopic instrument insulation failure: The hidden hazard

Study objectivesTo determine the prevalence of insulation failure in gynecologic laparoscopic instruments and to assess the impact of routine static insulation failure testingDesignCross-sectional study (Canadian Task Force classification II-2).SettingPublic tertiary teaching hospitals.InterventionRoutine static insulation failure testingMeasurements and main resultsDichotomous assessment of instrument insulation failure. Characterization of insulation defects. One hundred eleven instruments were tested. The overall prevalence of insulation failure was 27% with a rate of 39% in dedicated monopolar instruments. The sensitivity of visual inspection to predict a damaged instrument was 10%. Even when the site of the failure was identified, the defect was detectable only in 35% of instruments without magnification. The mean site of insulation failure was at 71 mm from the tip of the instrument, placing most insulation defects within the abdominopelvic cavity during surgery. After the introduction of routine static electrosurgical instrument testing, the overall prevalence of insulation failure dropped to 5.9%.ConclusionThere is an unacceptably high prevalence of instrument insulation failure in gynecologic laparoscopic instruments. Visual inspection is not an appropriate screening mechanism for insulation failure but routine biomedical testing reduces the prevalence of defective laparoscopic instruments.