腹腔鏡下手術におけるリスクマネージメント―InsulScanⓇの使用―

Risk management during laparoscopic surgery : the use of InsulScanⓇ

◆要旨：腹腔鏡下手術は急速に普及しているが，電気メスの絶縁被覆部破損による臓器損傷が存在するという事実があり，手術の安全性確保上，外科医にとり看過できない問題である．当院では鉗子に高電圧をかけて鉗子表面の漏電を検出できる器具InsulScan^Ⓡを導入した．患者アンケートでは97.8％がこのような安全性に対する病院の姿勢を評価し，75.6％が自費であっても使用を望んでいた．当院で使用している鉗子のうち3本に絶縁損傷を認めたが，すべて外観上ではわからないものであり，InsulScan^Ⓡにて初めて損傷が判明した．InsulScan^Ⓡの使用は，内視鏡外科における事故防止というリスクマネージメント上，重要な役割を果たすと考えられた．

　Laparoscopic surgery, despite its popularity and the rapid expansion in its application, is associated with potential complication of organ injury due to insulation failure of electrosurgically active surgical instruments. Surgeons should be responsible for the safety of such surgical instruments. We have introduced clinically the InsulScan^Ⓡthat detects the presence of the insulation failure by applying high voltage to the instrument and sensing the presence of the current leakage on the surface of the insulation layer. According to our patient survey, 97.8%considered the use of such preventive method as favorable attitude of the hospital toward safety, and 65.2%preferred the use of the method even at their own expenses. We conducted the examination using InsulScan^Ⓡto all applicable surgical instruments prior to the surgery. As a result, three instruments, which lacked any external visual sign of breakage, was detected as having an electrical insulation failure. Use of the InsulScan^Ⓡcan be a big step toward the prevention of accident, which is one of the important factors for risk management.