Indirect electrical injuries from capacitive coupling: a rarely mentioned electrosurgical complication in monopolar laparoscopy.

Electrothermal injuries in monopolar laparoscopy may derive indirectly, but rarely, from capacitive coupling releasing stray currents into neighboring non-targeted tissues, with intact instrument insulation. Since 2007, seven episodes of indirect electrosurgical damage to non-targeted tissues have been observed in our gynecological practice, including incidental coagulative necrosis of appendix, Fallopian tube, cystic pedicle, and broad ligament stump. Such an electrical response becomes greater where there is increased contact with the cystic wall (cysts <3 cm in diameter). Appropriate measures are available for minimizing capacitive coupling specifically caused by monopolar electrocautery. Thorough staff training, regular safety inspections, and strict procedure performance should exist to minimize such risks and injuries.