Vol. 114, October Printed in U.S.A.
THE JOURNAL OF UROLOGY
Copyright© 1975 by The Williams & Wilkins Co.
EYE INJURY DURING TRANSURETHRAL SURGERY S. DWANE THOMAS
ABSTRACT
An injury to a surgeon's cornea, which resulted in permanent damage, is reported. The accident could have been prevented if there had been no exposed metal in the telescope eyepiece and if the surgeon had been wearing glasses. Any telescope with exposed metal in the center of the eyepiece should be returned to the manufacturer for replacement with a more protective and insulated type of eyepiece. There have been several reports in the literature, suggesting eye injury while doing a transurethral operation. In these reports injuries are only implied and we have been unable to document in the literature any injury of significance. In the course of doing transurethral operations most surgeons have experienced shocks and burns to the hands, often to the cheeks, nose and ears and occasionally arcing to the patient. Since the eye of the surgeon is the most vulnerable tissue in the area of the operation the purpose of this paper is to call attention to a hazard and the elimination of that hazard.
the resectoscope came from an electrosurgical unit of the spark-gap variety. During the operation the entire instrument heated and warmth eminated to the surgeon's hands. Various parts of the instrument were exchanged but the final instrument was as described. While cutting a piece of tissue the author experienced sudden severe pain in the right eye. The pain was so intense that the operation had to be completed by another surgeon. Examination by an ophthamologist revealed a burn and laceration to the cornea. The eye was treated symptomatically and conservatively with the resulting residual effects of myopia and uniocular diplopia producing 4 images in the injured eye (see figure).
REPORT OF AN ACCIDENT DISCUSSION
In 1971 the author was doing transurethral resection of a prostate, using an Iglesias resectoscope element with a telescope fitted with the photographic type eyepiece. The current supplying Accepted for publication February 21, 1975.
Subsequent investigation of the factors permitting this accident to occur took into account radiofrequency current and its behavior, which, includes return of the active current through the path of least resistance to ground and specifically,
Photograph of eye using slit-lamp shows scar extending through all layers of cornea secondary to electrical burn
584
EYE INJURY DURING TRANSURETHRAL SURGERY
a tendency to arcing. Necessary for safety in the use of a resectoscope is satisfactory grounding for return of this radiofrequency current. If the current cannot return to the electrosurgical unit or be dissipated through the patient's arcing, shocks and burns can occur to the surgeon who is such shocks and if also ear or are of no consequ,rnce. a burn to the eye can leave permanent residual such as occurred in this case, of this accident revealed the as occur to the to occur. The of this accident confined itself to the instrument used. many use) have metal around the piano lens of the telescope ocular and are, in the opinion of this unsafe for use with electrosllrgical
585
units inasmuch as unrelated electrical problems or system breakdown exposes the surgeon's eye to a risk of serious injury. To prevent eye I would recommend that each telescope used in a resectoscope element be examined. If any metal, or not, can be seen in the area of the arrangements with the manufacturer of the instrument should be made for the c,_,1ac,soun,, with metal to be in the area the surgeon should vvear and should not have ~rire frames. The source of' any electrical in an system should be traced as soon as evident. This is deemed necessary of the surgeon as well as the
160 Rutledge Ave,, 29403
South Carolina
THE JOURNAL OF UROLOGY
Copyright© 1975 by The Williams & Wilkins Co.
EYE INJURY DURING TRANSURETHRAL SURGERY S. DWANE THOMAS
ABSTRACT
An injury to a surgeon's cornea, which resulted in permanent damage, is reported. The accident could have been prevented if there had been no exposed metal in the telescope eyepiece and if the surgeon had been wearing glasses. Any telescope with exposed metal in the center of the eyepiece should be returned to the manufacturer for replacement with a more protective and insulated type of eyepiece. There have been several reports in the literature, suggesting eye injury while doing a transurethral operation. In these reports injuries are only implied and we have been unable to document in the literature any injury of significance. In the course of doing transurethral operations most surgeons have experienced shocks and burns to the hands, often to the cheeks, nose and ears and occasionally arcing to the patient. Since the eye of the surgeon is the most vulnerable tissue in the area of the operation the purpose of this paper is to call attention to a hazard and the elimination of that hazard.
the resectoscope came from an electrosurgical unit of the spark-gap variety. During the operation the entire instrument heated and warmth eminated to the surgeon's hands. Various parts of the instrument were exchanged but the final instrument was as described. While cutting a piece of tissue the author experienced sudden severe pain in the right eye. The pain was so intense that the operation had to be completed by another surgeon. Examination by an ophthamologist revealed a burn and laceration to the cornea. The eye was treated symptomatically and conservatively with the resulting residual effects of myopia and uniocular diplopia producing 4 images in the injured eye (see figure).
REPORT OF AN ACCIDENT DISCUSSION
In 1971 the author was doing transurethral resection of a prostate, using an Iglesias resectoscope element with a telescope fitted with the photographic type eyepiece. The current supplying Accepted for publication February 21, 1975.
Subsequent investigation of the factors permitting this accident to occur took into account radiofrequency current and its behavior, which, includes return of the active current through the path of least resistance to ground and specifically,
Photograph of eye using slit-lamp shows scar extending through all layers of cornea secondary to electrical burn
584
EYE INJURY DURING TRANSURETHRAL SURGERY
a tendency to arcing. Necessary for safety in the use of a resectoscope is satisfactory grounding for return of this radiofrequency current. If the current cannot return to the electrosurgical unit or be dissipated through the patient's arcing, shocks and burns can occur to the surgeon who is such shocks and if also ear or are of no consequ,rnce. a burn to the eye can leave permanent residual such as occurred in this case, of this accident revealed the as occur to the to occur. The of this accident confined itself to the instrument used. many use) have metal around the piano lens of the telescope ocular and are, in the opinion of this unsafe for use with electrosllrgical
585
units inasmuch as unrelated electrical problems or system breakdown exposes the surgeon's eye to a risk of serious injury. To prevent eye I would recommend that each telescope used in a resectoscope element be examined. If any metal, or not, can be seen in the area of the arrangements with the manufacturer of the instrument should be made for the c,_,1ac,soun,, with metal to be in the area the surgeon should vvear and should not have ~rire frames. The source of' any electrical in an system should be traced as soon as evident. This is deemed necessary of the surgeon as well as the
160 Rutledge Ave,, 29403
South Carolina
