Label - Laser energy in urology

Context and issues

The accreditation system's feedback database collects adverse events associated with healthcare (AEAS) that occur in the day-to-day practice of the doctors and medical teams involved. The lessons learned from these events are used to draw up SSPs designed to improve practices, reduce the occurrence of events or mitigate their consequences. Type 2 SSPs are reports produced by accredited bodies on the risks associated with a particular speciality.

The laser offers major surgical advantages, but can present risks for patients if it is misused or malfunctions. The consequences can be serious, and may even lead to death: a survey carried out by the AFU recorded more than 40 deaths following flexible laser ureteroscopy over the last 15 years. Yet most of the adverse events associated with laser treatment in urology are avoidable.

Analysis

In-depth analysis of the feedback database revealed 208 AEIAS associated with the use of a laser in urology reported between May 2016 and September 2023. Analysis of the first 149 AEIAS showed that the main cause of AEIAS was faulty or unavailable equipment (n = 71/149).

A practice survey of 1884 urologists was conducted in February 2023. The main events reported by the 177 respondents were stenosis (40%), haemorrhage (34%), fire and thermal tissue damage (26%), infection (20%) and eye damage (19%).

How can risks be reduced?

This SSP proposes a list of key points covering the essential elements for limiting the occurrence or severity of undesirable events associated with laser energy: 

• train professionals in the use of laser energy and the various fibres;
• maintain the equipment;
• check the equipment before each operation;
• use the equipment in accordance with the recommendations;
• record the methods of laser use in the operating report;
• inform the patient of any risks;
• implement the appropriate measures in the event of an undesirable event. In particular, the SSP provides a sheet on what to do in the event of eye injuries and a sheet on what to do in the event of a fire;
• declare and analyse any undesirable event.