Pascal Fuchshuber

Fundamental Use of Surgical Energy™ (FUSE): a curriculum on surgical energy-based devices

The Fundamental Use of Surgical Energy (FUSE) is a new curriculum developed by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Surgeons and anesthesiologists can earn CME credits, nurses can earn CEUs, and those who master the curriculum content can obtain a certificate. But why is this needed? Almost every surgical procedure, regardless of specialty or geographic location, involves the use of devices that apply energy to tissues. This practice has existed for thousands of years, whether it is cautery used by Egyptians in 3000 BCE to manage hemorrhagic shock [1] or Bovie’s revolutionary electrosurgical unit introduced by Cushing into surgical practice in the early twentieth century [2]. Since their introduction, electrosurgical devices have become ubiquitous throughout operating theaters, endoscopy suites, and other procedural rooms. One of the most remarkable developments in surgery over the last two decades has been the introduction of a large variety of complex and task-specific energy devices, incorporating novel technologies, newer designs, and advanced functions. Common examples include ultrasonic devices using mechanical energy, advanced bipolar electrosurgical devices with cutting blades and impedance measurement, and image-guided radiofrequency ablation instruments. Regardless of one’s practice, the momentum in surgical energy innovation has transformed the operating room and endoscopy suite into a place with a wide array of technologies and tools. The success of energy devices is largely due to their ease of use, diverse configurations and proven utility for hemostasis, tissue dissection, and ablation. However, this success poses safety challenges. Energy devices can lead to severe iatrogenic complications, including operating room fires, accidental tissue injury, and interference with other implantable medical devices (e.g., pacemakers, implantable cardiac defibrillators). One contributing factor is that the devices tend to be poorly understood by operators, regardless of their level of experience [3]. Many surgeons For the SAGES FUSE Task Force: Sharon L. Bachman, L. Michael Brunt, Bipan Chand, Suvranu De, Warren S. Grundfest, Daniel M. Herron, Gretchen Purcell Jackson, Stephanie B Jones, Dean J. Mikami, Malcolm Munro, Chan W. Park, William S. Richardson.

Fundamental use of surgical energy (FUSE) closing a gap in medical education

Traditional medical education curricula for students, residents and trainees do not address the rapidly growing number of technological devices that are fundamentally changing health care delivery today. This is most relevant in those medical specialties that rely heavily on the use of advanced technologies and devices, for example minimally invasive surgery, interventional radiology, gastroenterology, cardiology and anesthesia. Health care professionals in these domains are increasingly sharing procedures that use energy devices of many different designs and functionality without training in their fundamental use and safety. This exposes both operators and patients to increasing risk for injury. The definitive gap in adequate education and training in new technologies prompted the development of The Fundamental Use of Surgical Energy (FUSE) program by a multidisciplinary team of clinicians, nurses, educators and engineers under the leadership of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). The sweeping changes in the surgical and interventional professions due to technological innovation call for the development of additional curricula to close the educational gap on other medically important technologies. The FUSE program and future educational curricula on medical technologies are fundamental to patient care and represent a necessary paradigm shift in traditional medical education.

Ensuring safety in the operating room: the "fundamental use of surgical energy" (FUSE) program.

The Fundamental Use of Surgical Energy program by SAGES has multiple components: a comprehensive educational curriculum on the principles and safety of surgical and endoscopic energy devices available as a postgraduate course, a comprehensive manual and an online multimedia CME approved program; and a psychometrically sound high-stakes examination for physicians that can be used for maintenance of certification. Future developments of the FUSE program will include specific modules tailored to individual energy devices. These modules will be developed in collaboration with industry to provide standardized education for the safe and appropriate use of current and new energy devices. This will ensure that FUSE continues on its mission to fill the unmet curricular, regulatory, safety and competency assessment needs that exist for the use of energy devices in patients by surgeons, endoscopists, anesthesiologists and nurses.

The SAGES Fundamental Use of Surgical Energy program (FUSE): history, development, and purpose

BackgroundAdverse events due to energy device use in surgical operating rooms are a daily occurrence. These occur at a rate of approximately 1–2 per 1000 operations. Hundreds of operating room fires occur each year in the United States, some causing severe injury and even mortality. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) therefore created the first comprehensive educational curriculum on the safe use of surgical energy devices, called Fundamental Use of Surgical Energy (FUSE). This paper describes the history, development, and purpose of this important training program for all members of the operating room team.MethodsThe databases of SAGES and the FUSE committee as well as personal photographs and documents of members of the FUSE task force were used to establish a brief history of the FUSE program from its inception to its current status.ResultsThe authors were able to detail all aspects of the history, development, and national as well as global implementation of the third SAGES Fundamentals Program FUSE.ConclusionsThe written documentation of the making of FUSE is an important contribution to the history and mission of SAGES and allows the reader to understand the idea, concept, realization, and implementation of the only free online educational tool for physicians on energy devices available today. FUSE is the culmination of the SAGES efforts to recognize gaps in patient safety and develop state-of-the-art educational programs to address those gaps. It is the goal of the FUSE task force to ensure that general FUSE implementation becomes multinational, involving as many countries as possible.

Erratum to: Surgeons don’t know what they don’t know about the safe use of energy in surgery

Members of the FUSE (Fundamental Use of Surgical EnergyTM) Task Force include: Daniel B. Jones MD (Chair), Liane S. Feldman MD (Co-Chair), Pascal Fuchshuber MD (Co-Chair), Sharon L. Bachman MD, L. Michael Brunt MD, James Choi MD, Suvranu De ScD, Brian J. Dunkin MD, Warren Grundfest MD, Charlotte Gugliemi RN, Jeffrey W. Hazey MD, Scott Helton MD, Daniel M. Herron MD, David Iannitti MD, Gretchen Purcell Jackson MD, Stephanie Jones MD, Jarrod Kaufman MD, Leena Khaitan MD, Dean J. Mikami MD, William S. Richardson MD, Thomas N. Robinson MD, Marc Rozner MD, Steven D. Schwaitzberg MD, Daniel J. Scott MD, Victoria J. Steelman PhD, Thadeus L. Trus MD, J. Esteban Varela MD, C. Randy Voyles MD, Eelco Wassenaar MD and Malcolm G. Munro MD.