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Giorgi M, Schettini G, La Banca L, Cannoni A, Ginetti A, Colombi I, Habib N, Rovira R, Martire F, Lazzeri L, Zupi E, Centini G. Prevention and Treatment of Intraoperative Complications During Gynecological Laparoscopic Surgery: Practical Tips and Tricks-A Narrative Review. Adv Ther 2025; 42:2089-2117. [PMID: 40106176 PMCID: PMC12006249 DOI: 10.1007/s12325-025-03165-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2024] [Accepted: 02/28/2025] [Indexed: 03/22/2025]
Abstract
Several complications can occur during laparoscopic gynecological surgery. The insertion of trocars and the induction of pneumoperitoneum are essential steps, but they can still pose potential risks during laparoscopic surgery. Bowel injuries are the most common during gynecological procedures as a result of thermal damage and trocar placement, while vessel injuries may carry a high mortality rate. Gynecologic surgeons should be aware of the risks associated with laparoscopic procedures and be able to prevent and treat potential complications. We conducted a literature search using three electronic databases (Pubmed/MEDLINE, Google Scholar, Embase) from inception to May 2024 to identify the most common intraoperative gynecological laparoscopic complications, including those related to trocar insertion, bowel, urinary, and vessel injury. The aim of this narrative review is to describe the most common complications during gynecological laparoscopic surgery and to outline the safety rules and techniques necessary for their prevention and treatment.
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Affiliation(s)
- Matteo Giorgi
- Obstetrics and Gynecology Unit, Valdarno Hospital, Montevarchi, 52025, Arezzo, Italy
| | - Giorgia Schettini
- Department of Molecular and Developmental Medicine, Obstetrics, Gynecological Clinic University of Siena, 51300, Siena, Italy
| | - Luca La Banca
- Obstetrics and Gynecology Unit, Valdarno Hospital, Montevarchi, 52025, Arezzo, Italy
| | - Alberto Cannoni
- Department of Molecular and Developmental Medicine, Obstetrics, Gynecological Clinic University of Siena, 51300, Siena, Italy
| | - Alessandro Ginetti
- Department of Molecular and Developmental Medicine, Obstetrics, Gynecological Clinic University of Siena, 51300, Siena, Italy
| | - Irene Colombi
- Department of Molecular and Developmental Medicine, Obstetrics, Gynecological Clinic University of Siena, 51300, Siena, Italy
| | - Nassir Habib
- Department of Obstetrics and Gynecology, Francois Quesnay Hospital, 78201, Mantes-la-Jolie, France
| | - Ramon Rovira
- Department of Gynecology and Obstetrics, Hospital de la Santa Creu i de Sant Pau, C/Sant Quintí 89, 08041, Barcelona, Spain
| | - Francesco Martire
- Department of Molecular and Developmental Medicine, Obstetrics, Gynecological Clinic University of Siena, 51300, Siena, Italy
| | - Lucia Lazzeri
- Department of Molecular and Developmental Medicine, Obstetrics, Gynecological Clinic University of Siena, 51300, Siena, Italy
| | - Errico Zupi
- Department of Molecular and Developmental Medicine, Obstetrics, Gynecological Clinic University of Siena, 51300, Siena, Italy
| | - Gabriele Centini
- Department of Molecular and Developmental Medicine, Obstetrics, Gynecological Clinic University of Siena, 51300, Siena, Italy.
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Li J, Liu Z, Li J, Cheng W. Abdominal wall hematoma as a complication of drainage after laparoscopic cholecystectomy: a case report. Front Med (Lausanne) 2025; 12:1468200. [PMID: 40012980 PMCID: PMC11861199 DOI: 10.3389/fmed.2025.1468200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Accepted: 01/28/2025] [Indexed: 02/28/2025] Open
Abstract
Background Abdominal wall hematoma represents a potential postoperative complication that requires prompt identification and appropriate management. This case report retrospectively analyzes a patient who developed an abdominal wall hematoma associated with a drainage tube and puncture site following laparoscopic cholecystectomy at our hospital. The clinical characteristics, treatment modalities, and relevant literature are reviewed to highlight strategies for the prevention and management of postoperative hematomas, with the aim of providing valuable insights for clinical practice. We managed a patient who had undergone laparoscopic cholecystectomy for gallstones complicated by cholecystitis. On the first postoperative day, a hematoma developed at the site of the abdominal drainage tube insertion. Despite initial attempts at hemostasis through abdominal wall compression, these measures proved ineffective, necessitating the use of a urinary catheter balloon for effective compression hemostasis. Case presentation We treated a patient who had undergone laparoscopic cholecystectomy for gallstones complicated by cholecystitis. On the first postoperative day, a hematoma developed at the site of the abdominal drainage tube insertion. Despite initial attempts at hemostasis using abdominal wall compression, these measures were ineffective, necessitating the use of a urinary catheter balloon for effective compression hemostasis. Conclusion The urinary catheter balloon tamponade was effectively employed postoperatively to achieve hemostasis for the hematoma at the abdominal wall drainage site. It provides a viable alternative for early intervention in hematoma management.
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Affiliation(s)
| | | | - Jia Li
- Department of Hepatobiliary Surgery, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Wei Cheng
- Department of Hepatobiliary Surgery, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
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Mansouri G, Nikseresht A, Robati FK, Salehiniya H, Allahqoli L, Alkatout I. Comparison of three umbilical entry sites for intraperitoneal access by the direct trocar insertion technique: a randomized pilot study. J Turk Ger Gynecol Assoc 2024; 25:116-123. [PMID: 39219186 DOI: 10.4274/jtgga.galenos.2024.2023-6-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Abstract
Objective The most effective methods and entry sites for laparoscopic surgery remain a subject of ongoing investigation and discussion. The purpose of the study was to analyze and compare three umbilical entry sites for intraperitoneal access using the direct trocar insertion technique. Material and Methods A randomized pilot study was conducted between March 2021 and January 2023, involving women eligible for laparoscopic gynecological surgery. The women were allocated to one of three equally sized groups based on trocar entry points: subumbilical, supraumbilical, or umbilical. Success and failure rates of trocar entry, factors influencing success or failure, and early and late complications were systematically evaluated and compared across groups. Results A total of 243 patients, with a mean age of 32.93±8.33 years, were included in three groups of 81 each. Trocar entry success rates were 97.5%, 89.2%, and 89.5% in the supraumbilical, umbilical, and subumbilical groups, respectively (p>0.05). Failed trocar entry was significantly associated with age, gravidity, body mass index (BMI), waist circumference, hip circumference, and abdominal subcutaneous fat thickness (p<0.001). Regression analysis revealed that, in the subumbilical group, higher gravidity [odds ratios (OR): 0.390, 95% confidence interval (CI): 0.174-0.872, p=0.022) and greater abdominal subcutaneous fat thickness (OR: 0.090, 95% CI: 0.019-0.431, p=0.03) were associated with lower odds of successful trocar entry. In contrast, in the umbilical group, a higher waist circumference was associated with lower odds of successful trocar entry (OR: 0.673, 95% CI: 0.494-0.918, p=0.012). None of the covariates were significant in the supraumbilical group. Conclusion The study highlighted the importance of selecting the appropriate trocar entry site in laparoscopic gynecological surgery. Surgeons should consider factors such as age, gravidity, BMI, waist circumference, hip circumference, and abdominal subcutaneous fat thickness, as these factors significantly influence the success of trocar entry.
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Affiliation(s)
- Ghazal Mansouri
- Department of Obstetrics and Gynecology, Afzalipour Hospital, Kerman University of Medical Sciences School of Medicine, Kerman, Iran
| | - Afsaneh Nikseresht
- Department of Obstetrics and Gynecology, Afzalipour Hospital, Kerman University of Medical Sciences School of Medicine, Kerman, Iran
| | - Fatemeh Karami Robati
- Clinical Research Development Unit, Afzalipour Hospital, Kerman University of Medical Sciences School of Medicine, Kerman, Iran
| | - Hamid Salehiniya
- Social Determinants of Health Research Center, Birjand University of Medical Sciences School of Medicine, Birjand, Iran
| | - Leila Allahqoli
- Department of Midwifery, Ministry of Health, Treatment and Medical Education, Tehran, Iran
| | - Ibrahim Alkatout
- Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Kiel, Germany
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Spiller M, Esmaeili N, Sühn T, Boese A, Turial S, Gumbs AA, Croner R, Friebe M, Illanes A. Enhancing Veress Needle Entry with Proximal Vibroacoustic Sensing for Automatic Identification of Peritoneum Puncture. Diagnostics (Basel) 2024; 14:1698. [PMID: 39125574 PMCID: PMC11311580 DOI: 10.3390/diagnostics14151698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 07/12/2024] [Accepted: 07/31/2024] [Indexed: 08/12/2024] Open
Abstract
Laparoscopic access, a critical yet challenging step in surgical procedures, often leads to complications. Existing systems, such as improved Veress needles and optical trocars, offer limited safety benefits but come with elevated costs. In this study, a prototype of a novel technology for guiding needle interventions based on vibroacoustic signals is evaluated in porcine cadavers. The prototype consistently detected successful abdominal cavity entry in 100% of cases during 193 insertions across eight porcine cadavers. The high signal quality allowed for the precise identification of all Veress needle insertion phases, including peritoneum puncture. The findings suggest that this vibroacoustic-based guidance technology could enhance surgeons' situational awareness and provide valuable support during laparoscopic access. Unlike existing solutions, this technology does not require sensing elements in the instrument's tip and remains compatible with medical instruments from various manufacturers.
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Affiliation(s)
- Moritz Spiller
- SURAG Medical GmbH, 04229 Leipzig, Germany; (N.E.); (T.S.); (A.I.)
| | - Nazila Esmaeili
- SURAG Medical GmbH, 04229 Leipzig, Germany; (N.E.); (T.S.); (A.I.)
- Chair for Computer Aided Medical Procedures and Augmented Reality, Technical University of Munich, 85748 Munich, Germany
| | - Thomas Sühn
- SURAG Medical GmbH, 04229 Leipzig, Germany; (N.E.); (T.S.); (A.I.)
- Department of Orthopaedic Surgery, Otto-von-Guericke University Magdeburg, 39106 Magdeburg, Germany
| | - Axel Boese
- INKA—Innovation Laboratory for Image Guided Therapy, Otto-von-Guericke University Magdeburg, 39106 Magdeburg, Germany; (A.B.); (M.F.)
| | - Salmai Turial
- Department of Pediatric Surgery and Pediatric Traumatology, University Clinic for General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, 39120 Magdeburg, Germany;
| | - Andrew A. Gumbs
- University Clinic for General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, 39120 Magdeburg, Germany; (A.A.G.); (R.C.)
- Advanced & Minimally Invasive Surgery Excellence Center, American Hospital Tblisi, 0102 Tblisi, Georgia
| | - Roland Croner
- University Clinic for General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, 39120 Magdeburg, Germany; (A.A.G.); (R.C.)
| | - Michael Friebe
- INKA—Innovation Laboratory for Image Guided Therapy, Otto-von-Guericke University Magdeburg, 39106 Magdeburg, Germany; (A.B.); (M.F.)
- Faculty of Computer Science, AGH University of Science and Technology, 30-059 Krakow, Poland
- Center for Innovation, Business Development & Entrepreneurship, FOM University of Applied Sciences, 45141 Essen, Germany
| | - Alfredo Illanes
- SURAG Medical GmbH, 04229 Leipzig, Germany; (N.E.); (T.S.); (A.I.)
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Nishino H, Nishimura T, Miyashita S, Tada M, Fujimoto Y, Fujimoto J, Iijima H, Hatano E. Preoperative diagnosis of adhesion severity between the abdominal wall and intestinal tract with novel abdominal ultrasound methodology to enhance surgical safety. Surgery 2024; 176:469-476. [PMID: 38811324 DOI: 10.1016/j.surg.2024.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 03/26/2024] [Accepted: 04/13/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Adhesions between the abdominal wall and intestinal tract from previous surgeries can complicate reoperations; however, predicting the extent of adhesions preoperatively is difficult. This study aimed to develop a straightforward approach for predicting adhesion severity using a novel abdominal ultrasound technique that quantifies the displacement of motion vectors of two organs to enhance surgical safety. The efficacy of this methodology was assessed experimentally and clinically. METHODS Using Aplio500T, a system we developed, we measured the displacement of the upper peritoneum and intestinal tract as a vector difference and computed the motion difference ratio. Twenty-five rats were randomized into surgery and nonsurgery groups. The motion difference ratio was assessed 7 days after laparotomy to classify adhesions. In a clinical trial, 51 patients undergoing hepatobiliary pancreatic surgery were evaluated for the motion difference ratio within 3 days preoperatively. Intraoperatively, adhesion severity was rated and compared with the motion difference ratio. A receiver operating characteristic curve was used to appraise the diagnostic value of the motion difference ratio. RESULTS In the animal experiment, the adhesion group exhibited a significantly higher motion difference ratio than the no-adhesion group (0.006 ± 0.141 vs 0.435 ± 0.220, P < .001). In the clinical trial, the no-adhesion or no-laparotomy group had a motion difference ratio of 0.128 ± 0.074; mild-adhesion group, 0.143 ± 0.170; moderate-adhesion group, 0.326 ± 0.153; and high-adhesion group, 0.427 ± 0.152. The motion difference ratio receiver operating characteristic curve to diagnose the adhesion level (≥moderate) was 0.938, indicating its high diagnostic value (cut-off 0.204). CONCLUSION This methodology may preoperatively predict moderate-to-high adhesions.
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Affiliation(s)
- Hiroto Nishino
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Nishimura
- Department of Gastroenterology, Hyogo Medical University, Nishinomiya, Japan
| | - Seikan Miyashita
- Department of Hepato-Biliary-Pancreatic Surgery, Hyogo Medical University, Nishinomiya, Japan
| | - Masaharu Tada
- Department of Hepato-Biliary-Pancreatic Surgery, Hyogo Medical University, Nishinomiya, Japan
| | - Yasuhiro Fujimoto
- Department of Hepato-Biliary-Pancreatic Surgery, Hyogo Medical University, Nishinomiya, Japan
| | - Jiro Fujimoto
- Department of Hepato-Biliary-Pancreatic Surgery, Hyogo Medical University, Nishinomiya, Japan; Osaka Heavy Ion Therapy Center, Osaka International Cancer Treatment Foundation, Osaka, Japan
| | - Hiroko Iijima
- Department of Gastroenterology, Hyogo Medical University, Nishinomiya, Japan
| | - Etsuro Hatano
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Hepato-Biliary-Pancreatic Surgery, Hyogo Medical University, Nishinomiya, Japan.
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Chauvet P, Enguix A, Sautou V, Slim K. A systematic review comparing the safety, cost and carbon footprint of disposable and reusable laparoscopic devices. J Visc Surg 2024; 161:25-31. [PMID: 38272757 DOI: 10.1016/j.jviscsurg.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
INTRODUCTION The objective of this systematic review of the literature is to compare a selection of currently utilized disposable and reusable laparoscopic medical devices in terms of safety (1st criteria), cost and carbon footprint. MATERIAL AND METHODS A search was carried out on electronic databases for articles published up until 6 May 2022. The eligible works were prospective (randomized or not) or retrospective clinical or medical-economic comparative studies having compared disposable scissors, trocars, and mechanical endoscopic staplers to the same instruments in reusable. Two different independent examiners extracted the relevant data. RESULTS Among the 2882 articles found, 156 abstracts were retained for examination. After comprehensive analysis concerning the safety and effectiveness of the instruments, we included four articles. A study on trocars highlighted increased vascular complications with disposable instruments, and another study found more perioperative incidents with a hybrid stapler as opposed to a disposable stapler. As regards cost analysis, we included 11 studies, all of which showed significantly higher costs with disposable instruments. The results of the one study on carbon footprints showed that hybrid instruments leave four times less of a carbon footprint than disposable instruments. CONCLUSION The literature on the theme remains extremely limited. Our review demonstrated that from a medical and economic standpoint, reusable medical instruments, particularly trocars, presented appreciable advantages. While there exist few data on the ecological impact, those that do exist are unmistakably favorable to reusable instruments.
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Affiliation(s)
- Pauline Chauvet
- Gynecology and Obstetrics Department, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France.
| | - Audrey Enguix
- Pharmacy Department, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Valérie Sautou
- Clermont Auvergne University, CHU de Clermont Ferrand, Clermont Auvergne INP, CNRS, ICCF, 63000 Clermont-Ferrand, France
| | - Karem Slim
- Digestive Surgery Department CHU de Clermont-Ferrand, Clermont-Ferrand, France; Collectif d'Eco-Responsabilité En Santé, Beaumont, France
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Shapira SS, Ehrlich Z, Koren P, Sroka G. Comparing a novel wide field of view laparoscope with conventional laparoscope while performing laparoscopic cholecystectomy. Surg Endosc 2023; 37:8910-8918. [PMID: 37735219 DOI: 10.1007/s00464-023-10393-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/13/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND The limited 70° field of view (FoV) used in standard laparoscopy necessitates maneuvering the laparoscope to view the ports, follow the surgical tools, and search for a target region. Complications related to events that take place outside the FoV are underreported. Recently, a novel laparoscopic system (SurroundScope, 270Surgical) was reported to dramatically expand the FoV from 70 to 270°. This study focuses on differences in performing laparoscopic cholecystectomy using the SurroundScope compared to the standard laparoscope. METHODS Forty-four laparoscopic surgeries were performed and video recorded. A subanalysis of 21 Cholecystectomies was performed and compared to 21 Cholecystectomies, performed with the standard laparoscope during the study period by the same surgeon. RESULTS No accidental or intraoperative adverse events occurred when using the SurroundScope. Subanalysis of 21 Cholecystectomies revealed shorter fog/smoke cleaning times using the SurroundScope compared to the standard scope (1.45 ± 5.08 sec vs. 54.95 ± 137.77 sec, p = 0.0454). Furthermore, operations performed with the SurroundScope had a shorter trocar placement duration (85.0 ± 40.9 sec vs. 111.3 ± 70.5 sec; p = 0.077), shorter time to achieve critical view of safety (9.5 ± 4.14 min vs. 15.8 ± 11.87 min; p = 0.015), and shorter procedure duration (31.9 ± 10.4 min vs. 42.9 ± 22 min; p = 0.025). In post-operative evaluations, the surgeon noted that tools could be continuously followed and ports were visible without camera manipulation. Also, the surgeon agreed that the procedure could be better planned due to the wide FoV and that surgical workflow was improved. Furthermore, the surgeon agreed that the procedure was safer using the SurroundScope. CONCLUSIONS Initial results demonstrate the advantages of the SurroundScope over standard laparoscopy. By expanding the FoV, visualization is improved, the procedure is more efficient, significantly shorter and most important, patient safety, per surgeons' testimonials is improved. Further investigation to quantify these benefits in a larger group of patients and among various surgical procedures should be considered.
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Affiliation(s)
| | - Zvi Ehrlich
- Department of Obstetrics and Gynaecology, Shaare Zedek Medical Centre, Hebrew University, Jerusalem, Israel
| | - Pazit Koren
- Department of Surgery, Bnai Zion Medical Center, Haifa, Israel
| | - Gideon Sroka
- Department of Surgery, Bnai Zion Medical Center, Haifa, Israel.
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Zadey S, Leraas H, Gupta A, Biswas A, Hollier P, Vissoci JRN, Mugaga J, Ssekitoleko RT, Everitt JI, Loh AHP, Lee YT, Saterbak A, Mueller JL, Fitzgerald TN. KeyLoop retractor for global gasless laparoscopy: evaluation of safety and feasibility in a porcine model. Surg Endosc 2023; 37:5943-5955. [PMID: 37074419 PMCID: PMC10338623 DOI: 10.1007/s00464-023-10054-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 03/26/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND Many surgeons in low- and middle-income countries have described performing surgery using gasless (lift) laparoscopy due to inaccessibility of carbon dioxide and reliable electricity, but the safety and feasibility of the technique has not been well documented. We describe preclinical testing of the in vivo safety and utility of KeyLoop, a laparoscopic retractor system to enable gasless laparoscopy. METHODS Experienced laparoscopic surgeons completed a series of four laparoscopic tasks in a porcine model: laparoscopic exposure, small bowel resection, intracorporeal suturing with knot tying, and cholecystectomy. For each participating surgeon, the four tasks were completed in a practice animal using KeyLoop. Surgeons then completed these tasks using standard-of-care (SOC) gas laparoscopy and KeyLoop in block randomized order to minimize learning curve effect. Vital signs, task completion time, blood loss and surgical complications were compared between SOC and KeyLoop using paired nonparametric tests. Surgeons completed a survey on use of KeyLoop compared to gas laparoscopy. Abdominal wall tissue was evaluated for injury by a blinded pathologist. RESULTS Five surgeons performed 60 tasks in 15 pigs. There were no significant differences in times to complete the tasks between KeyLoop and SOC. For all tasks, there was a learning curve with task completion times related to learning the porcine model. There were no significant differences in blood loss, vital signs or surgical complications between KeyLoop and SOC. Eleven surgeons from the United States and Singapore felt that KeyLoop could be used to safely perform several common surgical procedures. No abdominal wall tissue injury was observed for either KeyLoop or SOC. CONCLUSIONS Procedure times, blood loss, abdominal wall tissue injury and surgical complications were similar between KeyLoop and SOC gas laparoscopy for basic surgical procedures. This data supports KeyLoop as a useful tool to increase access to laparoscopy in low- and middle-income countries.
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Affiliation(s)
- Siddhesh Zadey
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA.
- Association for Socially Applicable Research (ASAR), Pune, MH, India.
| | - Harold Leraas
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Aryaman Gupta
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, USA
| | - Arushi Biswas
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
| | | | - Joao Ricardo Nickenig Vissoci
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
| | - Julius Mugaga
- Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Jeffrey I Everitt
- Department of Pathology, Duke University of School of Medicine, Durham, NC, USA
| | - Amos H P Loh
- Duke-NUS Medical School, SingHealth Duke-NUS Global Health Institute, Singapore, Singapore
| | - York Tien Lee
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore, Singapore
| | - Ann Saterbak
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, USA
| | - Jenna L Mueller
- Fischell Department of Bioengineering, University of Maryland, College Park, MD, USA
- Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tamara N Fitzgerald
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
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Nillahoot N, Pillai BM, Sharma B, Wilasrusmee C, Suthakorn J. Interactive 3D Force/Torque Parameter Acquisition and Correlation Identification during Primary Trocar Insertion in Laparoscopic Abdominal Surgery: 5 Cases. SENSORS (BASEL, SWITZERLAND) 2022; 22:8970. [PMID: 36433567 PMCID: PMC9698636 DOI: 10.3390/s22228970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/08/2022] [Accepted: 11/17/2022] [Indexed: 06/16/2023]
Abstract
Laparoscopic procedures have become indispensable in gastrointestinal surgery. As a minimally invasive process, it begins with primary trocar insertion. However, this step poses the threat of injuries to the gastrointestinal tract and blood vessels. As such, the comprehension of the insertion process is crucial to the development of robotic-assisted/automated surgeries. To sustain robotic development, this research aims to study the interactive force/torque (F/T) behavior between the trocar and the abdomen during the trocar insertion process. For force/torque (F/T) data acquisition, a trocar interfaced with a six-axis F/T sensor was used by surgeons for the insertion. The study was conducted during five abdominal hernia surgical cases in the Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University. The real-time F/T data were further processed and analyzed. The fluctuation in the force/torque (F/T) parameter was significant, with peak force ranging from 16.83 N to 61.86 N and peak torque ranging from 0.552 Nm to 1.76 Nm. The force parameter was observed to positively correlate with procedural time, while torque was found to be negatively correlated. Although during the process a surgeon applied force and torque in multiple axes, for a robotic system, the push and turn motion in a single axis was observed to be sufficient. For minimal tissue damage in less procedural time, a system with low push force and high torque was observed to be advantageous. These understandings will eventually benefit the development of computer-assisted or robotics technology to improve the outcome of the primary trocar insertion procedure.
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Affiliation(s)
- Nantida Nillahoot
- Department of Biomedical Engineering, Center for Biomedical and Robotics Technology (BART LAB), Faculty of Engineering, Mahidol University, Nakhon Pathom 73170, Thailand
| | - Branesh M. Pillai
- Department of Biomedical Engineering, Center for Biomedical and Robotics Technology (BART LAB), Faculty of Engineering, Mahidol University, Nakhon Pathom 73170, Thailand
| | - Bibhu Sharma
- Department of Biomedical Engineering, Center for Biomedical and Robotics Technology (BART LAB), Faculty of Engineering, Mahidol University, Nakhon Pathom 73170, Thailand
| | - Chumpon Wilasrusmee
- Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Jackrit Suthakorn
- Department of Biomedical Engineering, Center for Biomedical and Robotics Technology (BART LAB), Faculty of Engineering, Mahidol University, Nakhon Pathom 73170, Thailand
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10
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Spiller M, Bruennel M, Grosse V, Sühn T, Esmaeili N, Stockheim J, Turial S, Croner R, Boese A, Friebe M, Illanes A. Surgeons' requirements for a surgical support system to improve laparoscopic access. BMC Surg 2022; 22:279. [PMID: 35854297 PMCID: PMC9297603 DOI: 10.1186/s12893-022-01724-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 07/11/2022] [Indexed: 11/12/2022] Open
Abstract
Creating surgical access is a critical step in laparoscopic surgery. Surgeons have to insert a sharp instrument such as the Veress needle or a trocar into the patient’s abdomen until the peritoneal cavity is reached. They solely rely on their experience and distorted tactile feedback in that process, leading to a complication rate as high as 14% of all cases. Recent studies have shown the feasibility of surgical support systems that provide intraoperative feedback regarding the insertion process to improve laparoscopic access outcomes. However, to date, the surgeons’ requirements for such support systems remain unclear. This research article presents the results of an explorative study that aimed to acquire data about the information that helps surgeons improve laparoscopic access outcomes. The results indicate that feedback regarding the reaching of the peritoneal cavity is of significant importance and should be presented visually or acoustically. Finally, a solution should be straightforward and intuitive to use, should support or even improve the clinical workflow, but also cheap enough to facilitate its usage rate. While this study was tailored to laparoscopic access, its results also apply to other minimally invasive procedures.
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Affiliation(s)
- Moritz Spiller
- INKA-Innovation Laboratory for Image Guided Therapy (IGTLAB), Medical Faculty, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany.
| | | | | | - Thomas Sühn
- INKA-Innovation Laboratory for Image Guided Therapy (IGTLAB), Medical Faculty, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Nazila Esmaeili
- INKA-Innovation Laboratory for Image Guided Therapy (IGTLAB), Medical Faculty, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Jessica Stockheim
- Department of General, Visceral, Vascular and Transplantation Surgery, Medical Faculty, University Hospital Magdeburg, Magdeburg, Germany
| | - Salmai Turial
- Department of Pediatric Surgery, Department of General, Visceral, Vascular and Transplantation Surgery, Medical Faculty, University Hospital Magdeburg, Magdeburg, Germany
| | - Roland Croner
- Department of General, Visceral, Vascular and Transplantation Surgery, Medical Faculty, University Hospital Magdeburg, Magdeburg, Germany
| | - Axel Boese
- INKA-Innovation Laboratory for Image Guided Therapy (IGTLAB), Medical Faculty, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Michael Friebe
- Otto-von-Guericke-University Magdeburg, Magdeburg, Germany.,Department of Measurement and Electronics, AGH University of Science and Technology, Kraków, Poland
| | - Alfredo Illanes
- INKA-Innovation Laboratory for Image Guided Therapy (IGTLAB), Medical Faculty, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
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11
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Preoperative prediction of inadvertent enterotomy during adhesive small bowel obstruction surgery using combination of CT features. Eur Radiol 2022; 32:6646-6657. [PMID: 35763093 DOI: 10.1007/s00330-022-08951-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 06/02/2022] [Accepted: 06/08/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The purpose of this study was to identify the preoperative CT features that are associated with inadvertent enterotomy (IE) during adhesive small bowel obstruction (ASBO) surgery. METHODS From January 2015 to December 2019, all patients with ASBO who underwent an abdominal CT were reviewed. Abdominal CT were retrospectively reviewed by two radiologists with a consensus read in case of disagreement. IE during ASBO surgery was retrospectively recorded. Univariate and multivariate analyses of CT features associated with IE were performed and a simple CT score was built to stratify the risk of IE. This score was validated in an independent retrospective cohort. Abdominal CT of the validation cohort was reviewed by a third independent reader. RESULTS Among the 368 patients with ASBO during the study period, 169 were surgically treated, including 129 ASBO for single adhesive band and 40 for matted adhesions. Among these, there were 47 IE. By multivariate analysis, angulation of the transitional zone (OR = 4.19, 95% CI [1.10-18.09]), diffuse intestinal adhesions (OR = 4.87, 95% CI [1.37-19.76]), a fat notch sign (OR = 0.32, 95% CI [0.12-0.85]), and mesenteric haziness (OR = 0.13, 95% CI [0.03-0.48]) were independently associated with inadvertent enterotomy occurrence. The simple CT score built to stratify risk of IE displayed an AUC of 0.85 (95% CI [0.80-0.90]) in the study sample and 0.88 (95% CI [0.80-0.96]) in the validation cohort. CONCLUSION A simple preoperative CT score is able to inform the surgeon about a high risk of IE and therefore influence the surgical procedure. KEY POINTS • In this retrospective study of 169 patients undergoing abdominal surgery for adhesive small bowel obstruction, 47 (28%) inadvertent enterotomy occurred. • A simple preoperative CT score enables accurate stratification of inadvertent enterotomy risk (area under the curve 0.85). • By multivariable analysis, diffuse intestinal adhesions and angulation of the transitional zone were predictive of inadvertent enterotomy occurrence.
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Yumioka T, Honda M, Teraoka S, Kimura Y, Iwamoto H, Morizane S, Hikita K, Takenaka A. The Influence of Prior Abdominal Surgery on Robot-Assisted Partial Nephrectomy. Yonago Acta Med 2021; 64:184-191. [PMID: 34025193 DOI: 10.33160/yam.2021.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/14/2021] [Indexed: 11/05/2022]
Abstract
Background We evaluated the influence of prior abdominal surgery on perioperative outcomes in patients who underwent robot-assisted partial nephrectomy in initial Japanese series. Methods We reviewed patients with small renal tumors who underwent robot-assisted partial nephrectomy from October 2011 to September 2020 at our institution. Patients with prior abdominal surgery were compared with those without prior surgery based on perioperative outcomes. The chi-square test and Mann-Whitney U test were used for statistical analyses of variables. Results Of 156 patients who underwent robot-assisted partial nephrectomy, 90 (58%) had no prior abdominal surgery, whereas 66 patients (42%) underwent prior abdominal surgery. No significant differences in perioperative outcomes were observed between with and without prior abdominal surgery groups. In transperitoneal approach robot-assisted partial nephrectomy, 31 patients (80.4%) had prior abdominal surgery. Trocar insertion time in the with prior abdominal surgery group took longer than the without prior abdominal surgery group (32 vs. 28.5 min, P = 0.031). No significant difference was observed in the conversion rate between the two groups (P = 0.556). Conclusion Robot-assisted partial nephrectomy appears to be a safe approach for patients with prior abdominal surgery. In transperitoneal approach robot-assisted partial nephrectomy with prior abdominal surgery, trocar insertion time was longer, but no significant differences were found in other outcomes. Transperitoneal approach robot-assisted partial nephrectomy is thus considered a safe procedure for patients with prior abdominal surgery.
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Affiliation(s)
- Tetsuya Yumioka
- Division of Urology, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Masashi Honda
- Division of Urology, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Shogo Teraoka
- Division of Urology, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Yusuke Kimura
- Division of Urology, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Hideto Iwamoto
- Division of Urology, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Shuichi Morizane
- Division of Urology, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Katsuya Hikita
- Division of Urology, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Atsushi Takenaka
- Division of Urology, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
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13
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Udwadia TE. Method for safe Verres needle entry at the umbilicus, with modification for first trocar entry to reduce the complication rate of first entry. J Minim Access Surg 2021; 17:329-336. [PMID: 33885028 PMCID: PMC8270035 DOI: 10.4103/jmas.jmas_235_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Initial intraperitoneal access and first trocar entry are responsible for nearly half of all complications of laparoscopic surgery. The purpose of this article is to detail our method of initial intraperitoneal access with Veress needle and first trocar at the umbilicus used over the past 28 years. Patients and Methods Since 1990, a single surgeon performed laparoscopic surgery in 7600 patients. From 1992 onward, 6975 patients underwent laparoscopic surgery. On assessment, 739 cases (10.6%) were found unsuitable for Veress needle entry at the umbilicus. The remaining, 6236, patients form the study group for this article. Every patient was operated in the identical, repetitive manner. Every detail was considered important. The method of the first trocar entry is modified to minimise complications of this manoeuvre. Results The average time from cleaning umbilicus again to Veress needle tip in peritoneum was 1 min 40 s (25 s-7 min). Out of the 4228 patients in whom no adhesions were observed at first trocar entry (Group 1), the Veress needle insertion was successful at first attempt in 3829 (90.5%) patients, at second attempt in 322 (7.6%) and at third attempt in 30 (0.7%). In the 2008 patients with significant adhesions observed after first trocar entry (Group 2), successful insertion of the Veress needle was achieved at first attempt in 1700 (84.6%) patients, at second attempt in 182 (9%) and at third attempt in 19 (0.9%). In this group, there was one bowel injury (0.05%) and 3 (0.15%) minor vascular injuries. There was no mortality in either group. In the overall series, the Veress needle was successfully introduced in 6082 of the 6236 patients (97.5%) and 154 patients (2.4%) failed Veress needle entry. The incidence of bowel injury in the series was 0.016% and that of minor vascular injuries was 0.048%. Conclusions Initial intraperitoneal access must be performed with utmost caution after adequate training and proctorship. This paper stresses with meticulous attention to every detail, this safe, method of initial intraperitoneal access leads to low complication rates.
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Affiliation(s)
- Tehemton Erach Udwadia
- Department of Surgery, Grant Medical College and J. J. Hospital; Breach Candy Hospital and Medical Research Centre; Department of Surgery, B. D. Petit Parsee General Hospital; Department of Minimal Access Surgery, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
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14
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Vilos GA, Ternamian A, Laberge PY, Vilos AG, Abu-Rafea B, Scattolon S, Leyland N. Directive clinique n° 412: Entrée laparoscopique en chirurgie gynécologique. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 43:390-405.e1. [PMID: 33373696 DOI: 10.1016/j.jogc.2020.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Vilos GA, Ternamian A, Laberge PY, Vilos AG, Abu-Rafea B, Scattolon S, Leyland N. Guideline No. 412: Laparoscopic Entry for Gynaecological Surgery. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 43:376-389.e1. [PMID: 33373697 DOI: 10.1016/j.jogc.2020.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the benefits and risks of laparoscopic surgery and provide clinical direction on entry techniques, technologies, and their associated complications in gynaecological surgery. TARGET POPULATION All patients, including pregnant women and women with obesity, undergoing laparoscopic surgery for various gynaecological indications. OPTIONS The laparoscopic entry techniques and technologies reviewed in formulating this guideline included the closed (Veress needle-pneumoperitoneum-trocar) technique, direct trocar insertion, open (Hasson) technique, visual entry systems, and disposable shielded and radially expanding trocars. OUTCOMES Implementation of this guideline should optimize decision-making in the selection of entry technique for laparoscopic surgery. EVIDENCE We searched English-language articles from September 2005 to December 2019 in PubMed/MEDLINE, Embase, Science Direct, Scopus, and Cochrane Library using the following MeSH search terms alone or in combination: laparoscopic entry, laparoscopy access, pneumoperitoneum, Veress needle, open (Hasson), direct trocar, visual entry, shielded trocars, radially expanded trocars, and laparoscopic complications. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Canadian Task Force on Preventive Health Care approach (Appendix A). INTENDED AUDIENCE Surgeons performing laparoscopic gynaecological surgery. SUMMARY STATEMENTS RECOMMENDATIONS.
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Abstract
This review article summarizes the epidemiology of vascular injuries during urologic surgery and discusses intraoperative strategies to control bleedings. Techniques of vascular approaches (arteries and veins) are discussed and tricks for vascular repair are explained. Generally, vascular injuries during urologic surgery are rare. However, hemorrhage due to vascular injury is a common cause of critical morbidity and mortality in the perioperative period. Susceptibility to vascular complications such as oncological debulking and revision surgery increase risk for damage. As vascular injuries range from arrosion to avulsion, treatment is also broad, ranging from vascular suture to open or endovascular repair. Prevention of exsanguination requires visual control to stop the bleeding. The surgeon must act quickly to initiate appropriate repair, aiming for damage control and stabilization of the patient. Planning the surgery and consulting an experienced surgeon are decisive for successful management. Catastrophic bleeding has to be controlled and in the case of arterial injury it is often necessary to reconstitute perfusion. Reconstructions such as vascular anastomoses, patch angioplasty or interposition grafts are the preferred surgical techniques which are influenced by the nature of the injury. Vessels have to be thoroughly prepared before cross clamping to prevent injury by vascular clamps. Veins can often be ligated. Endovascular repair is also a possibility to control the bleeding, but nowadays it is often a definitive therapy method. For example, resuscitative endovascular balloon occlusion is useful to stabilize the patient and then to initiate vascular repair. Depending on the type of surgery performed, different vessels are concerned. Severe bleeding is usually located retroperitoneal affecting the aorta, renovisceral and iliac vessels. Predisposing urologic operations are lymphadenectomy, nephrectomy and (cysto)prostatectomy and also the laparoscopic approach can cause bleeding complications.
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Affiliation(s)
- J D Süss
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, St. Antonius Hospital gGmbH Eschweiler, Akademisches Lehrkrankenhaus der RWTH Aachen, Dechant-Deckers-Straße 8, 52249, Eschweiler, Deutschland.
| | - J Kranz
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, St. Antonius Hospital gGmbH Eschweiler, Akademisches Lehrkrankenhaus der RWTH Aachen, Dechant-Deckers-Straße 8, 52249, Eschweiler, Deutschland
| | - M Gawenda
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, St. Antonius Hospital gGmbH Eschweiler, Akademisches Lehrkrankenhaus der RWTH Aachen, Dechant-Deckers-Straße 8, 52249, Eschweiler, Deutschland
| | - J Steffens
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, St. Antonius Hospital gGmbH Eschweiler, Akademisches Lehrkrankenhaus der RWTH Aachen, Dechant-Deckers-Straße 8, 52249, Eschweiler, Deutschland
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Uslu Yuvaci H, Cevrioğlu AS, Gündüz Y, Akdemir N, Karacan A, Erkorkmaz Ü, Keskin A. Does applied ultrasound prior to laparoscopy predict the existence of intra-abdominal adhesions? Turk J Med Sci 2020; 50:304-311. [PMID: 31905491 PMCID: PMC7164757 DOI: 10.3906/sag-1910-61] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/01/2020] [Indexed: 01/24/2023] Open
Abstract
Background/aim The purpose of this study was to evaluate the efficacy of trans-abdominal ultrasonography (USG), a noninvasive diagnostic tool, in predicting the presence of intraabdominal adhesions, especially near the trocar entry area, to provide safe surgical access to the abdomen. Materials and methods Fifty-nine women with a previous history of open abdominal surgery (group A) and a group of 91 women with no previous history of surgery (group B) underwent dynamic ultrasound evaluation of the abdominal fields before laparoscopic operations. The anterior abdominal wall was divided into six quadrants: right upper, right lower, left upper, left lower, suprapubic, and umbilical. Adhesions were evaluated by surgeons during the operation and by radiologists using USG prior to the operation. Visceral organ movements greater than 1 cm was defined as normal visceral slide (positive test), with less than 1 cm of movement defined as abnormal visceral slide (negative test). Sliding test measures movements of omental echogenicity or a stable echogenic focus that corresponds to intestine peritoneal echogenicity that underlies abdominal wall during exaggerated inspiration and expiration. Adhesions observed during surgery were evaluated on a four-point scale, with 0 indicating no adhesions present, 1 indicating the presence of a thin, filmy avascular adhesion, 2 indicating the presence of a dense and vascular adhesion, and 3 indicating adhesions that connect surrounding organs with the overlying peritoneal surfaces. The McNemar test was used to compare the results of USG and laparoscopy for each measure. Results We found that preoperative USG was successful in identifying adhesions [sensitivity, 96.39% (95% CI 89.8–99.2); specificity, 97.43%] Conclusion Preoperative ultrasound examination of the abdominal wall may enhance the safety of abdominal entry during laparoscopic operations.
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Affiliation(s)
- Hilal Uslu Yuvaci
- Department of Obstetrics and Gynecology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Arif Serhan Cevrioğlu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Yasemin Gündüz
- Department of Radiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Nermin Akdemir
- Department of Obstetrics and Gynecology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Alper Karacan
- Department of Radiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Ünal Erkorkmaz
- Department of Biostatistics, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Abdurrahim Keskin
- Department of Obstetrics and Gynecology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
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Breish MO, Whiting D, Sriprasad S. Laparoscopic Nephrectomy in Patients with Previous Abdominal Surgery. Cureus 2020; 12:e6991. [PMID: 32190519 PMCID: PMC7061772 DOI: 10.7759/cureus.6991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Laparoscopic nephrectomy is a minimally invasive procedure that provides significant benefits to the patient, such as reduced analgesic requirements and shorter recovery time. While the popularity of laparoscopy has grown substantially, there are associated risks of injury to the blood vessels and/or viscera during the insertion of the laparoscopic ports. Such injuries can lead to a significant increase in mortality rates. Patients who have had previous abdominal surgery have a higher risk of adhesions; this has been shown to increase the risk of complications from port placement. Consequently, previous abdominal surgery was viewed as a relative contraindication to laparoscopic surgery. However, studies have demonstrated the advantages of laparoscopic surgery over an open radical approach; hence, previous abdominal surgery is no longer viewed as a contraindication. Here, we describe the case of a 62-year-old man who presented with an incidental finding of right renal cell carcinoma (RCC). We performed a radical nephrectomy on this patient who had undergone multiple previous abdominal surgeries. During this procedure, a small bowel injury occurred. Herein, we review the available evidence and describe the risk factors and techniques to avoid injury from laparoscopic port-site placement in patients undergoing nephrectomy with a history of previous abdominal surgery.
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19
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Gerner-Rasmussen J, Donatsky AM, Bjerrum F. The role of non-invasive imaging techniques in detecting intra-abdominal adhesions: a systematic review. Langenbecks Arch Surg 2019; 404:653-661. [PMID: 30483880 DOI: 10.1007/s00423-018-1732-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 11/20/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Intra-abdominal adhesions after surgery are highly prevalent. Adhesions implicate complications during subsequent surgery and can cause chronic abdominal pain. The objective of this review was to investigate the usefulness of non-invasive diagnostic methods for detection of adhesions. METHODS We searched the electronic databases: MEDLINE, Embase, and The Cochrane Central Register of Controlled Trials for studies investigating the use of non-invasive diagnostic imaging techniques for detecting adhesions. Main outcome was the sensitivity and specificity of each technique. We used the Quality Assessment of Diagnostic Accuracy studies tool to assess bias. RESULTS In total, 25 studies were included: 18 using ultrasound (US), 5 using magnetic resonance imaging (MRI), 1 using computed tomography (CT), and 1 using both US and MRI. A total of 2195 patients were included. Overall accuracy ranged between 76 and 100% for US studies and between 79 and 90% for MRI and was 66% for CT. Sensitivity ranged between 21 and 100% for US and between 22 and 93% for MRI and was 61% for CT. Specificity was 32-100% for US, 25-93% for MRI, and 63% for CT. Bias analysis revealed that in most studies, investigators were blinded to the reference standard but not to the index test and 11 of 25 studies had a high risk of selection bias. CONCLUSIONS Currently, abdominal US can be used to determine the presence of adhesions between bowel and the abdominal wall. MRI is also an accurate diagnostic modality and can in addition visualize adhesions between viscera, however, with a tendency to over diagnose adhesions. There is insufficient evidence to support CT as a diagnostic modality for adhesions.
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Affiliation(s)
- Jonas Gerner-Rasmussen
- Department of Surgery, Slagelse Hospital, University of Copenhagen, Faelledvej 11, 4200, Slagelse, Denmark.
| | | | - Flemming Bjerrum
- Department of Surgery, Herlev Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
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20
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Leevan E, Carmichael JC. Iatrogenic bowel injury (early vs delayed). SEMINARS IN COLON AND RECTAL SURGERY 2019. [DOI: 10.1016/j.scrs.2019.100688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ciravolo G, Donarini P, Rampinelli F, Visenzi C, Odicino F. Laparoscopic Access with Optical Gasless Trocar: A Single-center Experience of 7431 Procedures. J Minim Invasive Gynecol 2019; 27:535-540. [PMID: 31301469 DOI: 10.1016/j.jmig.2019.03.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/12/2019] [Accepted: 03/28/2019] [Indexed: 10/26/2022]
Abstract
STUDY OBJECTIVE To analyze the complications experienced and describe laparoscopic surgery using a gasless optical trocar. DESIGN A retrospective study. SETTING A department of obstetrics and gynecology in a tertiary center in Italy. PATIENTS Seven thousand four hundred thirty-one surgical procedures were performed. INTERVENTIONS From the hospital database, data were evaluated regarding major complications of laparoscopy with the ENDOPATH XCEL Bladeless Trocar (Ethicon, Johnson & Johnson, Somerville, NJ) performed between 2000 and 2017 by different laparoscopic surgeons. MEASUREMENTS AND MAIN RESULTS The mean age of the patients was 40.66 ± 12.06 years (range, 13-91 years). The mean body mass index was 22.12 ± 3.64 kg/m2 (range, 15.74-41.51 kg/m2). The overall complication rate was 0.31% (23/7431 cases). Major complications included stomach perforation in 1 procedure (0.014%), ileal perforation in 2 procedures (0.028%), and blood vessel perforation in 1 procedure (0.014%). Twelve procedures were completed with initial access through the omentum and 2 through an ovarian cyst. In 5 procedures (0.067%), conversion to laparotomy was required because the optical trocar failed to reach the abdominal cavity. With regard to complications requiring further intervention (n = 9), the rate of complications was 0.12%. CONCLUSIONS The optical gasless trocar is a feasible laparoscopic entry technique. The complication rate is lower than those reported previously.
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Affiliation(s)
- Giuseppe Ciravolo
- Department of Obstetrics and Gynecology, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia, Italy (Drs. Ciravolo, Donarini, and Rampinelli)
| | - Paolo Donarini
- Department of Obstetrics and Gynecology, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia, Italy (Drs. Ciravolo, Donarini, and Rampinelli).
| | - Fabio Rampinelli
- Department of Obstetrics and Gynecology, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia, Italy (Drs. Ciravolo, Donarini, and Rampinelli)
| | - Chiara Visenzi
- Department of Obstetrics and Gynecology, Fondazione Poliambulanza, Brescia, Italy (Dr. Visenzi)
| | - Franco Odicino
- Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy (Mr. Odicino)
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Vilos GA, Ternamian A, Dempster J, Laberge PY. No. 193-Laparoscopic Entry: A Review of Techniques, Technologies, and Complications. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019. [PMID: 28625296 DOI: 10.1016/j.jogc.2017.04.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To provide clinical direction, based on the best evidence available, on laparoscopic entry techniques and technologies and their associated complications. OPTIONS The laparoscopic entry techniques and technologies reviewed in formulating this guideline include the classic pneumoperitoneum (Veress/trocar), the open (Hasson), the direct trocar insertion, the use of disposable shielded trocars, radially expanding trocars, and visual entry systems. OUTCOMES Implementation of this guideline should optimize the decision-making process in choosing a particular technique to enter the abdomen during laparoscopy. EVIDENCE English-language articles from Medline, PubMed, and the Cochrane Database published before the end of September 2005 were searched, using the key words laparoscopic entry, laparoscopy access, pneumoperitoneum, Veress needle, open (Hasson), direct trocar, visual entry, shielded trocars, radially expanded trocars, and laparoscopic complications. VALUES The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on the Periodic Health Examination. RECOMMENDATIONS AND SUMMARY STATEMENT.
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Pantoja Garrido M, Frías Sánchez Z, Zapardiel Gutiérrez I, Torrejón R, Jiménez Sánchez C, Polo Velasco A, Márquez Maraver F, Rodríguez Jiménez I, Jiménez Gallardo J, Fernández Alba JJ. Direct trocar insertion without previous pneumoperitoneum versus insertion after insufflation with Veress needle in laparoscopic gynecological surgery: a prospective cohort study. J OBSTET GYNAECOL 2019; 39:1000-1005. [PMID: 31210067 DOI: 10.1080/01443615.2019.1590804] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The aim of this study was to determine whether direct trocar entry without prior pneumoperitoneum at umbilical level (DTI) can be a safe alternative to access the abdominal cavity in gynaecological laparoscopic surgery. We present a prospective observational analytical study of cohorts, comparing DTI with umbilical entry with trocar after previous insufflation with a Veress needle at umbilical level (V). The study period was performed from June 2013 to April 2016; data was collected on 600 patients who underwent gynaecological laparoscopic surgery. There were no significant differences in the risk of suffering a complication during the access manoeuvres between DTI (6.49%) and V (7.39%), OR 0.89 (95% CI: 0.42-1.81). The duration of the access manoeuvres was 69 s in DTI and 193 s in V (p < .001). The percentage of patients in whom two or more access attempts were performed was lower in DTI (7.8%) than in V (12.3%) (p > .05). We concluded that DTI is at least as safe as V, regarding the risk of suffering complications arising from access into the abdominal cavity. DTI has advantages with regard to V, such as: the shorter duration of access manoeuvres or the lesser number of unsuccessful entry or insufflation attempts. Impact statement What is already known on this subject? There are few international publications comparing DTI and V. When we conducted a search in PubMed for the terms 'Veress needle and direct trocar insertion', 51 publications were obtained. When we increased the restriction and added the terms 'laparoscopic entry and laparoscopy complications', 27 publications were obtained; thus, the uniqueness of our study. What do the results of this study add? We present a 3-year observational prospective study of cohorts that included 600 patients. The aim of this study was to determine that in laparoscopic gynaecological surgery, DTI is an access method to the abdominal cavity at least as safe as V, with respect to the risk of complications. On the other hand, DTI has some advantages such as the shorter duration of access manoeuvres or the lower number of failed entry attempts. What are the implications of these findings for clinical practice and/or further research? Given the limited number of publications that compared both techniques, our study indicates that DTI can be a safe alternative for access to abdominal cavity in gynaecological surgery, compared to the traditional V.
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Affiliation(s)
- Manuel Pantoja Garrido
- Department of Gynecology and Obstetrics, University Hospital Virgen Macarena , Seville , Spain
| | - Zoraida Frías Sánchez
- Department of Gynecology and Obstetrics, University Hospital Virgen del Rocío , Seville , Spain
| | | | - Rafael Torrejón
- Department of Gynecology and Obstetrics, University Hospital Puerta del Mar , Cádiz , Spain
| | | | - Alfredo Polo Velasco
- Department of Gynecology and Obstetrics, University Hospital Virgen Macarena , Seville , Spain
| | | | | | - Julián Jiménez Gallardo
- Department of Gynecology and Obstetrics, University Hospital Virgen Macarena , Seville , Spain
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Ahmad G, Baker J, Finnerty J, Phillips K, Watson A, Cochrane Gynaecology and Fertility Group. Laparoscopic entry techniques. Cochrane Database Syst Rev 2019; 1:CD006583. [PMID: 30657163 PMCID: PMC6353066 DOI: 10.1002/14651858.cd006583.pub5] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Laparoscopy is a common procedure in many surgical specialties. Complications arising from laparoscopy are often related to initial entry into the abdomen. Life-threatening complications include injury to viscera (e.g. bowel, bladder) or to vasculature (e.g. major abdominal and anterior abdominal wall vessels). No clear consensus has been reached as to the optimal method of laparoscopic entry into the peritoneal cavity. OBJECTIVES To evaluate the benefits and risks of different laparoscopic entry techniques in gynaecological and non-gynaecological surgery. SEARCH METHODS We searched the Cochrane Gynaecology and Fertility (CGF) Group trials register, CENTRAL, MEDLINE, Embase, PsycINFO, and trials registers in January 2018. We also checked the references of articles retrieved. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared one laparoscopic entry technique versus another. Primary outcomes were major complications including mortality, vascular injury of major vessels and abdominal wall vessels, visceral injury of bladder or bowel, gas embolism, solid organ injury, and failed entry (inability to access the peritoneal cavity). Secondary outcomes were extraperitoneal insufflation, trocar site bleeding, trocar site infection, incisional hernia, omentum injury, and uterine bleeding. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, assessed risk of bias, and extracted data. We expressed findings as Peto odds ratios (Peto ORs) with 95% confidence intervals (CIs). We assessed statistical heterogeneity using the I² statistic. We assessed the overall quality of evidence for the main comparisons using GRADE methods. MAIN RESULTS The review included 57 RCTs including four multi-arm trials, with a total of 9865 participants, and evaluated 25 different laparoscopic entry techniques. Most studies selected low-risk patients, and many studies excluded patients with high body mass index (BMI) and previous abdominal surgery. Researchers did not find evidence of differences in major vascular or visceral complications, as would be anticipated given that event rates were very low and sample sizes were far too small to identify plausible differences in rare but serious adverse events.Open-entry versus closed-entryTen RCTs investigating Veress needle entry reported vascular injury as an outcome. There was a total of 1086 participants and 10 events of vascular injury were reported. Four RCTs looking at open entry technique reported vascular injury as an outcome. There was a total of 376 participants and 0 events of vascular injury were reported. This was not a direct comparison. In the direct comparison of Veress needle and Open-entry technique, there was insufficient evidence to determine whether there was a difference in rates of vascular injury (Peto OR 0.14, 95% CI 0.00 to 6.82; 4 RCTs; n = 915; I² = N/A, very low-quality evidence). Evidence was insufficient to show whether there were differences between groups for visceral injury (Peto OR 0.61, 95% CI 0.06 to 6.08; 4 RCTs; n = 915: I² = 0%; very low-quality evidence), or failed entry (Peto OR 0.45, 95% CI 0.14 to 1.42; 3 RCTs; n = 865; I² = 63%; very low-quality evidence). Two studies reported mortality with no events in either group. No studies reported gas embolism or solid organ injury.Direct trocar versus Veress needle entryTrial results show a reduction in failed entry into the abdomen with the use of a direct trocar in comparison with Veress needle entry (OR 0.24, 95% CI 0.17 to 0.34; 8 RCTs; N = 3185; I² = 45%; moderate-quality evidence). Evidence was insufficient to show whether there were differences between groups in rates of vascular injury (Peto OR 0.59, 95% CI 0.18 to 1.96; 6 RCTs; n = 1603; I² = 75%; very low-quality evidence), visceral injury (Peto OR 2.02, 95% CI 0.21 to 19.42; 5 RCTs; n = 1519; I² = 25%; very low-quality evidence), or solid organ injury (Peto OR 0.58, 95% Cl 0.06 to 5.65; 3 RCTs; n = 1079; I² = 61%; very low-quality evidence). Four studies reported mortality with no events in either group. Two studies reported gas embolism, with no events in either group.Direct vision entry versus Veress needle entryEvidence was insufficient to show whether there were differences between groups in rates of vascular injury (Peto OR 0.39, 95% CI 0.05 to 2.85; 1 RCT; n = 186; very low-quality evidence) or visceral injury (Peto OR 0.15, 95% CI 0.01 to 2.34; 2 RCTs; n = 380; I² = N/A; very low-quality evidence). Trials did not report our other primary outcomes.Direct vision entry versus open entryEvidence was insufficient to show whether there were differences between groups in rates of visceral injury (Peto OR 0.13, 95% CI 0.00 to 6.50; 2 RCTs; n = 392; I² = N/A; very low-quality evidence), solid organ injury (Peto OR 6.16, 95% CI 0.12 to 316.67; 1 RCT; n = 60; very low-quality evidence), or failed entry (Peto OR 0.40, 95% CI 0.04 to 4.09; 1 RCT; n = 60; very low-quality evidence). Two studies reported vascular injury with no events in either arm. Trials did not report our other primary outcomes.Radially expanding (STEP) trocars versus non-expanding trocarsEvidence was insufficient to show whether there were differences between groups in rates of vascular injury (Peto OR 0.24, 95% Cl 0.05 to 1.21; 2 RCTs; n = 331; I² = 0%; very low-quality evidence), visceral injury (Peto OR 0.13, 95% CI 0.00 to 6.37; 2 RCTs; n = 331; very low-quality evidence), or solid organ injury (Peto OR 1.05, 95% CI 0.07 to 16.91; 1 RCT; n = 244; very low-quality evidence). Trials did not report our other primary outcomes.Other studies compared a wide variety of other laparoscopic entry techniques, but all evidence was of very low quality and evidence was insufficient to support the use of one technique over another. AUTHORS' CONCLUSIONS Overall, evidence was insufficient to support the use of one laparoscopic entry technique over another. Researchers noted an advantage of direct trocar entry over Veress needle entry for failed entry. Most evidence was of very low quality; the main limitations were imprecision (due to small sample sizes and very low event rates) and risk of bias associated with poor reporting of study methods.
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Affiliation(s)
- Gaity Ahmad
- Pennine Acute Hospitals NHS TrustDepartment of Obstetrics and GynaecologyManchesterUK
| | - Jade Baker
- Pennine Acute Hospitals NHS TrustDepartment of Obstetrics and GynaecologyManchesterUK
| | | | - Kevin Phillips
- Castle Hill HospitalObstetrics and GynaecologyCastle RoadCottinghamNorth HumbersideUKHU16 5JQ
| | - Andrew Watson
- Tameside & Glossop Acute Services NHS TrustDepartment of Obstetrics and GynaecologyFountain StreetAshton‐Under‐LyneLancashireUKOL6 9RW
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Sanguandeekul N, Vallibhakara O, Arj-Ong Vallibhakara S, Sophonsritsuk A. Gastrointestinal injuries during gynaecologic operations at a university teaching hospital in Thailand: a 10-year review. J OBSTET GYNAECOL 2019; 39:384-388. [PMID: 30634877 DOI: 10.1080/01443615.2018.1525692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The objective of this study was to investigate the incidence of gastrointestinal injuries during gynaecologic operations, the management of such injuries and associated risk factors. This case-control study (1:4) examined patients who received gynaecologic operations from 2007 to 2016 in Ramathibodi Hospital. The study cases comprised patients who had gastrointestinal injuries, while the control cases comprised patients who had gynaecologic surgeries in the same period with matching the types of procedures. The 10-year incidence was 0.38% (104 cases of gastrointestinal injuries among a total of 27,520 cases). The most common injury site was the small bowel (43.3%). There were 102 cases (98%) of gastrointestinal injuries which were diagnosed intraoperatively and which were immediately repaired with successful outcomes. Logistic regression indicated that a pelvic adhesion, previous pelvic surgery and previous abdominal surgery were predictive risk factors associated with the injuries (odds ratios: 9.45, 3.20 and 11.84, respectively). An immediate consultation with a surgeon and surgical repair of the injury resulted in excellent outcomes. Impact statement What is already known about this subject? Gastrointestinal injury is a rare, but fatal complication of gynaecologic operations. The previous small study identified some risk factors such as surgical approach and pelvic surgery associated with the injury. What do the results of this study contribute? Our study identified the associated risk factors for gastrointestinal injury, including previous abdominal injury, pelvic adhesion and previous pelvic surgery. A previous abdominal surgery was the most associated risk factor. Patients with the history of abdominal surgery had an almost 4-fold higher odds ratio than the ones with previous pelvic surgery. Other factors, including endometriosis, ovarian cancer and subsequent oncological procedures, and surgical staging were less related to the gastrointestinal injury. What are the implications of these findings for clinical practice and/or further research? The knowledge is useful for pre-operative evaluation and preparation. Bowel preparation and consultation with surgeon are necessary for patients with these risk factors prior to their surgeries. Moreover, an immediate intra-operative surgical correction of the injury results in excellent outcomes.
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Affiliation(s)
- Nichaporn Sanguandeekul
- a Department of Obstetrics and Gynaecology , Faculty of Medicine Ramathibodi Hospital, Mahidol University , Bangkok , Thailand
| | - Orawin Vallibhakara
- b Reproductive Endocrinology and Infertility Unit, Department of Obstetrics and Gynaecology , Faculty of Medicine Ramathibodi Hospital, Mahidol University , Bangkok , Thailand
| | - Sakda Arj-Ong Vallibhakara
- c Section for Clinical Epidemiology and Biostatistics , Faculty of Medicine Ramathibodi, Mahidol University , Bangkok , Thailand
| | - Areepan Sophonsritsuk
- b Reproductive Endocrinology and Infertility Unit, Department of Obstetrics and Gynaecology , Faculty of Medicine Ramathibodi Hospital, Mahidol University , Bangkok , Thailand
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Chen CY, Elarbi M, Ragle CA, Fransson BA. Development and evaluation of a high-fidelity canine laparoscopic ovariectomy model for surgical simulation training and testing. J Am Vet Med Assoc 2019; 254:113-123. [DOI: 10.2460/javma.254.1.113] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Background and Objectives Rates of morbid obesity are skyrocketing worldwide. Not only bariatric surgeons, but also general surgeons are often operating on morbidly obese patients. Many general surgeons still use the same anatomic landmarks for patients with body mass index (BMI) over 35 mg/kg2 as they do for patients of normal weight and can therefore find accessing the morbidly obese abdominal organs difficult. This paper will describe a technique that is easily reproducible and applicable in a wide range of laparoscopic cases. Method The xiphoid process is the only landmark referenced. From the xiphoid process, the surgeon puts 2 fists together and places the first trocar inferiorly 2 cm lateral to the midline in either direction. The umbilicus is not used as a landmark. This placement is 15-18 cm inferior to the xiphoid process, but allows adequate visualization for any foregut case. An optical trocar is used. Results In over 1400 bariatric cases, the initial trocar was safely placed with this technique. Most of these cases were performed with the method, but some had one modification: the first trocar was placed in the midclavicular line in the subcostal area if there were previous midline scars. In no cases was an extra-long, or bariatric, trocar used. Conclusions Laparoscopic access in morbidly obese patients does not have to be difficult. Using an optical trocar off the midline 15-18 cm below the xiphoid process will provide reliable, safe access in the morbidly obese patient, with excellent visualization of the target anatomy.
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Cassata G, Palumbo V, Cicero L, De Luca A, Damiano G, Fazzotta S, Buscemi S, Lo Monte AI. OneShot-M: A New Device for Close Laparoscopy Pneumoperitoneum. Surg Innov 2018; 25:570-577. [PMID: 30196768 DOI: 10.1177/1553350618799542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The induction of pneumoperitoneum is the first and most critical phase of laparoscopy, due to the significant risk of serious vascular and visceral complications. The closed technique for the creation of pneumoperitoneum could lead to several surgical complications. The present study aimed to overcome the complications associated with the insertion of Veress needle, improving its use, and facilitating the rapid creation of pneumoperitoneum. METHODS Thirty large white female pigs were enrolled in our study. A common plunger was modified in order to allow the passage of a 15-cm long Veress needle. This method was applied to 26 laparoscopic procedures (26 pigs) of several specialist branches. RESULTS OneShot-M close laparoscopy pneumoperitoneum creation device allowed us to obtain pneumoperitoneum quickly in all attempts, without any intraoperative and postoperative complications related to the use of the Veress needle. CONCLUSION The use of the proposed device showed an induction time as quick as the standard laparoscopic closed abdominal entry. The patented device is cheap and allows a safe abdominal entry. In addition, abdominal entry is much faster than the classic open technique.
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Affiliation(s)
| | - Vincenzo Palumbo
- 2 Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy.,3 Euro-Mediterranean Institute of Science and Technology (IEMEST), Palermo, Italy
| | - Luca Cicero
- 1 "A. Mirri" Sicily Zooprophilactic Institute, Palermo, Italy
| | | | - Giuseppe Damiano
- 2 Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Salvatore Fazzotta
- 2 Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Salvatore Buscemi
- 2 Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
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Minimally invasive surgery techniques for the management of urgent or emergent small bowel pathology: A 2018 EAST Master Class Video Presentation. J Trauma Acute Care Surg 2018; 85:229-234. [DOI: 10.1097/ta.0000000000001889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Archivée: No 193-Entrée laparoscopique : Analyse des techniques, de la technologie et des complications. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017. [DOI: 10.1016/j.jogc.2017.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
Complications related to general pediatric surgery procedures are a major concern for pediatric surgeons and their patients. Although infrequent, when they occur the consequences can lead to significant morbidity and psychosocial stress. The purpose of this article is to discuss the common complications encountered during several common pediatric general surgery procedures including inguinal hernia repair (open and laparoscopic), umbilical hernia repair, laparoscopic pyloromyotomy, and laparoscopic appendectomy.
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Affiliation(s)
- Maria E Linnaus
- Department of Surgery, Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, Arizona 85016
| | - Daniel J Ostlie
- Department of Surgery, Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, Arizona 85016.
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Radunovic M, Lazovic R, Popovic N, Magdelinic M, Bulajic M, Radunovic L, Vukovic M, Radunovic M. Complications of Laparoscopic Cholecystectomy: Our Experience from a Retrospective Analysis. Open Access Maced J Med Sci 2016; 4:641-646. [PMID: 28028405 PMCID: PMC5175513 DOI: 10.3889/oamjms.2016.128] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 10/08/2016] [Accepted: 11/05/2016] [Indexed: 01/10/2023] Open
Abstract
AIM: The aim of this study was to evaluate the intraoperative and postoperative complications of laparoscopic cholecystectomy, as well as the frequency of conversions. MATERIAL AND METHODS: Medical records of 740 patients who had laparoscopic cholecystectomy were analysed retrospectively. We evaluated patients for the presence of potential risk factors that could predict the development of complications such as age, gender, body mass index, white blood cell count and C-reactive protein (CRP), gallbladder ultrasonographic findings, and pathohistological analysis of removed gallbladders. The correlation between these risk factors was also analysed. RESULTS: There were 97 (13.1%) intraoperative complications (IOC). Iatrogenic perforations of a gallbladder were the most common complication - 39 patients (5.27%). Among the postoperative complications (POC), the most common ones were bleeding from abdominal cavity 27 (3.64%), biliary duct leaks 14 (1.89%), and infection of the surgical wound 7 patients (0.94%). There were 29 conversions (3.91%). The presence of more than one complication was more common in males (OR = 2.95, CI 95%, 1.42-4.23, p < 0.001). An especially high incidence of complications was noted in patients with elevated white blood cell count (OR = 3.98, CI 95% 1.68-16.92, p < 0.01), and CRP (OR = 2.42, CI 95% 1.23-12.54, p < 0.01). The increased incidence of complications was noted in patients with ultrasonographic finding of gallbladder empyema and increased thickness of the gallbladder wall > 3 mm (OR = 4.63, CI 95% 1.56-17.33, p < 0.001), as well as in patients with acute cholecystitis that was confirmed by pathohistological analysis (OR = 1.75, CI 95% 2.39-16.46, p < 0.001). CONCLUSION: Adopting laparoscopic cholecystectomy as a new technique for treatment of cholelithiasis, introduced a new spectrum of complications. Major biliary and vascular complications are life threatening, while minor complications cause patient discomfort and prolongation of the hospital stay. It is important recognising IOC complications during the surgery so they are taken care of in a timely manner during the surgical intervention. Conversion should not be considered a complication.
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Affiliation(s)
- Miodrag Radunovic
- Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
| | - Ranko Lazovic
- Center for General and Digestive Surgery, Clinical Centre of Montenegro, Podgorica, Montenegro
| | - Natasa Popovic
- Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
| | | | - Milutin Bulajic
- Clinic for Gastroenterology, Clinical Centre of Belgrade, University of Belgrade, Belgrade, Serbia
| | - Lenka Radunovic
- General Medical Health, Primary Health Care Berane, Berane, Montenegro
| | - Marko Vukovic
- Urology and Nephrology Clinic, Clinical Centre of Montenegro, Podgorica, Montenegro
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Kaplan JR, Lee Z, Eun DD, Reese AC. Complications of Minimally Invasive Surgery and Their Management. Curr Urol Rep 2016; 17:47. [PMID: 27075019 DOI: 10.1007/s11934-016-0602-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Minimally invasive surgery, including both traditional laparoscopic and robot-assisted laparoscopic approaches, has increasingly become the standard of care for urologic abdominal and pelvic surgery. This is a comprehensive review of the contemporary literature regarding complications of laparoscopic and robotic urologic surgery. The review highlights pertinent studies with the goal of providing the minimally invasive urologic surgeon with an up-to-date overview of general and procedure-specific complications and their management.
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Affiliation(s)
- Joshua R Kaplan
- Temple University School of Medicine, 3509 North Broad Street, 6th Floor, Boyer Pavilion, Philadelphia, PA, 19140, USA
| | - Ziho Lee
- Temple University School of Medicine, 3509 North Broad Street, 6th Floor, Boyer Pavilion, Philadelphia, PA, 19140, USA
| | - Daniel D Eun
- Temple University School of Medicine, 3509 North Broad Street, 6th Floor, Boyer Pavilion, Philadelphia, PA, 19140, USA
| | - Adam C Reese
- Temple University School of Medicine, 3509 North Broad Street, 6th Floor, Boyer Pavilion, Philadelphia, PA, 19140, USA.
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Laparoscopic access overview: Is there a safest entry method? Actas Urol Esp 2016; 40:386-92. [PMID: 26922517 DOI: 10.1016/j.acuro.2015.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 11/26/2015] [Accepted: 11/27/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Laparoscopy is a minimally invasive technique to access the abdominal cavity, for diagnostic or therapeutic applications. Optimizing the access technique is an important step for laparoscopic procedures. The aim of this study is to assess the outcomes of different laparoscopic access techniques and to identify the safest one. METHODS Laparoscopic access questionnaire was forwarded via e-mail to the 60 centers who are partners in working group for laparoscopic and robotic surgery of the Italian Urological Society (SIU) and their American and European reference centers. RESULTS The response rate was 68.33%. The total number of procedures considered was 65.636. 61.5% of surgeons use Veress needle to create pneumoperitoneum. Blind trocar technique is the most commonly used, but has the greatest number of complications. Optical trocar technique seems to be the safest, but it's the less commonly used. The 28,2% of surgeons adopt open Hasson's technique. Total intra-operative complications rate was 3.3%. Open conversion rate was 0.33%, transfusion rate was 1.13%, and total post-operative complication rate was 2.53%. CONCLUSION Laparoscopic access is a safe technique with low complication rate. Most of complications can be managed conservatively or laparoscopically. The choice of access technique can affect the rate and type of complications and should be planned according to surgeon experience, safety of each technique and patient characteristics. All access types have perioperative complications. According with our study, optical trocar technique seems to be the safest.
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Djokovic D, Gupta J, Thomas V, Maher P, Ternamian A, Vilos G, Loddo A, Reich H, Downes E, Rachman IA, Clevin L, Abrao MS, Keckstein G, Stark M, van Herendael B. Principles of safe laparoscopic entry. Eur J Obstet Gynecol Reprod Biol 2016; 201:179-88. [DOI: 10.1016/j.ejogrb.2016.03.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Baggish MS. Sixty-Four Cases of Major Vessel Injury Associated with Laparoscopic Surgery. J Gynecol Surg 2016. [DOI: 10.1089/gyn.2015.29001.bag] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Michael S. Baggish
- St. Helena Hospital, St. Helena, CA, and Department of Obstetrics and Gynecology, University of California, San Francisco, San Francisco, CA
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Abdullah N, Rahbar H, Barod R, Dalela D, Larson J, Johnson M, Mass A, Zargar H, Allaf M, Bhayani S, Stifelman M, Kaouk J, Rogers C. Multicentre outcomes of robot-assisted partial nephrectomy after major open abdominal surgery. BJU Int 2016; 118:298-301. [PMID: 27417163 DOI: 10.1111/bju.13408] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the outcomes of robot-assisted partial nephrectomy RAPN after major prior abdominal surgery (PAS) using a large multicentre database. PATIENTS AND METHODS We identified 1 686 RAPN from five academic centres between 2006 and 2014. In all, 216 patients had previously undergone major PAS, defined as having an open upper midline/ipsilateral incision. Perioperative outcomes were compared with those 1 470 patients who had had no major PAS. The chi-squared test and Mann-Whitney U-test were used for categorical and continuous variables, respectively. RESULTS There was no statistically significant difference in Charlson comorbidity index, tumour size, R.E.N.A.L. nephrometry score or preoperative estimated glomerular filtration rate (eGFR) between the groups. Age and body mass index were higher in patients with PAS. The PAS group had a higher estimated blood loss (EBL) but this did not lead to a higher transfusion rate. A retroperitoneal approach was used more often in patients with major PAS (11.2 vs 5.4%), although this group did not have a higher percentage of posterior tumours (38.8 vs 43.3%, P = 0.286). Operative time, warm ischaemia time, length of stay, positive surgical margin, percentage change in eGFR, and perioperative complications were not significantly different between the groups. CONCLUSIONS RAPN in patients with major PAS is safe and feasible, with increased EBL but no increased rate of transfusion. Patients with major PAS had almost twice the likelihood of having a retroperitoneal approach.
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Affiliation(s)
- Newaj Abdullah
- Vattikutti Urology Institute, Henry Ford Health System, Detroit, MI
| | - Haider Rahbar
- Vattikutti Urology Institute, Henry Ford Health System, Detroit, MI
| | - Ravi Barod
- Vattikutti Urology Institute, Henry Ford Health System, Detroit, MI
| | - Deepansh Dalela
- Vattikutti Urology Institute, Henry Ford Health System, Detroit, MI
| | - Jeff Larson
- Division of Urology, Washington University in St. Louis, St. Louis, MO, USA
| | - Michael Johnson
- James Buchanan Brady Urological Institute, John Hopkins University, Baltimore, MD, USA
| | - Alon Mass
- Department of Urology, New York University, New York, NY, USA
| | - Homayoun Zargar
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Mohamad Allaf
- James Buchanan Brady Urological Institute, John Hopkins University, Baltimore, MD, USA
| | - Sam Bhayani
- Division of Urology, Washington University in St. Louis, St. Louis, MO, USA
| | | | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Craig Rogers
- Vattikutti Urology Institute, Henry Ford Health System, Detroit, MI
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Safety and Efficacy of Laparoscopic Access in a Surgical Training Program. Surg Laparosc Endosc Percutan Tech 2016; 26:17-20. [DOI: 10.1097/sle.0000000000000218] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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McGuire AR, DeJoseph ME, Gill JR. An approach to iatrogenic deaths. Forensic Sci Med Pathol 2016; 12:68-80. [DOI: 10.1007/s12024-016-9745-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2016] [Indexed: 12/19/2022]
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Siufi Neto J, Santos Siufi DF, Magrina JF. Trocar in conventional laparoscopic and robotic-assisted surgery as a major cause of iatrogenic trauma to the patient. Best Pract Res Clin Obstet Gynaecol 2016; 35:13-9. [PMID: 26723474 DOI: 10.1016/j.bpobgyn.2015.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 11/08/2015] [Accepted: 11/11/2015] [Indexed: 11/19/2022]
Abstract
All laparoscopic procedures, laparoscopic or robotic-assisted, start with a trocar entry. Unfortunately unknown to most, this is an extremely important part of the surgery, as 80% of major vascular injuries and 50% of intestinal injuries occur during this procedure. Laparoscopic first entry is often delegated to trainees with little experience, wrongly assuming that laparoscopic entry is similar to incisional entry at laparotomy. This may result in patient death (mortality of major vascular injuries is 11% and unrecognized intestinal injuries is 5%) or significant temporary or permanent morbidity.
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Affiliation(s)
- Joao Siufi Neto
- Department of Gynecologic Surgery, Mayo Clinic Hospital, Phoenix, AZ 85054, USA; Surgical Oncologist, Sírio - Libanês Hospital, São Paulo, SP 01308-050, Brazil.
| | - Daniela Freitas Santos Siufi
- Department of Gynecologic Surgery, Mayo Clinic Hospital, Phoenix, AZ 85054, USA; Surgical Oncologist, Sírio - Libanês Hospital, São Paulo, SP 01308-050, Brazil
| | - Javier F Magrina
- Department of Gynecologic Surgery, Mayo Clinic Hospital, Phoenix, AZ 85054, USA
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41
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Abstract
Over the last decade minimally invasive adrenalectomy has become the gold standard in adrenal surgery. Laparoscopic adrenalectomy with the patient in the lateral decubitus position and posterior retroperitoneoscopic adrenalectomy have gained worldwide acceptance. In this overview the complications of minimally invasive adrenalectomy are analyzed based on the published data. Die incidence of intraoperative and postoperative complications ranges from 0 % to 15 % for unilateral adrenalectomy and rises up to 23 % for bilateral surgery. No significant differences were found between laparoscopic and retroperitoneoscopic operations. Nevertheless, splenic injuries and intra-abdominal abscesses are reported only after laparoscopic procedures, while relaxation and/or hypoesthesia of the abdominal wall are typical for posterior retroperitoneoscopic surgery. Conversion to open surgery significantly influences the rate of perioperative and postoperative complications (odds ratio 6.2); therefore, high surgeon and center case volume could improve the results of adrenal surgery.
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Affiliation(s)
- P F Alesina
- Klinik für Chirurgie und Zentrum für Minimal Invasive Chirurgie, Kliniken Essen-Mitte, Henricistr. 92, 45136, Essen, Deutschland,
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42
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Ludwig K, Scharlau U, Schneider Koriath S. [Management of more frequent complications of laparoscopic surgery. Minimally invasive or always open surgery?]. Chirurg 2015; 86:1105-13. [PMID: 26495447 DOI: 10.1007/s00104-015-0101-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Two decades after the far-reaching establishment of elective laparoscopic surgery, the questions arise whether and when the benefits of this technology can be sufficiently and safely implemented even in cases of complications. MATERIAL AND METHODS The currently available literature was analyzed in the context of recommendations for the management of complications in laparoscopic surgery. RESULTS Intraoperative and postoperative complications of minimally invasive surgery necessitating treatment are extremely rare and can be expected in only 0.1–5 % of interventions, depending on the complexity of the intervention. In addition to adhesion-related and anatomical limitations, they are responsible for the necessity to convert to open surgery in approximately 40–60 % of the cases. DISCUSSION Due to the relative rarity and great variety of potential complications, there is no scientific evidence at the study level that can give reliable recommendations for a management strategy in every situation. It still has to be decided on an individual basis and depending on the particular clinical situation if a successful laparoscopic management can be sufficiently and safely carried out. It has been found that a number of complications can be well controlled by minimally invasive procedures; however, in addition to a high level of personal experience in laparoscopy, optimal technical, institutional and instrumental conditions must be available. If these factors are not present in total, a conventional open approach should still be given preference.
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43
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Sotelo RJ, Haese A, Machuca V, Medina L, Nuñez L, Santinelli F, Hernandez A, Kural AR, Mottrie A, Giedelman C, Mirandolino M, Palmer K, Abaza R, Ghavamian R, Shalhav A, Moinzadeh A, Patel V, Stifelman M, Tuerk I, Canes D. Safer Surgery by Learning from Complications: A Focus on Robotic Prostate Surgery. Eur Urol 2015; 69:334-44. [PMID: 26385157 DOI: 10.1016/j.eururo.2015.08.060] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 08/31/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND The uptake of robotic surgery has led to changes in potential operative complications, as many surgeons learn minimally invasive surgery, and has allowed the documentation of such complications through the routine collection of intraoperative video. OBJECTIVE We documented intraoperative complications from robot-assisted radical prostatectomy (RARP) with the aim of reporting the mechanisms, etiology, and necessary steps to avoid them. Our goal was to facilitate learning from these complications to improve patient care. DESIGN, SETTING, AND PARTICIPANTS Contributors delivered videos of complications that occurred during laparoscopic and robotic prostatectomy between 2010 and 2015. SURGICAL PROCEDURE Surgical footage was available for a variety of complications during RARP. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Based on these videos, a literature search was performed using relevant terms (prostatectomy, robotic, complications), and the intraoperative steps of the procedures and methods of preventing complications were outlined. RESULTS AND LIMITATIONS As a major surgical procedure, RARP has much potential for intra- and postoperative complications related to patient positioning, access, and the procedure itself. However, with a dedicated approach, increasing experience, a low index of suspicion, and strict adherence to safety measures, we suggest that the majority of such complications are preventable. CONCLUSIONS Considering the complexity of the procedure, RARP is safe and reproducible for the surgical management of prostate cancer. Insight from experienced surgeons may allow surgeons to avoid complications during the learning curve. PATIENT SUMMARY Robot-assisted radical prostatectomy has potential for intra- and postoperative complications, but with a dedicated approach, increasing experience, a low index of suspicion, and strict adherence to safety measures, most complications are preventable.
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Affiliation(s)
- René J Sotelo
- Center of Robotics and Minimally Invasive Surgery, Instituto Médico La Floresta, Caracas, Venezuela; University of Southern California, Los Angeles, CA, USA.
| | - Alexander Haese
- Martini Clinic Prostate Cancer Center, University Clinic Eppendorf, Hamburg, Germany
| | - Victor Machuca
- Center of Robotics and Minimally Invasive Surgery, Instituto Médico La Floresta, Caracas, Venezuela
| | - Luis Medina
- Center of Robotics and Minimally Invasive Surgery, Instituto Médico La Floresta, Caracas, Venezuela
| | - Luciano Nuñez
- Center of Robotics and Minimally Invasive Surgery, Instituto Médico La Floresta, Caracas, Venezuela
| | | | | | | | | | | | | | | | - Ronney Abaza
- Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Arieh Shalhav
- Duchossois Center for Advanced Medicine, Chicago, IL, USA
| | - Alireza Moinzadeh
- Lahey Hospital and Medical Center Institute of Urology, Burlington, MA, USA
| | - Vipul Patel
- Global Robotics Institute, Celebration, FL, USA
| | | | - Ingolf Tuerk
- St. Elizabeth's Medical Center, Brighton, MA, USA
| | - David Canes
- Lahey Hospital and Medical Center Institute of Urology, Burlington, MA, USA
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44
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Kindel T, Latchana N, Swaroop M, Chaudhry UI, Noria SF, Choron RL, Seamon MJ, Lin MJ, Mao M, Cipolla J, El Chaar M, Scantling D, Martin ND, Evans DC, Papadimos TJ, Stawicki SP. Laparoscopy in trauma: An overview of complications and related topics. Int J Crit Illn Inj Sci 2015; 5:196-205. [PMID: 26557490 PMCID: PMC4613419 DOI: 10.4103/2229-5151.165004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The introduction of laparoscopy has provided trauma surgeons with a valuable diagnostic and, at times, therapeutic option. The minimally invasive nature of laparoscopic surgery, combined with potentially quicker postoperative recovery, simplified wound care, as well as a growing number of viable intraoperative therapeutic modalities, presents an attractive alternative for many traumatologists when managing hemodynamically stable patients with selected penetrating and blunt traumatic abdominal injuries. At the same time, laparoscopy has its own unique complication profile. This article provides an overview of potential complications associated with diagnostic and therapeutic laparoscopy in trauma, focusing on practical aspects of identification and management of laparoscopy-related adverse events.
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Affiliation(s)
- Tammy Kindel
- Department of Surgery, Northwestern Memorial Hospital, Chicago, Illinois, United States
| | - Nicholas Latchana
- Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio, United States
| | - Mamta Swaroop
- Department of Surgery, Northwestern Memorial Hospital, Chicago, Illinois, United States
| | - Umer I Chaudhry
- Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio, United States
| | - Sabrena F Noria
- Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio, United States
| | - Rachel L Choron
- Department of Surgery, Cooper University Hospital, Camden, New Jersey, United States
| | - Mark J Seamon
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Maggie J Lin
- Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States
| | - Melissa Mao
- Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States
| | - James Cipolla
- Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States
| | - Maher El Chaar
- Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States
| | - Dane Scantling
- Department of Surgery, Drexel University/Hahnemann University Hospital, Philadelphia, Pennsylvania, United States
| | - Niels D Martin
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - David C Evans
- Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio, United States
| | - Thomas J Papadimos
- Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, Ohio, United States
| | - Stanislaw P Stawicki
- Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States
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45
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Karadag MA, Cecen K, Demir A, Bagcioglu M, Kocaaslan R, Kadioglu TC. Gastrointestinal complications of laparoscopic/robot-assisted urologic surgery and a review of the literature. J Clin Med Res 2015; 7:203-10. [PMID: 25699115 PMCID: PMC4330011 DOI: 10.14740/jocmr2090w] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2015] [Indexed: 01/10/2023] Open
Abstract
Gastrointestinal injuries that occur during or after laparoscopic and robot-assisted surgery are serious side effects that affect patient outcome. In this review, we attempt to highlight the identification, incidence and management of gastrointestinal and visceral complications of laparoscopic and robot-assisted surgery. A search of Medline and PubMed databases was performed using the following terms: gastrointestinal complications of laparoscopy, laparoscopic, kidney and robotic surgery. A total of 1,072 papers related to the subject were analyzed. Forty-six of these papers were included in the present review. These papers reported high numbers of participants and had a high level of evidence. Gastrointestinal complications during laparoscopic and robot-assisted surgery are rare, but similar, and can occur at any time between access and closure. Despite their infrequency, these complications can result in mortality. The early recognition and management of gastrointestinal complications is very important. Unrecognized or delayed identification of gastrointestinal complications may cause sepsis and death.
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Affiliation(s)
- Mert Ali Karadag
- Department of Urology, Faculty of Medicine, Kafkas University, Kars, Turkey
| | - Kursat Cecen
- Department of Urology, Faculty of Medicine, Kafkas University, Kars, Turkey
| | - Aslan Demir
- Department of Urology, Faculty of Medicine, Kafkas University, Kars, Turkey
| | - Murat Bagcioglu
- Department of Urology, Faculty of Medicine, Kafkas University, Kars, Turkey
| | - Ramazan Kocaaslan
- Department of Urology, Faculty of Medicine, Kafkas University, Kars, Turkey
| | - Teoman Cem Kadioglu
- Department of Urology, Istanbul University, Medical Faculty of Istanbul, Istanbul, Turkey
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46
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Sotelo R, Nunez Bragayrac LA, Machuca V, Garza Cortes R, Azhar RA. Avoiding and managing vascular injury during robotic-assisted radical prostatectomy. Ther Adv Urol 2015; 7:41-8. [PMID: 25642293 DOI: 10.1177/1756287214553967] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
There has been an increase in the number of urologic procedures performed robotically assisted; this is the case for radical prostatectomy. Currently, in the USA, 67% of prostatectomies are performed robotically assisted. With this increase in robotic urologic surgery it is clear that there are more surgeons in their learning curve, where most of the complications occur. Among the complications that can occur are vascular injuries. These can occur in the initial stages of surgery, such as in accessing the abdominal cavity, as well as in the intraoperative or postoperative setting. We present the most common vascular injuries in robot-assisted radical prostatectomy, as well as their management and prevention. We believe that it is of vital importance to be able to recognize these injuries so that they can be prevented.
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Affiliation(s)
- René Sotelo
- Instituto Médico La Floresta, Urbanización La Floresta, Calle Santa Ana, Clínica La Floresta, Caracas 1060, Venezuela
| | - Luciano A Nunez Bragayrac
- Instituto Médico La Floresta, CIMI Centro de Cirugía Robótica y de Invasión Mínima, Caracas, Venezuela
| | - Victor Machuca
- Instituto Médico La Floresta, CIMI Centro de Cirugía Robótica y de Invasión Mínima, Caracas, Venezuela
| | - Roberto Garza Cortes
- Instituto Médico La Floresta, CIMI Centro de Cirugía Robótica y de Invasión Mínima, Caracas, Venezuela
| | - Raed A Azhar
- Institute of Urology, Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA, and 2- Urology Department, King Abdulaziz University, Jeddah, Saudi Arabia
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47
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Hindman NM, Kang S, Parikh MS. Common postoperative findings unique to laparoscopic surgery. Radiographics 2015; 34:119-38. [PMID: 24428286 DOI: 10.1148/rg.341125181] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The interpretation of images obtained in patients who have recently undergone abdominal or pelvic surgery is challenging, in part because procedures that were previously performed with open surgical techniques are increasingly being performed with minimally invasive (laparoscopic) techniques. Thus, it is important to be familiar with the normal approach used for laparoscopic surgeries. The authors describe the indications for various laparoscopic surgical procedures (eg, cholecystectomy, appendectomy, hernia repair) as well as normal postoperative findings. For example, port site hernias are more commonly encountered in patients with trocar sites greater than 10 mm and occur at classic entry sites (eg, the periumbilical region). Similarly, preperitoneal air can be encountered postoperatively, often secondary to trocar dislodgement during difficult entry or positioning. In addition, intraperitoneal placement of mesh during commonly performed ventral or incisional hernia repairs typically leads to postoperative seroma formation. Familiarity with normal findings after commonly performed laparoscopic surgical procedures in the abdomen and pelvis allows accurate diagnosis of common complications and avoidance of diagnostic pitfalls.
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Affiliation(s)
- Nicole M Hindman
- From the Departments of Radiology (N.M.H., S.K.) and Surgery (M.S.P.), NYU School of Medicine, 660 First Ave, New York, NY 10016
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48
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Robot-assisted laparoscopic partial nephrectomy in patients with previous abdominal surgery: single center experience. Int J Med Robot 2015; 11:389-94. [DOI: 10.1002/rcs.1633] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 11/30/2014] [Accepted: 12/03/2014] [Indexed: 01/06/2023]
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49
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Ülker K, Anuk T, Bozkurt M, Karasu Y. Large bowel injuries during gynecological laparoscopy. World J Clin Cases 2014; 2:846-851. [PMID: 25516859 PMCID: PMC4266832 DOI: 10.12998/wjcc.v2.i12.846] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 09/04/2014] [Accepted: 09/17/2014] [Indexed: 02/05/2023] Open
Abstract
Laparoscopy is one of the most frequently preferred surgical options in gynecological surgery and has advantages over laparotomy, including smaller surgical scars, faster recovery, less pain and earlier return of bowel functions. Generally, it is also accepted as safe and effective and patients tolerate it well. However, it is still an intra-abdominal procedure and has the similar potential risks of laparotomy, including injury of a vital structure, bleeding and infection. Besides the well-known risks of open surgery, laparoscopy also has its own unique risks related to abdominal access methods, pneumoperitoneum created to provide adequate operative space and the energy modalities used during the procedures. Bowel, bladder or major blood vessel injuries and passage of gas into the intravascular space may result from laparoscopic surgical technique. In addition, the risks of aspiration, respiratory dysfunction and cardiovascular dysfunction increase during laparoscopy. Large bowel injuries during laparoscopy are serious complications because 50% of bowel injuries and 60% of visceral injuries are undiagnosed at the time of primary surgery. A missed or delayed diagnosis increases the risk of bowel perforation and consequently sepsis and even death. In this paper, we aim to focus on large bowel injuries that happen during gynecological laparoscopy and review their diagnostic and management options.
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50
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Successful laparoscopic management of ruptured tubal pregnancy with an ipsilateral ectopic pelvic kidney. Case Rep Obstet Gynecol 2014; 2014:682737. [PMID: 25136465 PMCID: PMC4129173 DOI: 10.1155/2014/682737] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 07/02/2014] [Indexed: 11/21/2022] Open
Abstract
Objective. To report a case of successful laparoscopic management of a left ruptured tubal pregnancy in the setting of an ipsilateral ectopic pelvic kidney. Method. Case report was prepared at Wayne State University/Detroit Medical Center. The patient is a young woman gravida 2 para 0 in her twenties who presented with severe abdominal pain and vaginal bleeding. She had a plateaued beta HCG and ultrasonographic findings suggestive of ectopic left tubal pregnancy along with an ectopic ipsilateral pelvic kidney. The IRB approval is not needed, as this is a case report. The informed consent could not be obtained, as the patient was not reachable. Result. Multiple intraperitoneal adhesions, left ruptured ampullary ectopic pregnancy and left retroperitoneal pelvic mass consistent with ipsilateral ectopic pelvic kidney.
Conclusion. Laparoscopic management of tubal pregnancy can be safely performed in the setting of an ipsilateral ectopic pelvic kidney.
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