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Inoue Y, Ishii M, Fujii K, Nihei K, Suzuki Y, Ota M, Kitada K, Kuramoto T, Shima T, Kodama H, Matsuo K, Miyaoka Y, Miyamoto T, Yokohama K, Ohama H, Imai Y, Tanaka R, Sanda M, Osumi W, Tsuchimoto Y, Terazawa T, Ogura T, Masubuchi S, Yamamoto M, Asai A, Shirai Y, Inoue M, Fukunishi S, Nakahata Y, Takii M, Goto M, Kimura F, Higuchi K, Uchiyama K. Safety and Efficacy of Laparoscopic Liver Resection for Colorectal Liver Metastasis With Obesity. Am Surg 2020; 87:919-926. [PMID: 33283542 DOI: 10.1177/0003134820952448] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Laparoscopic liver resection (LLR) in obese patients has been reported to be particularly challenging owing to technical difficulties and various comorbidities. METHODS The safety and efficacy outcomes in 314 patients who underwent laparoscopic or open nonanatomical liver resection for colorectal liver metastases (CRLM) were analyzed retrospectively with respect to the patients' body mass index (BMI) and visceral fat area (VFA). RESULTS Two hundred and four patients underwent LLR, and 110 patients underwent open liver resection (OLR). The rate of conversion from LLR to OLR was 4.4%, with no significant difference between the BMI and VFA groups (P = .647 and .136, respectively). In addition, there were no significant differences in terms of operative time and estimated blood loss in LLR (P = .226 and .368; .772 and .489, respectively). The incidence of Clavien-Dindo grade IIIa or higher complications was not significantly different between the BMI and VFA groups of LLR (P = .877 and .726, respectively). In obese patients, the operative time and estimated blood loss were significantly shorter and lower, respectively, in LLR than in OLR (P = .003 and < .001; < .001 and < .001, respectively). There was a significant difference in the incidence of postoperative complications, organ/space surgical site infections, and postoperative bile leakage between the LLR and OLR groups (P = .017, < .001, and < .001, respectively). CONCLUSION LLR for obese patients with CRLM can be performed safely using various surgical devices with no major difference in outcomes compared to those in nonobese patients. Moreover, LLR has better safety outcomes than OLR in obese patients.
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Affiliation(s)
- Yoshihiro Inoue
- Department of General and Gastroenterological Surgery, Osaka Medical College Hospital, Japan.,Department of General and Gastroenterological Surgery, Osaka Medical College Mishima-Minami Hospital, Japan
| | - Masatsugu Ishii
- Department of General and Gastroenterological Surgery, Osaka Medical College Hospital, Japan.,Department of General and Gastroenterological Surgery, Osaka Medical College Mishima-Minami Hospital, Japan
| | - Kensuke Fujii
- Department of General and Gastroenterological Surgery, Osaka Medical College Hospital, Japan
| | - Kentaro Nihei
- Department of General and Gastroenterological Surgery, Osaka Medical College Hospital, Japan
| | - Yusuke Suzuki
- Department of General and Gastroenterological Surgery, Osaka Medical College Hospital, Japan
| | - Masato Ota
- Department of General and Gastroenterological Surgery, Osaka Medical College Hospital, Japan
| | - Kazuya Kitada
- Department of General and Gastroenterological Surgery, Osaka Medical College Hospital, Japan
| | - Toru Kuramoto
- Department of General and Gastroenterological Surgery, Osaka Medical College Hospital, Japan
| | - Takafumi Shima
- Department of General and Gastroenterological Surgery, Osaka Medical College Hospital, Japan
| | - Hiroyuki Kodama
- Second Department of Internal Medicine, Osaka Medical College Hospital, Japan
| | - Kentaro Matsuo
- Department of General and Gastroenterological Surgery, Osaka Medical College Hospital, Japan.,Department of General and Gastroenterological Surgery, Osaka Medical College Mishima-Minami Hospital, Japan
| | - Yuta Miyaoka
- Department of General and Gastroenterological Surgery, Osaka Medical College Hospital, Japan.,Department of General and Gastroenterological Surgery, Osaka Medical College Mishima-Minami Hospital, Japan
| | - Takahiro Miyamoto
- Second Department of Internal Medicine, Osaka Medical College Hospital, Japan
| | - Keisuke Yokohama
- Second Department of Internal Medicine, Osaka Medical College Hospital, Japan
| | - Hideko Ohama
- Second Department of Internal Medicine, Osaka Medical College Hospital, Japan
| | - Yoshiro Imai
- Department of General and Gastroenterological Surgery, Osaka Medical College Hospital, Japan
| | - Ryo Tanaka
- Department of General and Gastroenterological Surgery, Osaka Medical College Hospital, Japan
| | - Mariko Sanda
- Department of Internal Medicine, Osaka Medical College Mishima-Minami Hospital, Japan
| | - Wataru Osumi
- Department of General and Gastroenterological Surgery, Osaka Medical College Hospital, Japan
| | - Yusuke Tsuchimoto
- Second Department of Internal Medicine, Osaka Medical College Hospital, Japan
| | - Tetsuji Terazawa
- Second Department of Internal Medicine, Osaka Medical College Hospital, Japan
| | - Takeshi Ogura
- Second Department of Internal Medicine, Osaka Medical College Hospital, Japan
| | - Shinsuke Masubuchi
- Department of General and Gastroenterological Surgery, Osaka Medical College Hospital, Japan
| | - Masashi Yamamoto
- Department of General and Gastroenterological Surgery, Osaka Medical College Hospital, Japan.,Department of General and Gastroenterological Surgery, Osaka Medical College Mishima-Minami Hospital, Japan
| | - Akira Asai
- Second Department of Internal Medicine, Osaka Medical College Hospital, Japan
| | | | - Masaya Inoue
- Department of Surgery, Katsuragi Hospital, Japan
| | - Shinya Fukunishi
- Second Department of Internal Medicine, Osaka Medical College Hospital, Japan
| | - Yoshikatsu Nakahata
- Department of Internal Medicine, Osaka Medical College Mishima-Minami Hospital, Japan
| | - Michiaki Takii
- Department of Internal Medicine, Osaka Medical College Mishima-Minami Hospital, Japan
| | - Masahiro Goto
- Second Department of Internal Medicine, Osaka Medical College Hospital, Japan
| | - Fumiharu Kimura
- Department of Internal Medicine, Osaka Medical College Mishima-Minami Hospital, Japan
| | - Kazuhide Higuchi
- Second Department of Internal Medicine, Osaka Medical College Hospital, Japan
| | - Kazuhisa Uchiyama
- Department of General and Gastroenterological Surgery, Osaka Medical College Hospital, Japan
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Ryan MA, Russell JO, Schoo DP, Upchurch PA, Walsh JM. Transoral Endoscopic Vestibular Thyroglossal Duct Cyst Excision. Ann Otol Rhinol Laryngol 2020; 129:1239-1242. [PMID: 32560593 DOI: 10.1177/0003489420936712] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Thyroglossal duct cysts (TGDCs) are relatively common congenital midline neck masses that are treated with surgical excision. Traditionally these are removed along with any associated tract and the central portion of the hyoid bone through an anterior neck incision. Some patients with TGDCs want to avoid an external neck scar. METHODS We describe the details of a transoral endoscopic vestibular excision of a TGDC and the associated hyoid bone in an adolescent patient. RESULTS This novel approach was successful and there were no complications. CONCLUSION We propose that cervical TGDCs can be safely and completely removed with this approach in appropriately selected patients while avoiding a neck scar.
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Affiliation(s)
- Marisa A Ryan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Jonathon O Russell
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Desi P Schoo
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Patrick A Upchurch
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Jonathan M Walsh
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, USA
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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: 2.6] [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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de Jong KIF, de Leeuw PW. Venous carbon dioxide embolism during laparoscopic cholecystectomy a literature review. Eur J Intern Med 2019; 60:9-12. [PMID: 30352722 DOI: 10.1016/j.ejim.2018.10.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 10/14/2018] [Indexed: 12/21/2022]
Abstract
Laparoscopy has become the procedure of choice for routine gallbladder removal. A serious complication of this technique is the occurrence of gas emboli due to insufflation. It is associated with a high mortality rate of around 28%. The present systematic review intends to provide more insight into causes, symptoms and risk factors for this specific complication and to explore which measures should be taken to treat and prevent it. The Cochrane library and Pubmed were used as sources. Articles and their references were selected when they were related to the subject in sufficient detail. The course of this complication can vary from asymptomatic up to impairment of normal flow through the right ventricle (RV) or pulmonary artery, potentially leading to acute heart failure. The severity depends on the amount of gas, the rate of accumulation and the ability to remove the gas bubbles. It is difficult to estimate the true incidence of venous gas embolism during laparoscopic cholecystectomy as there are various diagnostic tools, each with different sensitivity. Precautions that need to be taken are: correct positioning of the needle, low insufflation pressure, low insufflation speed, screening for hypovolemia, Trendelenburg positioning, availability of intervention equipment at operation table, no placement of venous catheters during inspiration and catheter removing during expiration. Physicians need to be more aware of this harmful complication and the preventative measurements that need to be taken. As there are virtually no prospective data, future studies are needed to gain more knowledge on gas emboli during laparoscopic cholecystectomy.
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Affiliation(s)
- Kiki I F de Jong
- Department of Medicine, Zuyderland Medical Center, Sittard/Heerlen and Department of Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Peter W de Leeuw
- Department of Medicine, Zuyderland Medical Center, Sittard/Heerlen and Department of Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands.
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Tanaka C, Fujiwara M, Kanda M, Murotani K, Iwata N, Hayashi M, Kobayashi D, Yamada S, Kodera Y. Optical trocar access for initial trocar placement in laparoscopic gastrointestinal surgery: A propensity score-matching analysis. Asian J Endosc Surg 2019; 12:37-42. [PMID: 29673123 DOI: 10.1111/ases.12484] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 02/07/2018] [Accepted: 02/22/2018] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Optical trocar access is a technique to place the initial trocar in laparoscopic surgery. With optical trocar access, each tissue layer can be visualized before insertion, which can help prevent organ injury, and air leaks at the trocar site can be minimized even in obese patients. The aim of this study was to compare the time needed for trocar insertion using optical trocar access and an open method in patients who underwent laparoscopic gastrointestinal surgery. METHODS We reviewed our prospectively collected database and identified 384 patients who underwent laparoscopic gastrointestinal surgery involving initial trocar insertion near the umbilicus by either the optical trocar access or the open method. Before the two methods were compared, propensity score matching was used to adjust for essential variables between the optical trocar access and open groups. RESULTS Patients categorized in the optical trocar access and open groups were matched one-to-one by propensity score matching, and 137 pairs of patients were generated. The time needed for trocar insertion was significantly shorter in the optical trocar access group than in the open group (36.6 vs 209.8 s, P < 0.01). The multivariable analysis identified an inexperienced surgeon as the only independent risk factor for prolonged time for initial trocar insertion using the optical trocar access. CONCLUSIONS This study indicated that optical trocar access may be recommended for inserting the initial trocar in laparoscopic gastrointestinal surgery.
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Affiliation(s)
- Chie Tanaka
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Michitaka Fujiwara
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mitsuro Kanda
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenta Murotani
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Iwata
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masamichi Hayashi
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Daisuke Kobayashi
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Suguru Yamada
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Nishimura K, Yoshimura K, Hoshino K, Myoga M, Hachisuga T. Aiming for complete safety of first trocar insertion of laparoscopic surgery: usefulness of preoperative ultrasonography of umbilical region. J Obstet Gynaecol Res 2018; 45:652-656. [PMID: 30575236 DOI: 10.1111/jog.13880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 11/12/2018] [Indexed: 01/07/2023]
Abstract
AIM Vascular or intestinal injuries at the time of the first trocar insertion can cause serious complications during laparoscopic surgeries. In this study, we evaluate the usefulness of ultrasound scans of the umbilical region as well as intraumbilical conditions to help prevent serious complications. METHODS The subjects included 430 cases who underwent laparoscopic gynecologic surgeries. The umbilical ultrasound scan was performed after tracheal intubation to observe the intestinal movements associated with respiration. Structures of the umbilical region as well as peristalsis and the movement of the intestinal tract were observed. Then, the thickness of the subcutaneous fat (between the umbilical skin surface and the rectus fascia) and the preperitoneal fat (between the rectus fascia and the peritoneum) were measured. The relationship between body mass index (BMI), insertion time of the first trocar and ultrasound measurements were analyzed. RESULTS The anatomical structures of the umbilical region (the subcutaneous tissue and the preperitoneal fat) were clearly observed in all cases. The BMI score had a significant relationship with subcutaneous fat thickness (r = 0.547), but remarkably not with preperitoneal fat thickness (r = 0.174). There was no significant relationship between BMI and insertion time. However, insertion time of the first trocar had a significant relationship with preperitoneal fat thickness (r = 0.534). CONCLUSIONS Preoperative ultrasonography of the umbilical region is asimple process, and it is helpful inpreventing serious complications caused by the first trocar insertion. We have found that preperitoneal fat thickness seems to be an important factor in predicting the potential difficulty of the first trocar insertion.
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Affiliation(s)
- Kazuaki Nishimura
- Department of Obstetrics and Gynecology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kazuaki Yoshimura
- Department of Obstetrics and Gynecology, Wakamatsu Hospital of University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kaori Hoshino
- Department of Obstetrics and Gynecology, Wakamatsu Hospital of University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Mai Myoga
- Department of Obstetrics and Gynecology, Wakamatsu Hospital of University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Toru Hachisuga
- Department of Obstetrics and Gynecology, University of Occupational and Environmental Health, Kitakyushu, Japan
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7
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Russell JO, Vasiliou E, Razavi CR, Prescott JD, Tufano RP. Letter to the Editor regarding "Carbon dioxide embolism during transoral robotic thyroidectomy: A case report". Head Neck 2018; 41:830-831. [PMID: 30549371 DOI: 10.1002/hed.25500] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 06/20/2018] [Indexed: 11/10/2022] Open
Affiliation(s)
- Jonathon O Russell
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Elya Vasiliou
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christopher R Razavi
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jason D Prescott
- Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ralph P Tufano
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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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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Abraham MA, Jose R, Paul MJ. Seesawing end-tidal carbon dioxide: portent of critical carbon dioxide embolism in retroperitoneoscopy. BMJ Case Rep 2018; 2018:bcr-2017-219397. [PMID: 29367357 DOI: 10.1136/bcr-2017-219397] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
An abrupt increase in end-tidal CO2 (EtCO2; from 35 to 58 mm Hg) followed by a sudden fall (to 18 mm Hg) was noted during retroperitoneoscopic adrenalectomy under general anaesthesia in a 23-year-old patient with adrenal hyperplasia. This was accompanied by hypotension (systolic blood pressure of 60 mm Hg), desaturation (88% SpO2) and ST depression (3.5 mm). The patient was resuscitated with fluids and vasopressor drugs and about 4 mL of air was aspirated through the central venous catheter, confirming the diagnosis of an intraoperative gas embolism. Later, a rent in the adrenal vein extending into the inferior vena cava was discovered and sutured. The blood pressure, EtCO2, ST segment and pulse oximetry returned to normal after 15 min. This case demonstrates that gas embolism may transpire during retroperitoneoscopic adrenalectomy and an acute rise followed by a sharp fall in EtCO2 should alert the anaesthesiologist to this rare but potentially fatal complication.
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Affiliation(s)
- Melvin Alex Abraham
- Department of Anaesthesiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Riya Jose
- Department of Anaesthesiology, Christian Medical College, Vellore, Tamil Nadu, India
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Sakamoto A, Kikuchi I, Shimanuki H, Tejima K, Saito J, Sakai K, Kumakiri J, Kitade M, Takeda S. Initial closed trocar entry for laparoscopic surgery: Technique, umbilical cosmesis, and patient satisfaction. Gynecol Minim Invasive Ther 2017; 6:167-172. [PMID: 30254907 PMCID: PMC6135191 DOI: 10.1016/j.gmit.2017.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 04/11/2017] [Accepted: 04/27/2017] [Indexed: 11/23/2022] Open
Abstract
Background/Aims: Despite the benefits of laparoscopic surgery, which is being performed with increasing frequency, complications that do not occur during laparotomy are sometimes encountered. Such complications commonly occur during the initial trocar insertion, making this a procedural step of critical importance. Methods: In 2002, we experienced, upon initial trocar insertion, a serious major vascular injury (MVI) that led to hemorrhagic shock, and we thus modified the conventional closed entry method to an approach that we have found to be safe. We began developing the method by first measuring, in a patient undergoing laparoscopic cystectomy, the distance between the inner surface of the abdominal wall and the anterior spine when the abdominal wall was lifted manually for trocar insertion and when it was lifted by other methods, and we determined which method provided the greatest distance. We then devised a new approach, summarized as follows: The umbilical ring is elevated with Kocher forceps. The umbilicus is everted, and the base is incised longitudinally. This allows penetration of the abdominal wall at its thinnest point, and it shortens the distance to the abdominal cavity. A bladeless trocar (Step trocar) is used to allow insertion of the Veress needle. We began applying the new entry technique in July 2002, and by December 2014, we had applied it to 9676 patients undergoing laparoscopic gynecology surgery. Results: All entries were performed successfully, and no MVI occurred. The umbilical incision often resulted in an umbilical deformity, but in a questionnaire-based survey, patients generally reported satisfaction with the cosmetic outcome. Conclusion: A current new approach provides safe outcome with a minor cosmetic problem.
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Affiliation(s)
- Aiko Sakamoto
- Department of Gynecology, Juntendo Tokyo Koto Geriatric Medical Center, Japan
| | - Iwaho Kikuchi
- Department of Obstetrics and Gynecology, Juntendo University Urayasu Hospital, Japan
| | - Hiroto Shimanuki
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Japan
| | - Kaoru Tejima
- Department of Gynecology, Juntendo Tokyo Koto Geriatric Medical Center, Japan
| | - Juichiro Saito
- Department of Gynecology, Juntendo Tokyo Koto Geriatric Medical Center, Japan
| | - Kano Sakai
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Japan
| | - Jun Kumakiri
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Japan
| | - Mari Kitade
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Japan
| | - Satoru Takeda
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Japan
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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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Loureiro M, Ramadan M, Skalli EM, Blanc P, Fabre JM, Nocca D. A multicentric prospective study evaluating the safety and efficacy of Kii ® Fios ® First Entry Trocar in laparoscopic bariatric surgery. Surg Endosc 2017; 31:4680-4687. [PMID: 28389805 DOI: 10.1007/s00464-017-5536-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 03/20/2017] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Laparoscopic surgery has evolved as an important field of surgery due to its clear benefits when compared to open laparotomy surgery. However, specific complications of laparoscopic surgery have been reported, of which the majority are complications associated with first entry to the abdominal cavity. The emergence of bariatric surgery, combined with the special considerations of the abdominal wall and cavity of obese patients, leads to seeking new modalities of access to the abdominal cavity in this specific population.Kii Fios First Entry Bladeless Trocar (Applied) is a new device that may allow surgeons to facilitate the creation of pneumoperitoneum. This prospective multicenter nonrandomized trial aims to evaluate the safety and efficacy of Kii Fios First Entry Bladeless Trocar in laparoscopic bariatric surgery. METHODS In the period between December 2013 and June 2014, 588 patients were included by 18 surgeons from several French hospitals to undergo laparoscopic surgery using Kii Fios First Entry Trocar as a first-entry trocar. The surgeons filled out a questionnaire assessing the safety and efficacy of the trocar for every patient. RESULTS There were no mortality and no major complications. However, 11 cases (1.87%) of minor complications (liver and greater omentum injuries) were reported. The surgeons reported successful entry in less than 1 min for 70.58% of the cases. CONCLUSIONS Kii Fios First Entry Trocar (Applied) is a safe and efficient method to establish first entry in laparoscopic bariatric surgery when all the recommendations are followed and respected.
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Affiliation(s)
- Marcelo Loureiro
- CHU de Montpellier, Montpellier, France.
- University Montpellier 1, Montpellier, France.
- Universidade Positivo, Rua Angelo Bom 315 casa 1, Curitiba, 81210340, Brazil.
| | | | | | | | - Jean Michel Fabre
- CHU de Montpellier, Montpellier, France
- University Montpellier 1, Montpellier, France
| | - David Nocca
- CHU de Montpellier, Montpellier, France
- University Montpellier 1, Montpellier, France
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Atkinson TM, Giraud GD, Togioka BM, Jones DB, Cigarroa JE. Cardiovascular and Ventilatory Consequences of Laparoscopic Surgery. Circulation 2017; 135:700-710. [DOI: 10.1161/circulationaha.116.023262] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Although laparoscopic surgery accounts for >2 million surgical procedures every year, the current preoperative risk scores and guidelines do not adequately assess the risks of laparoscopy. In general, laparoscopic procedures have a lower risk of morbidity and mortality compared with operations requiring a midline laparotomy. During laparoscopic surgery, carbon dioxide insufflation may produce significant hemodynamic and ventilatory consequences such as increased intraabdominal pressure and hypercarbia. Hemodynamic insults secondary to increased intraabdominal pressure include increased afterload and preload and decreased cardiac output, whereas ventilatory consequences include increased airway pressures, hypercarbia, and decreased pulmonary compliance. Hemodynamic effects are accentuated in patients with cardiovascular disease such as congestive heart failure, ischemic heart disease, valvular heart disease, pulmonary hypertension, and congenital heart disease. Prevention of cardiovascular complications may be accomplished through a sound understanding of the hemodynamic and physiological consequences of laparoscopic surgery as well as a defined operative plan generated by a multidisciplinary team involving the preoperative consultant, anesthesiologist, and surgeon.
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Affiliation(s)
- Tamara M. Atkinson
- From Knight Cardiovascular Institute (T.M.A., G.D.G.), Department of Anesthesiology and Perioperative Medicine (B.M.T.), Oregon Health and Science University, Portland; Division of Cardiology, Portland VA Medical Center, Oregon (T.M.A., G.D.G.); and Beth Israel Deaconess Medical Center, Harvard University, Boston, MA (D.B.J.)
| | - George D. Giraud
- From Knight Cardiovascular Institute (T.M.A., G.D.G.), Department of Anesthesiology and Perioperative Medicine (B.M.T.), Oregon Health and Science University, Portland; Division of Cardiology, Portland VA Medical Center, Oregon (T.M.A., G.D.G.); and Beth Israel Deaconess Medical Center, Harvard University, Boston, MA (D.B.J.)
| | - Brandon M. Togioka
- From Knight Cardiovascular Institute (T.M.A., G.D.G.), Department of Anesthesiology and Perioperative Medicine (B.M.T.), Oregon Health and Science University, Portland; Division of Cardiology, Portland VA Medical Center, Oregon (T.M.A., G.D.G.); and Beth Israel Deaconess Medical Center, Harvard University, Boston, MA (D.B.J.)
| | - Daniel B. Jones
- From Knight Cardiovascular Institute (T.M.A., G.D.G.), Department of Anesthesiology and Perioperative Medicine (B.M.T.), Oregon Health and Science University, Portland; Division of Cardiology, Portland VA Medical Center, Oregon (T.M.A., G.D.G.); and Beth Israel Deaconess Medical Center, Harvard University, Boston, MA (D.B.J.)
| | - Joaquin E. Cigarroa
- From Knight Cardiovascular Institute (T.M.A., G.D.G.), Department of Anesthesiology and Perioperative Medicine (B.M.T.), Oregon Health and Science University, Portland; Division of Cardiology, Portland VA Medical Center, Oregon (T.M.A., G.D.G.); and Beth Israel Deaconess Medical Center, Harvard University, Boston, MA (D.B.J.)
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Teo XL, Lim SK. Robotic assisted adrenalectomy: Is it ready for prime time? Investig Clin Urol 2016; 57:S130-S146. [PMID: 27995217 PMCID: PMC5161013 DOI: 10.4111/icu.2016.57.s2.s130] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 10/05/2016] [Indexed: 01/23/2023] Open
Abstract
Adrenal surgery is undergoing continuous evolution and minimally invasive surgery is increasingly being used for the surgical management of adrenal masses. With robotic-assisted surgery being a widely accepted surgical treatment for many urological conditions such as prostate carcinoma and renal cell carcinoma, the use of the robot has been expanded to include robotic-assisted adrenalectomy, offering an alternative minimally invasive platform for adrenal surgery. We performed a literature review on robotic-assisted adrenalectomy, reviewing the current surgical techniques and perioperative outcomes.
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Affiliation(s)
- Xin Ling Teo
- Department of Urology, Changi General Hospital, Singapore
| | - Sey Kiat Lim
- Department of Urology, Changi General Hospital, Singapore
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15
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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: 0.9] [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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Tröbs RB, Vahdad MR, Cernaianu G. Transumbilical cord access (TUCA) for laparoscopy in infants and children: simple, safe and fast. Surg Today 2016; 46:235-40. [PMID: 26031233 PMCID: PMC4722059 DOI: 10.1007/s00595-015-1191-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 03/16/2015] [Indexed: 12/19/2022]
Abstract
PURPOSE We herein report a case series evaluating the safety and complication rate of transumbilical cord access (TUCA) for pediatric laparoscopic surgery. METHODS Data were collected for 556 infants and children. Access into the abdominal cavity was gained via a transverse infraumbilical stab incision passing the fibrotic umbilical cord remnant. Ninety-two infants underwent laparoscopic pyloromyotomy (LPM), 159 female infants underwent herniorrhaphy (LHR) and 309 infants underwent appendectomy (LAP). Of the total operations, 70 % were performed by board-certified surgeons and 30 % were performed by non-board-certified surgeons. The median time of follow-up was 24 months. RESULTS No cases of acute severe bleeding or organ laceration were noted. TUCA-related complications were observed in nine patients (1.6 %). Omphalitis and persistent wound secretion were detected in eight children and foreign bodies consisting of cyanoacrylate were removed from three of these patients. Meanwhile, umbilical pain leading to surgical revision was observed in one child, and eight umbilical hernias were repaired during the TUCA procedures. No signs of postoperative incisional hernia were recorded. CONCLUSIONS TUCA is a safe and comfortable access method for pediatric laparoscopic surgery in various age groups. This method is easy to learn and can be quickly and safely performed in the vast majority of children.
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Affiliation(s)
- Ralf-Bodo Tröbs
- Department of Pediatric Surgery, Catholic Foundation Marienhospital Herne, Ruhr-University of Bochum, Widumer Str. 8, 44627, Herne, Germany.
| | - M Reza Vahdad
- Department of Pediatric and Adolescent Surgery, Klinikum Der Stadt Köln, Amsterdamer Str. 59, 50735, Cologne, Germany.
| | - Grigore Cernaianu
- Department of Pediatric Surgery, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany.
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Yong J, Hibbert P, Runciman WB, Coventry BJ. Bradycardia as an early warning sign for cardiac arrest during routine laparoscopic surgery. Int J Qual Health Care 2015; 27:473-8. [DOI: 10.1093/intqhc/mzv077] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2015] [Indexed: 11/14/2022] Open
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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: 28] [Impact Index Per Article: 3.1] [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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Lawson G. Gynaecological laparoscopy deaths in Australia. Aust N Z J Obstet Gynaecol 2015; 55:477-81. [PMID: 26122114 DOI: 10.1111/ajo.12369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 03/11/2015] [Indexed: 12/27/2022]
Abstract
AIM To determine the incidence and clinical features of laparoscopic gynaecological deaths in Australia. MATERIALS AND METHODS Gynaecological laparoscopic mortality data were obtained from the National Coronial Information Systems (NCIS) and Australian State Coroners Courts, for the period July 1 2000 to December 31 2012. RESULTS Eighteen deaths were identified, providing a mortality rate of approximately 1 per 70,000 laparoscopic procedures. The commonest cause of death was from bowel perforation, most of which were unrecognised during the operation. CONCLUSION Gynaecologists should be trained to recognise and manage the rare event of laparoscopic perforation of a viscus or a blood vessel.
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Affiliation(s)
- Gerald Lawson
- Former Consultant, Obstetrics and Gynaecology, John Hunter Hospital, Newcastle, Hamilton, NSW, Australia
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20
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European Hernia Society guidelines on the closure of abdominal wall incisions. Hernia 2015; 19:1-24. [DOI: 10.1007/s10029-014-1342-5] [Citation(s) in RCA: 241] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Accepted: 12/29/2014] [Indexed: 02/07/2023]
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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: 1.2] [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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Cuss A, Bhatt M, Abbott J. Coming to terms with the fact that the evidence for laparoscopic entry is as good as it gets. J Minim Invasive Gynecol 2014; 22:332-41. [PMID: 25460522 DOI: 10.1016/j.jmig.2014.10.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 10/27/2014] [Accepted: 10/30/2014] [Indexed: 02/07/2023]
Abstract
Entry to the peritoneal cavity for laparoscopic surgery is associated with defined morbidity, with all entry techniques associated with substantial complications. Debate over the safest entry technique has raged over the last 2 decades, and yet, we are no closer to arriving at a scientifically valid conclusion regarding technique superiority. With hundreds of thousands of patients required to perform adequately powered studies, it is unlikely that appropriately powered comparative studies could be undertaken. This review examines the risk of complications related to laparoscopic entry, current statements from examining bodies around the world, and the medicolegal ramifications of laparoscopic entry complications. Because of the numbers required for any complications study, with regard to arriving at an evidence-based decision for laparoscopic entry, we ask: is the current literature perhaps as good as it gets?
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Affiliation(s)
- Amanda Cuss
- Royal Hospital for Women, Sydney, Australia and University of New South Wales, Sydney, Australia
| | | | - Jason Abbott
- Royal Hospital for Women, Sydney, Australia and University of New South Wales, Sydney, Australia.
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Lal P, Sharma R, Chander R, Ramteke VK. A technique for open trocar placement in laparoscopic surgery using the umbilical cicatrix tube. Surg Endosc 2014; 16:1366-70. [PMID: 12296314 DOI: 10.1007/s00464-001-8308-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Increasingly the open method for placement of the initial or first trocar is replacing the conventional technique with the Veress needle. Indeed, it is preferred because it affords peritoneal access under direct vision. A number of methods have been described in the literature using a variety of approaches and different instruments. METHODS We describe a method of open trocar placement in the supra- or subumbilical region that follows a stepwise procedure and employs specific instruments sequentially, while utilizing the umbilical cicatrix pillar or tube. RESULTS This technique has been done in 525 cases with no complications or port site hernias. CONCLUSION This is a simple technique that is safe and easy to learn. It can be performed rapidly and is a reliable method for the insertion of the first port under vision.
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Affiliation(s)
- Pawanindra Lal
- Department of Surgery, Maulana Azad Medical College and Lok Nayak Hospital, Bahadur Shah Zafar Marg, New Delhi, PIN 110002, India.
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Hyink S, Whittemore JC, Mitchell A, Reed A. Diagnostic accuracy of tissue impedance measurement interpretation for correct Veress needle placement in feline cadavers. Vet Surg 2013; 42:623-8. [PMID: 23373816 DOI: 10.1111/j.1532-950x.2013.01098.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Accepted: 11/01/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the diagnostic accuracy of tissue impedance measurement interpretation (TIMI) for determining correct versus incorrect Veress needle placement in feline cadavers. STUDY DESIGN Prospective, randomized, blinded trial. STUDY POPULATION Cat cadavers (n = 24). METHODS Two laparoscopists (1 experienced, 1 novice), blinded to TIMI, placed reusable Veress needles in study subjects in a randomized order. A third individual interpreted impedance measurements as consistent with correct versus incorrect placement. Veress needle tip locations were marked by injecting contrasting colors of India ink. Tissue dissection was performed to localize ink. Sensitivity, specificity, accuracy, precision, and kappa statistics for TIMI for placements by the experienced and novice laparoscopist were determined. P < .05 was considered significant. RESULTS TIMI identified 36/38 correct and 2/10 incorrect placements. TIMI identified 2/2 bowel perforations but was unable to identify 8 inappropriate placements in the retroperitoneal fat pad. Impedance measurement interpretation had 94.7% sensitivity, 20% specificity, 79.2% accuracy, and 81% precision overall. Agreement between TIMI and Veress needle location was absent (kappa = -0.15, P = .01) for placements by the experienced laparoscopist and substantial (kappa = 0.78, P < .01) for the novice laparoscopist. CONCLUSIONS Failure of TIMI to identify placement in the retroperitoneal fat pad resulted in poor accuracy. Small cat size limited the number of appropriate placement sites, perhaps resulting in excessively dorsal placements. Use of TIMI may increase detection of clinically significant inappropriate Veress needle placements, like bowel perforations, and decrease installment phase complications. Further evaluation of Veress needle placement with and without TIMI is warranted.
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Affiliation(s)
- Sara Hyink
- Department of Small Animal Clinical Sciences at the College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996, USA.
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Whittemore JC, Mitchell A, Hyink S, Reed A. Diagnostic Accuracy of Tissue Impedance Measurement Interpretation for Correct Veress Needle Placement in Canine Cadavers. Vet Surg 2013; 42:613-22. [DOI: 10.1111/j.1532-950x.2013.01107.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 12/01/2011] [Indexed: 01/29/2023]
Affiliation(s)
- Jacqueline C. Whittemore
- Department of Small Animal Clinical Sciences at the College of Veterinary Medicine; University of Tennessee; Knoxville, Tennessee
| | - Amanda Mitchell
- Department of Small Animal Clinical Sciences at the College of Veterinary Medicine; University of Tennessee; Knoxville, Tennessee
| | - Sara Hyink
- Department of Small Animal Clinical Sciences at the College of Veterinary Medicine; University of Tennessee; Knoxville, Tennessee
| | - Ann Reed
- Office of Information Technology; University of Tennessee; Knoxville, Tennessee
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Lee DY, Rehmani SS, Guend H, Park K, Ross RE, Alkhalifa M, McGinty JJ, Teixeira JA. The incidence of trocar-site hernia in minimally invasive bariatric surgery: a comparison of multi versus single-port laparoscopy. Surg Endosc 2012; 27:1287-91. [PMID: 23232997 DOI: 10.1007/s00464-012-2597-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 09/17/2012] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Single-port laparoscopy (SPL) employs a 1.5- to 2.5-cm incision at the umbilicus for the placement of a single working port. We hypothesized that the longer incision created by SPL compared with multiport laparoscopy may increase the incidence of trocar-site hernias. We examined our experience with SPL in bariatric operations. METHODS There were 734 laparoscopic sleeve gastrectomy and laparoscopic adjustable gastric banding procedures performed at our institution between 2001 and 2011. Fifty-eight patients were lost to follow-up or had a short duration of follow-up (<1 month). Of the remaining 676 cases, 163 were performed via SPL. All laparoscopic wounds created by trocar size greater than 12 mm were closed with absorbable suture. RESULTS Patient demographics of the SPL group and the multiport group were similar in terms of age, gender, and comorbidities. The average body mass index (BMI) of the SPL group was lower than the multiport group (43.5 ± 5.3 vs. 45.8 ± 7.7, p < 0.01). The mean follow-up for the SPL group was 11 months versus 24 months for the multiport group. There were three trocar-site hernias out of 513 cases in the multiport compared to one hernia out of 163 cases in the SPL group (0.6 vs. 0.6 %, p = 0.967). All trocar-site hernias occurred at the 15-mm port site. The median time to hernia occurrence for the multiport group was 13 months (range, 1-18). In the SPL group, the hernia occurred at 8 months. On multivariate analysis, age, BMI, SPL, procedure type, and the postoperative weight loss were not associated with the development of trocar-site hernias. CONCLUSIONS SPL did not increase the rate of trocar-site hernia in this series. A low rate of trocar-site hernia can be achieved with the use of SPL in bariatric surgery.
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Affiliation(s)
- David Y Lee
- St. Luke's-Roosevelt Hospital Center, Institute for Bariatric and Minimally Invasive Surgery, 1111 Amsterdam Avenue, Babcock 4W, New York, NY 10025, USA.
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Cipullo L, Lucio C, Zullo F, Fulvio Z, Visconti F, Federica V, Palatucci V, Valeria P, Pascale R, Renato P, Marra ML, Luisa MM, Guida M, Maurizio G. Gastric injuries during gynaecologic laparoscopy. Arch Gynecol Obstet 2012; 286:1081-6. [PMID: 22639137 DOI: 10.1007/s00404-012-2389-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 05/10/2012] [Indexed: 10/28/2022]
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Abstract
Clinically significant carbon dioxide embolism is a rare but potentially fatal complication of anesthesia administered during laparoscopic surgery. Its most common cause is inadvertent injection of carbon dioxide into a large vein, artery or solid organ. This error usually occurs during or shortly after insufflation of carbon dioxide into the body cavity, but may result from direct intravascular insufflation of carbon dioxide during surgery. Clinical presentation of carbon dioxide embolism ranges from asymptomatic to neurologic injury, cardiovascular collapse or even death, which is dependent on the rate and volume of carbon dioxide entrapment and the patient's condition. We reviewed extensive literature regarding carbon dioxide embolism in detail and set out to describe the complication from background to treatment. We hope that the present work will improve our understanding of carbon dioxide embolism during laparoscopic surgery.
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Affiliation(s)
- Eun Young Park
- Department of Anesthesiology and Pain Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Ja-Young Kwon
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Ki Jun Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Adikibi BT, Mackinlay GA, Clark MCC, Duthie GHM, Munro FD. The risks of minimal access surgery in children: an aid to consent. J Pediatr Surg 2012; 47:601-5. [PMID: 22424362 DOI: 10.1016/j.jpedsurg.2011.12.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 11/25/2011] [Accepted: 12/06/2011] [Indexed: 10/28/2022]
Abstract
AIM The aim of this study was to determine the risk of complications and conversions for minimally invasive procedures in children, thus allowing properly informed consent. METHODS Data were retrieved for all minimally invasive surgical procedures performed between 1995 and 2009. RESULTS There were 2352 cases performed in 2288 (1428 were male) patients. Of these, 2210 cases (94%) were laparoscopic, and 143 (6%), thoracoscopic. The median age at operation was 6 years and 4 months. The overall complication rate was 3.6%, with the risk of early reoperation at 1.7%. The risk was highest for fundoplication and pyloromyotomy at 3.2% and 4%, respectively. The risk of an infective complication was 0.5% and was highest for appendicectomy and nephrectomy. The risk of visceral injury overall in this series was 0.4%. Visceral injury, explicable only by port insertion, occurred in just under 1 in 1000 cases. The conversion rate was 2.3%. The lowest rates were observed with appendicectomy, fundoplication, and pyloromyotomy. Thoracoscopic cases, nephrectomies, and procedures for an underlying oncological diagnosis had a higher conversion rate. CONCLUSION Informed consent requires knowledge of the risks of surgery. This series may serve as an aid for other units in obtaining consent for minimally invasive surgery in the pediatric population.
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Affiliation(s)
- Boma T Adikibi
- Royal Hospital for Sick Children, EH9 1LF Edinburgh, UK.
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Mayhew PD. Complications of Minimally Invasive Surgery in Companion Animals. Vet Clin North Am Small Anim Pract 2011; 41:1007-21, vii-viii. [DOI: 10.1016/j.cvsm.2011.05.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Safety of open technique for first-trocar placement in laparoscopic surgery: a series of 6,000 cases. Surg Endosc 2011; 26:182-8. [DOI: 10.1007/s00464-011-1852-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Accepted: 06/22/2011] [Indexed: 11/25/2022]
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Laparoscopic appendectomy in the pediatric age group. ANNALS OF PEDIATRIC SURGERY 2011. [DOI: 10.1097/01.xps.0000397457.03352.6c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Matsuse S, Maruyama A, Hara Y. Nitrogenous subcutaneous emphysema caused by spray application of fibrin glue during retroperitoneal laparoscopic surgery. J Anesth 2011; 25:426-30. [PMID: 21424902 DOI: 10.1007/s00540-011-1120-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2010] [Accepted: 02/22/2011] [Indexed: 11/25/2022]
Abstract
We report a case of a patient treated by retroperitoneoscopic partial nephrectomy who developed nitrogenous subcutaneous emphysema (SCE) as a complication. The use of a nitrogen gas-pressured fibrin tissue adhesive applied as a spray caused excessively increased pressure in the closed retroperitoneal space and resulted in widespread SCE with protracted clinical course. To the best of our knowledge, this is the first report of nitrogenous SCE associated with pneumoperitoneum. The clinical significance of nitrogenous SCE is emphasized, and the risks associated with the use of fibrin glue as a spray during laparoscopic surgery are discussed.
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Affiliation(s)
- Shinji Matsuse
- Department of Anesthesia, Kasukabe-chuo General Hospital, Midori-cho 5-9-4, Kasukabe, Saitama, 344-0063, Japan.
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Magaji BA, Moy FM, Roslani AC, Law CW, Buckley BS. Closed versus open approach in laparoscopic colorectal surgery. Hippokratia 2011. [DOI: 10.1002/14651858.cd003547.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Bello A Magaji
- Faculty of Medicine, University of Malaya; Julius Centre University of Malaya, Department of Social and Preventive Medicine; Kuala Lumpur Wilayah Persekutuan Malaysia 50603
| | - Foong Ming Moy
- Faculty of Medicine, University of Malaya; Julius Centre University of Malaya, Department of Social and Preventive Medicine; Kuala Lumpur Wilayah Persekutuan Malaysia 50603
| | - April Camilla Roslani
- Faculty of Medicine, University of Malaya; Department of Surgery; Kuala Lumpur Wilayah Persekutuan Malaysia 50603
| | - Chee Wei Law
- Faculty of Medicine, University of Malaya; Department of Surgery; Kuala Lumpur Wilayah Persekutuan Malaysia 50603
| | - Brian S Buckley
- National University of Ireland; Department of General Practice; Galway Ireland
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Dunne N, Booth MI, Dehn TCB. Establishing pneumoperitoneum: Verres or Hasson? The debate continues. Ann R Coll Surg Engl 2010; 93:22-4. [PMID: 21054924 DOI: 10.1308/003588411x12851639107557] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The technique of establishing pneumoperitoneum for laparoscopic surgery remains contentious, with various different techniques available and each having its own advocates. The Verres needle approach has attracted much criticism and is seen to entail more risk, but is this view justified in the era of evidence-based medicine? PATIENTS AND METHODS Over a 6-year period, a prospective study was undertaken of 3126 patients who underwent laparoscopic surgery performed by two upper gastrointestinal surgeons. One surgeon preferred the Verres needle and the other an open technique. A database was created of all cases and complication rates of the different techniques ascertained. RESULTS Peri-umbilical Verres needle was used in 1887 cases (60.4%) with two complications encountered, both of which were colonic injuries, with an incidence of 0.1%. Open port insertion was used in 1200 cases (38.4%) with one complication, a small bowel perforation, to give an incidence of 0.08%. The Verres needle was used in alternative positions in 22 cases (0.75%) and, when used in the left upper quadrant (19 cases), there was one complication, a left hepatic lobe puncture, with an incidence of 5.26%. Our overall incidence of intra-abdominal injury was 0.13%, all in patients who had undergone previous abdominal surgery, and in the subgroup of patients with previous surgery the rate was 0.78%. There was no mortality. CONCLUSIONS Practice varies as to the method chosen to induce pneumoperitoneum, but our results show there is no significant difference between the technique chosen and incidence of complications, and this is supported in the literature.
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Affiliation(s)
- N Dunne
- Department of General Surgery, Royal Berkshire Hospital, Reading, UK.
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Use of a No. 11 blade scalpel and reusable blunt trocar to establish pneumoperitoneum: description of a safe and inexpensive technique. J Minim Invasive Gynecol 2010; 17:760-5. [PMID: 20955985 DOI: 10.1016/j.jmig.2010.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2010] [Revised: 07/13/2010] [Accepted: 07/15/2010] [Indexed: 11/21/2022]
Abstract
First access is crucial in laparoscopic surgery because of its potentially life-threatening complications. A number of procedures using a variety of instruments have been previously described; however, the safest approach remains uncertain. Herein, we describe a simple and inexpensive method for direct trocar insertion using reusable instruments that was developed over 10 years in a series of 4721 consecutive gynecologic laparoscopic procedures. Observed data revealed that the technique is feasible, rapidly performed, and safe, with a likely cost savings, using a small set of reusable instruments. This procedure should be compared with other access methods in randomized studies to confirm the observed advantages.
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The effect of CO2 pneumovesicum on upper urinary tract. J Pediatr Surg 2010; 45:1863-7. [PMID: 20850633 DOI: 10.1016/j.jpedsurg.2010.04.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Revised: 03/11/2010] [Accepted: 04/21/2010] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Pneumovesicum allows minimal invasive intravesical surgeries. The possible deleterious effect of intravesical CO(2) pressure is not known. We assessed the effect of CO(2) pneumovesicum on the urinary tract and renal function. METHODS Pneumovesicum was established and maintained with CO(2) at 10 mm Hg in 10 sows. Cohen cross-trigonal reimplantation was carried out on the left ureter by a vesicoscopic approach. The right ureter was cannulated and served as control. CO(2) pneumovesicum was maintained for 2 hours. Color Doppler measurements of the upper urinary tract and blood sampling were carried out 30 minutes before and 2 hours after establishing pneumovesicum, and 30 minutes after releasing the pneumovesicum. RESULTS Compared with the preoperative values, the bilateral anteroposterior diameters of the renal pelves increased significantly after 2 hours of the pneumovesicum (P < .05). Thirty minutes after release of the pneumovesicum, the anteroposterior diameters decreased and showed no statistically significant difference compared with the preoperative values. No air embolus was detected in the ureters, renal pelves, renal veins, or renal arteries on either side 2 hours after establishing the pneumovesicum. There was no statistically significant change in arterial or venous blood flow. There was no significant change in the urea and creatinine levels 2 hours after establishing the pneumovesicum. CONCLUSION CO(2) pneumovesicum at a pressure of 10 mm Hg for 2 hours did not result in any demonstrable deleterious effect.
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Pickett SD, Rodewald KJ, Billow MR, Giannios NM, Hurd WW. Avoiding Major Vessel Injury During Laparoscopic Instrument Insertion. Obstet Gynecol Clin North Am 2010; 37:387-97. [DOI: 10.1016/j.ogc.2010.05.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Abut YC, Eryilmaz R, Okan I, Erkalp K. Venous air embolism during laparoscopic cholecystectomy. MINIM INVASIV THER 2010; 18:366-8. [PMID: 19929300 DOI: 10.3109/13645700903384443] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Vascular air embolism is a rare and potentially life-threatening event. In this study, a case of venous air embolism during laparoscopic cholecystectomy due to an injured inferior vena cava is presented. Anesthesiologists and surgeons must be aware of this dangerous complication. Emphasis is given to the prevention and prompt recognition of this event and to the use of all available tools in the management of cardiovascular complications.
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Affiliation(s)
- Yesim Cokay Abut
- Department of Anesthesiology, Vakif Gureba Training Hospital, Istanbul, Turkey
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41
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Hong JY, Kim WO, Kil HK. Detection of subclinical CO2 embolism by transesophageal echocardiography during laparoscopic radical prostatectomy. Urology 2009; 75:581-4. [PMID: 19879638 DOI: 10.1016/j.urology.2009.04.064] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Revised: 02/26/2009] [Accepted: 04/05/2009] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To document incidences of subclinical embolism in laparoscopic radical prostatectomy with continuous monitoring using transesophageal echocardiography (TEE). METHODS A total of 43 patients scheduled for elective robotic-assisted laparoscopic radical prostatectomy under general anesthesia were enrolled in this study. A 4-chamber view of 5.0-MHz multiplane TEE was continuously monitored to detect any intracardiac bubbles as an embolism. An independent TEE specialist reviewed the tapes for interpretation, and emboli were classified as 1 of 5 stages. Cardiorespiratory instability during gas emboli entry was defined as an appearance of cardiac arrhythmias, sudden decrease in mean arterial blood pressure >20 mm Hg, or an episode of pulse oximetric saturation <90%. RESULTS Gas embolisms were observed in 7 of 41 (17.1%) patients during transection of the deep dorsal venous complex. Of them, 1, 3, 1, and 2 showed stage I, II, III, and IV, respectively. However, there were no signs of cardiorespiratory instability associated with emboli. The 95% confidence interval for gas embolism was 0.204%-0.138%. No correlation was observed between episodes of gas embolism and blood gas variables or end-tidal CO(2) partial pressure. CONCLUSIONS Subclinical gas embolisms occur in 17.1% of laparoscopic radical prostatectomies. We should consider that this procedure has a potential for serious gas embolism, especially with the increasing popularity of laparoscopic prostatectomy using robot-assisted techniques.
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Affiliation(s)
- Jeong-Yeon Hong
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Whittle WL, Singh SS, Allen L, Glaude L, Thomas J, Windrim R, Leyland N. Laparoscopic cervico-isthmic cerclage: surgical technique and obstetric outcomes. Am J Obstet Gynecol 2009; 201:364.e1-7. [PMID: 19788969 DOI: 10.1016/j.ajog.2009.07.018] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Revised: 02/25/2009] [Accepted: 07/14/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The purpose of the study is to review the surgical technique, complication rate and obstetric outcome associated with the laparoscopic approach to the placement of the cervico-isthmic cerclage. STUDY DESIGN A prospective cohort study was conducted from 2003-2008 and compared with previously reported cases of cervico-isthmic cerclage by laparotomy and laparoscopy. RESULTS Thirty-one patients underwent cerclage placement during pregnancy and 34 patients were not pregnant at the time of the surgery. Seven cases were converted to laparotomy due to complications arising from uterine vessel bleeding or impaired surgical visibility; 2 pregnancies were lost perioperatively. No other complications occurred. The fetal salvage rate (n = 67 pregnancies) was 89% with a mean gestational age of 35.8 +/- 2.9 weeks. Six pregnancies were lost in the second trimester due to the consequences of acute or subacute chorioamnionitis. CONCLUSION Our findings suggest that the cervico-isthmic cerclage placed laparoscopically compares favorably with the traditional laparotomy approach.
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Primary midline peritoneal access with optical trocar is safe and effective in morbidly obese patients. Surg Obes Relat Dis 2009; 5:610-4. [DOI: 10.1016/j.soard.2009.05.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2008] [Revised: 05/13/2009] [Accepted: 05/13/2009] [Indexed: 11/21/2022]
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Laparoscopic Peritoneal Entry Preferences Among Canadian Gynaecologists. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2009; 31:641-8. [DOI: 10.1016/s1701-2163(16)34243-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Lam A, Kaufman Y, Khong SY, Liew A, Ford S, Condous G. Dealing with complications in laparoscopy. Best Pract Res Clin Obstet Gynaecol 2009; 23:631-46. [PMID: 19539536 DOI: 10.1016/j.bpobgyn.2009.03.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Accepted: 03/16/2009] [Indexed: 11/26/2022]
Abstract
With increasing adoption of laparoscopic surgery in gynaecology, there has been a corresponding rise in the types and rates of complications reported. This article sets out to classify complications associated with laparoscopy according to the phases of the surgery; assess the incidence, the mechanisms, the presentations; and recommend methods for preventing and dealing with complications in laparoscopic surgery. Its aim is to promote a culture of risk management based on the development of strategies to improve patient safety and outcome.
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Affiliation(s)
- Alan Lam
- Centre for Advanced Reproductive Endosurgery, (CARE), Royal North Shore Hospital, University of Sydney, Sydney, Australia.
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Perunovic RM, Scepanovic RP, Stevanovic PD, Ceranic MS. Complications during the establishment of laparoscopic pneumoperitoneum. J Laparoendosc Adv Surg Tech A 2009; 19:1-6. [PMID: 19196086 DOI: 10.1089/lap.2008.0236] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND A safe establishment of the laparoscopic pneumoperitoneum is of the utmost importance, as potentially fatal complications, such as vascular or visceral injury or gas embolism, may occur during the procedure. OBJECTIVE We used the published studies and our own experience to evaluate the advantages and disadvantages of various techniques for the establishment of the laparoscopic pneumoperitoneum, thus aiming to contribute to the reduction in the rate of fatal complications. METHODS We performed a retrospective review of 4940 medical charts of patients without prior history of abdominal surgeries who had the laparoscopic pneumoperitoneum established by using a modified closed method (i.e., the patient is in an anti-Trendelenburg's position 20-30 degrees and a left lateral tilt of 10-15 degrees, with the Veress needle and the first trocar introduced through the umbilicus and directed toward the intersection of the anterior axial line and the right costal arc). Additionally, we searched Medline, Embase, and the Cochrane libraries with a cut-off date of December 2006, using specific key-words (i.e., trocar injury, complication, laparoscopic surgery, Veress needle, open vs. closed pneumoperitoneum, prospective study). RESULTS There were no reports of injuries to the major blood vessels or visceral organs. However, liver capsule injury was reported in 432 (8.2%) patients, pneumo-omentum in 55 (1.1%) patients, and subfascial insufflations in 45 (0.9%) patients. CONCLUSIONS No reliable conclusions regarding advantages or disadvantages of different techniques for the laparoscopic pneumoperitoneum can be drawn in the absence of adequately powered, prospective, comparative studies. Based on the fact that no major blood vessel or visceral organ injuries were observed in our experience, we conclude that the modified closed method deserves further multicentric prospective evaluation.
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Kudsi OY, Jones SA, Brenn BR. Carbon dioxide embolism in a 3-week-old neonate during laparoscopic pyloromyotomy: a case report. J Pediatr Surg 2009; 44:842-5. [PMID: 19361651 DOI: 10.1016/j.jpedsurg.2008.11.045] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2008] [Revised: 11/14/2008] [Accepted: 11/17/2008] [Indexed: 11/25/2022]
Abstract
Laparoscopic pyloromyotomy has gained popularity in the treatment of hypertrophic pyloric stenosis. This is the first case report of carbon dioxide embolism during laparoscopic pyloromyotomy. We describe a case of carbon dioxide embolism in a 3-week-old neonate during laparoscopic pyloromyotomy by injection of carbon dioxide into a patent umbilical vein. The diagnosis of carbon dioxide embolism was made on the basis of the abrupt decrease in end-tidal CO(2), sudden decreased Spo(2), hypotension, and cyanosis. Portable x-ray with the clinical presentation was sufficient for a diagnosis of carbon dioxide embolism. Treatment included termination of CO(2) insufflation, placing the patient in Durant's position, and adequate resuscitation as necessary. Despite the fact that the insufflation pressure was in the recommended range, a carbon dioxide embolism was thought to be caused by injection of carbon dioxide into a patent umbilical vein. Although laparoscopic pyloromyotomy has demonstrated to be a safe and effective procedure, this is a serious and rare complication causing prolonged length of stay and skewed hospital charges.
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Affiliation(s)
- Omar Yusef Kudsi
- Department of Surgery, Lankenau Hospital and Institute for Medical Research, Wynnewood, PA 19096, USA
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Sasmal PK, Tantia O, Jain M, Khanna S, Sen B. Primary access-related complications in laparoscopic cholecystectomy via the closed technique: experience of a single surgical team over more than 15 years. Surg Endosc 2009; 23:2407-15. [PMID: 19296168 DOI: 10.1007/s00464-009-0437-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Revised: 02/17/2009] [Accepted: 02/27/2009] [Indexed: 11/24/2022]
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC), a common laparoscopic procedure, is a relatively safe invasive procedure, but complications can occur at every step, starting from creation of the pneumoperitoneum. Several studies have investigated procedure-related complications, but the primary access- or trocar-related complications generally are underreported, and their true incidence may be higher than studies show. Major vascular or visceral injury resulting from blind access to the abdominal cavity, although rare, has been reported. Of the two methods for creating pneumoperitoneum, the open access technique is reported to have the lower incidence of these injuries. The authors report their experience with the closed method and show that if performed with proper technique, it can be as rapid and safe as other techniques. However, injuries still happen, and the search for the predisposing factors must be continued. METHODS Between January 1992 and December 2007, a retrospective study examined 15,260 cases of LC performed for symptomatic gallstone disease in the authors' institution by a single team of surgeons. The primary access-related injuries in these cases were retrospectively analyzed. RESULTS In 15,260 cases of LC, 63 cases of primary access-related complications were identified, for an overall incidence of 0.41%. Major injuries in 11 cases included major vascular and visceral injuries, and minor injuries in 52 cases included omental and subcutaneous emphysema. For the closed method, the findings showed an overall incidence of 0.14% for primary access-related vascular injuries and 0.07% for visceral injuries. CONCLUSION Primary access-related complications during LC are common and can prove to be fatal if not identified early. The incidence of these injuries with closed methods is no greater than with open methods. No evidence suggests abandonment of the closed-entry method in laparoscopy.
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Affiliation(s)
- Prakash Kumar Sasmal
- Department of Minimal Access Surgery, ILS Multispeciality Clinic, DD-6, Sector-I, Salt Lake City, Kolkata, 700 064, India
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Meininger D, Byhahn C. [Special features of laparoscopic operations from an anesthesiologic viewpoint: a review]. Anaesthesist 2008; 57:760-6. [PMID: 18663418 DOI: 10.1007/s00101-008-1422-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The value of laparoscopic procedures has increased over the last decade. Many patients undergoing laparoscopic surgery also have coexisting diseases. The hemodynamic effects of intraperitoneal carbon dioxide insufflation depend on the extent of intraperitoneal pressure, severity of preexisting cardiopulmonary diseases, volume state of the patient and alterations of acid-base balance due to a capnoperitoneum. In addition to endocrinologic reactions, patient positioning also affects hemodynamic parameters. In high risk patients extended cardiopulmonary monitoring with an arterial line and repeated blood gas analysis is recommended intraoperatively, in addition to assessment of end-expiratory CO(2). In this patient group the intra-abdominal pressure should be maintained in the range of 5-7 mmHg.
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Affiliation(s)
- D Meininger
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Klinikum der Johann Wolfgang Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.
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50
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Abstract
Complications during gynecologic surgery result from the proximity of the uterus and ovaries to other critical pelvic structures. These structures include the urinary tract, bowel, nerves, and vasculature. Knowledge of pelvic anatomy is important when performing these procedures and is critical in cases of altered anatomy from adhesive disease and during intraoperative hemorrhage. Recognition and repair of an unintended injury gives the best chance for minimizing sequelae from these complications.
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Affiliation(s)
- Michael P Stany
- Division of Gynecologic Oncology, Walter Reed Army Medical Center, 6900 Georgia Avenue, NW, Washington, DC 20307, USA
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