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Eroglu A, Ekin RG. Comparison of Optical Trocar Access Versus Veress Needle Insertion Technique for Peritoneal Entry in Laparoscopic Donor Nephrectomy. Transplant Proc 2024; 56:306-309. [PMID: 38355368 DOI: 10.1016/j.transproceed.2023.12.014] [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: 10/04/2023] [Accepted: 12/28/2023] [Indexed: 02/16/2024]
Abstract
BACKGROUND Nearly half of all complications in laparoscopic surgery occur at the intraperitoneal access. We compared direct optical entry (DOE) with Veress needle entry (VNE) in terms of abdominal entry time and entry-associated complications in patients who underwent laparoscopic donor nephrectomy (LDN). METHODS Between June 2010 and July 2023, data from 813 patients who underwent LDN were analyzed. Age, male-to-female ratio, American Society of Anesthesiologists (ASA) score, body mass index, operation side, previous abdominal surgery, abdominal entry technique, abdominal entry time, entry-associated complications, conversion to different abdominal entry techniques, and conversion to open surgery were evaluated. RESULTS DOE and VNE were performed on 433 and 281 patients, respectively. Age (48.89 ± 12.11 vs 47.59 ± 11.34 years), male-to-female ratio (44.8% vs 40.9% males and 55.2% vs 59.1% females), ASA score (2 vs 2 median ASA score), body mass index (26.72 ± 6.11 vs 27.07 ± 5.83 kg/m2), and operation side (63.0% vs 61.3% left nephrectomy) were not statistically significant differences between the DOE and VNE groups (P > .05). However, abdominal entry time was significantly reduced in the DOE group compared with the VNE group (26.8 ± 20.8 vs 49.5 ± 34.1 seconds, P = .007, respectively). Entry-associated complications were observed in 8 (1.12%) patients. No major (grades 3-5) complications were observed. There were no statistically significant differences in overall (0.6% vs 1.7%, P = .291), grade 1, and grade 2 complication rates between the DOE and VNE groups (0.4% vs 1.4%, P = .366; 0.2% vs 0.3%, P = .714, respectively). CONCLUSIONS DOE and VNE are not foolproof. DOE is a safe, feasible, and faster technique in patients who underwent LDN.
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Affiliation(s)
- Askin Eroglu
- Acibadem Healthcare Group, Kent Hospital, Department of Urology and Kidney Transplantation, Izmir, Turkey
| | - Rahmi Gokhan Ekin
- Acibadem Healthcare Group, Kent Hospital, Department of Urology and Kidney Transplantation, Izmir, Turkey.
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Horeman-Franse T, Postema RR, Fischer T, Calleja-Agius J, Camenzuli C, Alvino L, Hardon SF, Bonjer HJ. The relevance of reducing Veress needle overshooting. Sci Rep 2023; 13:17471. [PMID: 37838824 PMCID: PMC10576755 DOI: 10.1038/s41598-023-44890-1] [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] [Received: 02/07/2023] [Accepted: 10/13/2023] [Indexed: 10/16/2023] Open
Abstract
Safe insertion of the Veress needle during laparoscopy relies on the surgeons' technical skills in order to stop needle insertion just in time to prevent overshooting in the underlying organs. To reduce this risk, a wide variety of Veress needle systems were developed with safety mechanisms that limit the insertion speed, insertion depth or decouple the driving force generated by the surgeon's hand on the needle. The aim of this study is to evaluate current surgeons' perceptions related to the use of Veress needles and to investigate the relevance of preventing overshooting of Veress needles among members of the European Association of Endoscopic Surgery (EAES). An online survey was distributed by the EAES Executive Office to all active members. The survey consisted of demographic data and 14 questions regarding the use of the Veress needle, the training conducted prior to usage, and the need for any improvement. A total of 365 members residing in 58 different countries responded the survey. Of the responding surgeons, 36% prefer the open method for patients with normal body mass index (BMI), and 22% for patients with high BMI. Of the surgeons using Veress needle, 68% indicated that the reduction of overshoot is beneficial in normal BMI patients, whereas 78% indicated that this is beneficial in high BMI patients. On average, the members using the Veress needle had used it for 1448 (SD 3031) times and felt comfortable on using it after 22,9 (SD 78,9) times. The average years of experience was 17,6 (SD 11,1) and the surgeons think that a maximum overshoot of 9.4 (SD 5.5) mm is acceptable before they can safely use the Veress needle. This survey indicates that despite the risks, Veress needles are still being used by the majority of the laparoscopic surgeons who responded. In addition, the surgeons responded that they were interested in using a Veress needle with an extra safety mechanism if it limits the risk of overshooting into the underlying structures.
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Affiliation(s)
- T Horeman-Franse
- Department of Biomechanical Engineering, Delft University of Technology, TU-Delft, Mekelweg 2, 2628CD, Delft, The Netherlands.
- European Association of Endoscopic Surgery, Eindhoven, The Netherlands.
| | - R R Postema
- Department of Biomechanical Engineering, Delft University of Technology, TU-Delft, Mekelweg 2, 2628CD, Delft, The Netherlands
- Department of Surgery, Amsterdam University Medical Centers, Location VUMC, Amsterdam, The Netherlands
| | - T Fischer
- Department of Biomechanical Engineering, Delft University of Technology, TU-Delft, Mekelweg 2, 2628CD, Delft, The Netherlands
| | - J Calleja-Agius
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - C Camenzuli
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - L Alvino
- Neyenrode Business School, Amsterdam, The Netherlands
| | - S F Hardon
- Department of Biomechanical Engineering, Delft University of Technology, TU-Delft, Mekelweg 2, 2628CD, Delft, The Netherlands
- Department of Surgery, Amsterdam University Medical Centers, Location VUMC, Amsterdam, The Netherlands
| | - H J Bonjer
- Department of Surgery, Amsterdam University Medical Centers, Location VUMC, Amsterdam, The Netherlands
- European Association of Endoscopic Surgery, Eindhoven, The Netherlands
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Bansal R, Bhuyan S, Gupta R, Garg A, Bansal AR. Spontaneous Cerebral Air Embolism-An Unusual Scenario. Neurol India 2023; 71:772-774. [PMID: 37635514 DOI: 10.4103/0028-3886.383877] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
The introduction of air into cerebral venous or arterial circulation known as cerebral air embolism (CAE) is a rare clinical entity. CAE is commonly iatrogenic secondary to central venous catheter (CVC) placement or removal, various endoscopic procedures, or trauma or surgical scenarios. Here we report a case of spontaneous CAE in an unusual scenario. A 71-year-old male presented to emergency after developing giddiness following a yoga session. His MRI showed air embolism in the posterior fossa along cerebellar folia, prepontine, and suprasellar cisterns and tracking superiorly along the tentorium cerebelli. CAE is a rare clinical entity. Our case had CAE as a complication of cholesteatoma and possibly got triggered due to change in air pressor dynamics during yoga session.
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Affiliation(s)
- Rishu Bansal
- Department of Neurology, Institute of Neuroscience, Medanta-The Medicity, Gurgaon, Haryana, India
| | - Sushant Bhuyan
- Department of Neurology, Institute of Neuroscience, Medanta-The Medicity, Gurgaon, Haryana, India
| | - Rajiv Gupta
- Department of Radiology and Imaging, Institute of Neuroscience, Medanta-The Medicity, Gurgaon, Haryana, India
| | - Arun Garg
- Department of Neurology, Institute of Neuroscience, Medanta-The Medicity, Gurgaon, Haryana, India
| | - Atma R Bansal
- Department of Neurology, Institute of Neuroscience, Medanta-The Medicity, Gurgaon, Haryana, India
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Gunadi, Oktavian A, Iskandar K, Vujira KA, Fauzi AR. Bladder injury in an incarcerated inguinal hernia in a pediatric patient. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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Wang C, Reynolds JC, Calle P, Ladymon AD, Yan F, Yan Y, Ton S, Fung KM, Patel SG, Yu Z, Pan C, Tang Q. Computer-aided Veress needle guidance using endoscopic optical coherence tomography and convolutional neural networks. JOURNAL OF BIOPHOTONICS 2022; 15:e202100347. [PMID: 35103420 PMCID: PMC9097560 DOI: 10.1002/jbio.202100347] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/17/2022] [Accepted: 01/20/2022] [Indexed: 05/03/2023]
Abstract
During laparoscopic surgery, the Veress needle is commonly used in pneumoperitoneum establishment. Precise placement of the Veress needle is still a challenge for the surgeon. In this study, a computer-aided endoscopic optical coherence tomography (OCT) system was developed to effectively and safely guide Veress needle insertion. This endoscopic system was tested by imaging subcutaneous fat, muscle, abdominal space, and the small intestine from swine samples to simulate the surgical process, including the situation with small intestine injury. Each tissue layer was visualized in OCT images with unique features and subsequently used to develop a system for automatic localization of the Veress needle tip by identifying tissue layers (or spaces) and estimating the needle-to-tissue distance. We used convolutional neural networks (CNNs) in automatic tissue classification and distance estimation. The average testing accuracy in tissue classification was 98.53 ± 0.39%, and the average testing relative error in distance estimation reached 4.42 ± 0.56% (36.09 ± 4.92 μm).
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Affiliation(s)
- Chen Wang
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK 73019
| | | | - Paul Calle
- School of Computer Science, University of Oklahoma, Norman, OK 73019
| | - Avery D. Ladymon
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK 73019
| | - Feng Yan
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK 73019
| | - Yuyang Yan
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK 73019
| | - Sam Ton
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK 73019
| | - Kar-ming Fung
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104
| | - Sanjay G. Patel
- Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104
| | - Zhongxin Yu
- Children’s Hospital, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104
| | - Chongle Pan
- School of Computer Science, University of Oklahoma, Norman, OK 73019
- ,
| | - Qinggong Tang
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK 73019
- ,
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Huang EYH, Kao MC, Ting CK, Huang WJS, Yeh YT, Ke HH, Kuo WC. Needle-Probe Optical Coherence Tomography for Real-Time Visualization of Veress Peritoneal Needle Placement in a Porcine Model: A New Safety Concept for Pneumoperitoneum Establishment in Laparoscopic Surgery. Biomedicines 2022; 10:biomedicines10020485. [PMID: 35203693 PMCID: PMC8962299 DOI: 10.3390/biomedicines10020485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/10/2022] [Accepted: 02/14/2022] [Indexed: 12/01/2022] Open
Abstract
The safe establishment of pneumoperitoneum is a critical step in all laparoscopic surgeries. A closed pneumoperitoneum is usually obtained by inserting a Veress needle into the peritoneal cavity. However, there is no definite measure to visually confirm the position of the Veress needle tip inside the peritoneal cavity. This study aimed to describe a method of real-time visual detection of peritoneal placement of the Veress needle using an incorporated optical coherence tomography (OCT) probe in a porcine model. A 14-gauge Veress needle was incorporated with a miniature fiber probe to puncture the piglet’s abdominal wall into the peritoneal cavity. A total of 80 peritoneal punctures were attempted in four piglets. For each puncture, continuous two-dimensional OCT images of the abdominal wall were acquired for real-time visual detection of the needle placement into the peritoneal cavity. Characteristic OCT image patterns could be observed during the puncturing process, especially a deep V-shaped concave pattern before the peritoneum puncture, which was a crucial feature. A statistical difference in the OCT signal standard deviation value also indicated the differentiability of images between the peritoneum and extra-peritoneal tissue layers. A success rate of 97.5% could be achieved with the guidance of the OCT images. OCT images translate the blind closed technique of peritoneal access into a visualized procedure, thus improving peritoneal access safety.
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Affiliation(s)
- Eric Yi-Hsiu Huang
- Department of Urology, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (E.Y.-H.H.); (W.J.S.H.)
- Department of Urology, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Meng-Chun Kao
- Institute of Biophotonics, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan; (M.-C.K.); (Y.-T.Y.); (H.-H.K.)
| | - Chien-Kun Ting
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei 11217, Taiwan;
| | - William J. S. Huang
- Department of Urology, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (E.Y.-H.H.); (W.J.S.H.)
- Department of Urology, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Yi-Ting Yeh
- Institute of Biophotonics, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan; (M.-C.K.); (Y.-T.Y.); (H.-H.K.)
| | - Hui-Hsuan Ke
- Institute of Biophotonics, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan; (M.-C.K.); (Y.-T.Y.); (H.-H.K.)
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei 11217, Taiwan;
| | - Wen-Chuan Kuo
- Institute of Biophotonics, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan; (M.-C.K.); (Y.-T.Y.); (H.-H.K.)
- Correspondence:
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Bowel injury in laparoscopic gynaecological surgery; 19 medicolegal cases. Eur J Obstet Gynecol Reprod Biol 2021; 270:261-264. [PMID: 34974932 DOI: 10.1016/j.ejogrb.2021.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 11/24/2021] [Accepted: 12/22/2021] [Indexed: 11/23/2022]
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Postema RR, Cefai D, van Straten B, Miedema R, Hardjo LL, Dankelman J, Nickel F, Horeman-Franse T. A novel Veress needle mechanism that reduces overshooting after puncturing the abdominal wall. Surg Endosc 2021; 35:5857-5866. [PMID: 34159463 PMCID: PMC8437840 DOI: 10.1007/s00464-021-08603-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 06/06/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Complications that occur in laparoscopic surgery are often associated with the initial entry into the peritoneal cavity. The literature reported incidences of Veress needle (VN) injuries of e.g. 0.31% and 0.23%. In a 2010 national survey of laparoscopic entry techniques in the Canadian General Surgical practice, 57.3% of respondents had either experienced or witnessed a serious laparoscopic entry complication like bowel perforation and vascular injury. As those complications are potentially life threatening and should be avoided at all costs, improving safety of this initial action is paramount. METHODS Based on a bare minimum design approach with focus on function expansion of existing components, a new Safety mechanism was developed for the VN that decreases the risks of VN overshooting. The mechanism works by preventing the puncturing acceleration of the tip of the VN by decoupling the surgeon's hand from the VN immediately after entering the abdomen. RESULTS Based on a set of requirements, a first prototype of the VN+ with force decoupling safety mechanism is presented and evaluated on an ex vivo porcine abdominal wall tissue model in a custom setup. The experiments conducted by two novices and one experienced surgeon indicated a significant difference between the attempts with a standard, conventional working VN (41.4 mm [37.5-45 mm]) and VN+ with decoupling mechanism (20.8 mm [17.5-22.5 mm]) of p < 0.001. CONCLUSION A new decoupling safety mechanism was integrated successfully in a standard VN resulting in a VN+ . The results from the pilot study indicate that this new VN+ reduces overshooting with a minimum of 50% in a standardised ex vivo setting on fresh porcine abdominal wall specimens.
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Affiliation(s)
- Roelf R Postema
- Department of BioMechanical Engineering, Faculty of Biomedical Engineering, University of Technology Delft, Mekelweg 2, 2628 CD, Delft, The Netherlands
- Department of Surgery, University Medical Centers Amsterdam, Location VUMC, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - David Cefai
- Engineering Department, ProVinci Medtech, 2631 CM, Nootdorp, The Netherlands
| | - Bart van Straten
- Department of BioMechanical Engineering, Faculty of Biomedical Engineering, University of Technology Delft, Mekelweg 2, 2628 CD, Delft, The Netherlands
| | - Rein Miedema
- Department of BioMechanical Engineering, Faculty of Biomedical Engineering, University of Technology Delft, Mekelweg 2, 2628 CD, Delft, The Netherlands
| | - Latifa Lesmana Hardjo
- Department of BioMechanical Engineering, Faculty of Biomedical Engineering, University of Technology Delft, Mekelweg 2, 2628 CD, Delft, The Netherlands
| | - Jenny Dankelman
- Department of BioMechanical Engineering, Faculty of Biomedical Engineering, University of Technology Delft, Mekelweg 2, 2628 CD, Delft, The Netherlands
| | - Felix Nickel
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Tim Horeman-Franse
- Department of BioMechanical Engineering, Faculty of Biomedical Engineering, University of Technology Delft, Mekelweg 2, 2628 CD, Delft, The Netherlands.
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Nassar AHM, Ng HJ. Risk identification and technical modifications reduce the incidence of post-cholecystectomy bile leakage: analysis of 5675 laparoscopic cholecystectomies. Langenbecks Arch Surg 2021; 407:213-223. [PMID: 34436660 PMCID: PMC8847250 DOI: 10.1007/s00423-021-02264-z] [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: 01/22/2021] [Accepted: 07/01/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE The main sources of post-cholecystectomy bile leakage (PCBL) not involving major duct injuries are the cystic duct and subvesical/hepatocystic ducts. Of the many studies on the diagnosis and management of PCBL, few addressed measures to avoid this serious complication. The aim of this study was to examine the causes and mechanisms leading to PCBL and to evaluate the effects of specific preventative strategies. METHODS A prospectively maintained database of 5675 consecutive laparoscopic cholecystectomies was analysed. Risk factors for post-cholecystectomy bile leakage were identified and documented and technical modifications and strategies were adopted to prevent this complication. The incidence, causes and management of patients who suffered bile leaks were studied and their preoperative characteristics, operative data and postoperative outcomes were compared with patients where potential risks were identified and PCBL avoided and with the rest of the series. RESULTS Twenty-five patients (0.4%) had PCBL (7 expected and less than half requiring reintervention): 11 from cystic ducts (0.2%), 3 from subvesical ducts (0.05%) and 11 from unconfirmed sources (0.2%). The incidence of cystic duct leakage was significantly lower with ties (0.15%) than with clips (0.7%). Fifty-two percent had difficulty grades IV or V, 36% had empyema or acute cholecystitis and 16% had contracted gallbladders. Twelve patients required 17 reinterventions before PCBL resolved; 7 percutaneous drainage, 6 ERCP and 4 relaparoscopy. The median hospital stay was 17 days with no mortality. Hepatocystic ducts were encountered in 72 patients (1.3%) and were secured with loops (54.2%), ties (25%) or sutures (20.8%) with no PCBL. Eighteen sectoral ducts were identified and secured. CONCLUSION Ligation of the cystic duct reduces the incidence of PCBL resulting from dislodged endoclips. Careful blunt dissection in the proper anatomical planes avoiding direct or thermal injury to subvesical and sectoral ducts and a policy of actively searching for hepatocystic ducts during gallbladder separation to identify and secure them can reduce bile leakage from such ducts.
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Affiliation(s)
- Ahmad H M Nassar
- Laparoscopic Biliary Surgery Service, University Hospital Monklands, Lanarkshire, Airdrie, Scotland, ML6 0JS, UK.
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10
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King NR, Lin E, Yeh C, Wong JMK, Friedman J, Traylor J, Tsai S, Chaudhari A, Milad MP. Laparoscopic Major Vascular Injuries in Gynecologic Surgery for Benign Indications: A Systematic Review. Obstet Gynecol 2021; 137:434-442. [PMID: 33543898 DOI: 10.1097/aog.0000000000004280] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/19/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify the incidence, location, etiology, and mortality of major vascular injuries in gynecologic laparoscopy for benign indications. DATA SOURCES A systematic review of PubMed, EMBASE, Cochrane Library, ClinicalTrials.gov, and MEDLINE was conducted. METHODS OF STUDY SELECTION One thousand ninety-seven studies were screened for inclusion with 147 full-text articles reviewed. Sixty-six studies published between 1978 and 2016 met inclusion criteria, representing 197,062 surgeries. Articles that were included reported the incidence of major vascular injuries during gynecologic laparoscopy for benign indications. Exclusion criteria included surgery for gynecologic malignancy, duplicated data, case series and reports, manuscripts not in English, and studies published only as abstracts. TABULATION, INTEGRATION, AND RESULTS Injuries to the aorta, inferior vena cava, iliac (common, external, or internal), and inferior epigastric vessels were recorded, as were injuries denoted as major but not otherwise specified. A total of 179 major vascular injuries were reported with an incidence of 0.09% (95% CI 0.08-0.10). The inferior epigastric vessels were the most commonly injured vessel (0.04%, 95% CI 0.03-0.05), comprising 48% (95% CI 40-55) of all injuries. The majority of injuries occurred during abdominal entry (82%, 95% CI 76-89), and the remainder occurred during surgical dissection (18%, 95% CI 11-24). Most injuries were recognized intraoperatively (93%, 95% CI 87-100), and approximately half (55%, 95% CI 46-63) required laparotomy for repair. Only two of the 179 major vascular injuries resulted in death, for an overall mortality rate from vascular injuries of 0.001% (95% CI 0.000-0.004). CONCLUSION The incidence of major vascular injury during gynecologic laparoscopy found in this review is very low, and the vast majority of injuries did not result in death. Laparoscopy remains a safe surgical technique in relation to vascular injuries when performed for benign gynecologic disease.
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Affiliation(s)
- Nathan R King
- Department of Obstetrics and Gynecology and the Division of Biostatistics, Department of Preventive Medicine, Northwestern Feinberg School of Medicine, Chicago, Illinois; and the Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Muthukumar M, Bobji MS, Simha KRY. Needle insertion-induced quasiperiodic cone cracks in hydrogel. SOFT MATTER 2021; 17:2823-2831. [PMID: 33554985 DOI: 10.1039/d0sm02145h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Needle insertion, a standard process for various minimally invasive surgeries, results in tissue damage which sometimes leads to catastrophic outcomes. Opaqueness and inhomogeneity of the tissues make it difficult to observe the underlying damage mechanisms. In this paper, we use transparent and homogeneous polyacrylamide hydrogel as a tissue mimic to investigate the damages caused during needle insertion. The insertion force shows multiple events, characterised by a gradual increase in the force followed by a sharp fall. Synchronised recording of the needle displacement into the gel shows that each event corresponds to propagation of stable cone crack. Though sporadic uncontrolled cracking has been discussed earlier, this is the first report of nearly periodic, stable and well-controlled 3-D cone cracks inside the hydrogel during deep penetration. We show that the stress field around the needle tip is responsible for the symmetry and periodicity of the cone cracks. These results provide a better understanding of the fracture processes in soft and brittle materials and open a promising perspective in needle designs and the control of tissue damages during surgical operations.
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Affiliation(s)
- M Muthukumar
- Department of Mechanical Engineering, Indian Institute of Science, Bangalore - 560012, India. and Department of Aeronautical Engineering, Acharya Institute of Technology, Bangalore, 560107, India.
| | - M S Bobji
- Department of Mechanical Engineering, Indian Institute of Science, Bangalore - 560012, India.
| | - K R Y Simha
- Department of Mechanical Engineering, Indian Institute of Science, Bangalore - 560012, India.
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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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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: 0.3] [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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Cheng S, Zheng Q, Xu L, Zhao W, Li G, Ding G. Management of major vascular injury in laparoscopic urology. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2020. [DOI: 10.1016/j.lers.2020.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Recknagel JD, Goodman LR. Clinical Perspective Concerning Abdominal Entry Techniques. J Minim Invasive Gynecol 2020; 28:467-474. [PMID: 32712324 DOI: 10.1016/j.jmig.2020.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/15/2020] [Accepted: 07/18/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Entry into the abdomen during operative laparoscopy is a source of some controversy regarding the safest and most useful method. The objective of this review is to describe, compare, and contrast the most popular entry techniques. DATA SOURCES Data were collected from the historical starting point until present day from English language journal articles and book chapters. METHODS OF STUDY SELECTION Descriptive accounts dating back to the start of laparoscopy in the 1970s and spanning to present day well-designed randomized controlled trials and Cochrane reviews were compiled to evaluate the evidence for the effectiveness and safety of abdominal entry techniques. TABULATION, INTEGRATION, AND RESULTS The most common sites of entry are the umbilicus and the left upper quadrant. Between the Veress needle, direct trocar insertion, and open entry there is no high-quality evidence to suggest that any of these offers a universal safety advantage. The Veress needle is still the most used among gynecologists and facilitates primary trocar placement. Direct trocar entry under laparoscopic visualization may be underused, is faster, and may result in fewer failed entries. Open (Hasson) entry can be more technically challenging, but may be best for patients with suspected intra-abdominal adhesions. CONCLUSION Surgeon comfort is critical in choosing the entry site, method, and equipment. Surgeon familiarity with entry-failure troubleshooting, possible complications, and management is essential because major entry complications are rare in modern laparoscopy but critical because the essential steps of recognition and management can be lifesaving.
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Affiliation(s)
- Johnathon D Recknagel
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of North Carolina Hospitals, Chapel Hill, North Carolina (all authors)
| | - Linnea R Goodman
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of North Carolina Hospitals, Chapel Hill, North Carolina (all authors).
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Joo P, Guilbert L, Sepúlveda EM, Ortíz CJ, Donatini G, Zerrweck C. Unexpected Intraoperative Findings, Situations, and Complications in Bariatric Surgery. Obes Surg 2020; 29:1281-1286. [PMID: 30610676 DOI: 10.1007/s11695-018-03672-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Bariatric surgery is considered a safe therapy to treat obesity. Postoperative complications are well known; however, there is a lack of data describing intraoperative complications and/or unexpected findings, and if there is further impact on outcomes. METHODS Retrospective study with patients operated between 2013 and 2016 at a single institution. All operative information was collected prospectively and aimed to analyze the incidence and causes of unexpected intraoperative findings, complications, change in surgical plan, extra surgeries, and procedure interruption in patients submitted to bariatric surgery. Secondarily, a morbidity analysis was performed, correlating intraoperative complications with postoperative complications and length of stay. RESULTS Four-hundred and five patients were included. Female sex comprised 82% of cases, and a median age of 38 years old was observed; almost 90% were gastric bypass. In 29.3% of cases, there were intraoperative findings, mainly adhesions, abdominal wall hernias, positive methylene blue test, hiatal hernias, and gastrointestinal stromal tumors. Associated surgeries were performed in 8.6% cases, and intraoperative adverse events reported in 7.1%, where organ injury and anastomosis problems were the most frequent. A change in the operative plan was done in 0.9% and surgery interruption in 1.2% of the cases. Early complications were observed in 6.6%. There was no correlation between intraoperative complications and length of stay or early complications. CONCLUSION Unexpected intraoperative findings/complications are common in bariatric surgery, but without increasing morbidity or length of stay. Surgery suspension, change in the planned technique, or adding extra (non-bariatric) procedures may occur.
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Affiliation(s)
- Paul Joo
- The Obesity Clinic at Hospital General Tláhuac, Avenida la Turba # 655, Col. Villa Centroamericana y del Caribe, Delegación Tláhuac, Zip 13250, México City, Mexico
| | - Lizbeth Guilbert
- The Obesity Clinic at Hospital General Tláhuac, Avenida la Turba # 655, Col. Villa Centroamericana y del Caribe, Delegación Tláhuac, Zip 13250, México City, Mexico
| | - Elisa M Sepúlveda
- The Obesity Clinic at Hospital General Tláhuac, Avenida la Turba # 655, Col. Villa Centroamericana y del Caribe, Delegación Tláhuac, Zip 13250, México City, Mexico
| | - Cristian J Ortíz
- The Obesity Clinic at Hospital General Tláhuac, Avenida la Turba # 655, Col. Villa Centroamericana y del Caribe, Delegación Tláhuac, Zip 13250, México City, Mexico
| | - Gianluca Donatini
- Digestive and Endocrine Surgery Department, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Carlos Zerrweck
- The Obesity Clinic at Hospital General Tláhuac, Avenida la Turba # 655, Col. Villa Centroamericana y del Caribe, Delegación Tláhuac, Zip 13250, México City, Mexico.
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Daemen JHT, Deden LN, van den Ende A, Pijl MEJ, Slump CH, Berends FJ, Aarts EO. A novel abdominal wall entry suction device to increase Veress needle safety: A prospective cohort pilot study. Ann Med Surg (Lond) 2019; 47:70-74. [PMID: 31645941 PMCID: PMC6804323 DOI: 10.1016/j.amsu.2019.10.001] [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: 07/24/2019] [Revised: 09/24/2019] [Accepted: 10/02/2019] [Indexed: 11/24/2022] Open
Abstract
Background In laparoscopic surgery, the Veress needle technique is most often used to initiate a pneumoperitoneum. Although low, entry-related injuries of the intestines and major vascular structures occur in 0.04–0.1% of cases. Up to 50% of these injuries remain undiagnosed at the time of surgery, resulting in mortality rates between 2.5 and 30%. In an effort to minimize such injuries we objectively assessed a novel abdominal wall entry suction device (AWESD) that was hypothesized to lift the abdominal wall and create an additional post-peritoneum safe margin for safer Veress needle introduction. Materials and methods A prospective pilot study was conducted in which CT-scans with and without AWESD application (centered above the umbilicus) were assessed to determine its effect on the distance from the linea alba to the intestines, vena cava and abdominal aorta. Paired measurements were subjected to the Wilcoxon signed rank test. Results Twelve participants were included. The AWESD significantly increased the median distance towards the intestines in the axial and sagittal plane (P = 0.01 and P = 0.006) from 0.93 (Inter Quartile Range (IQR): 0.33–1.51) and 0.85 (IQR: 0.32–1.47) to 1.35 (IQR: 0.39–2.27) and 1.25 (IQR: 0.42–2.10) centimeters, respectively. Similarly, for the median axial distances towards the vena cava and abdominal aorta (both P = 0.002) that were increased from 10.00 (IQR: 7.18–11.12) and 9.33 (IQR: 6.55–10.28) to 13.23 (IQR: 11.76–14.31) and 12.49 (IQR: 10.98–13.32) centimeters, respectively. Conclusion The AWESD significantly increased the distances between the peritoneum and main intra-abdominal structures. However, conclusions on subsequent increased safety cannot be drawn as high-volume studies are required to determine its clinical relevance. Veress needle related injuries are rare but associated with high mortality rates. A novel abdominal entry suction device to increase Veress needle safety was studied. The device increased the distance between peritoneum and intra-abdominal structures. The increased distance was greatest for the vena cava and abdominal aorta. Despite the increased distances, the devices' clinical relevance remains unknown.
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Affiliation(s)
- Jean H T Daemen
- Department of Surgery, Zuyderland Medical Centre, Heerlen, the Netherlands
| | - Laura N Deden
- Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands
| | | | - Milan E J Pijl
- Department of Radiology, Rijnstate Hospital, Arnhem, the Netherlands
| | - Cornelis H Slump
- Department of Robotics and Mechatronics, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - Frits J Berends
- Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands
| | - Edo O Aarts
- Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands
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Wolthuis AM. Veress Needle Creation of a Pneumoperitoneum: Is It Risky? Results of the First Belgian Group for Endoscopic Surgery-Snapshot Study. J Laparoendosc Adv Surg Tech A 2019; 29:1023-1026. [PMID: 31140894 DOI: 10.1089/lap.2019.0243] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Every laparoscopic procedure starts with the creation of a pneumoperitoneum. The open trocar introduction and the use of a Veress needle (VN) are the two most frequent techniques used. The aim of this study was to evaluate safety of the techniques used to create pneumoperitoneum in laparoscopic abdominal surgery by Belgian minimally invasive surgeons. Materials and Methods: This is a prospective study including all consecutive patients undergoing a laparoscopic surgical procedure for a 2-month period. Primary endpoint was access-related problems during creation of a pneumoperitoneum. Access-related problems were registered using a special smartphone application, facilitating data recording and patient registration. Results: Overall, 9 out of 212 invited surgeons (4.2%) actively registered patients during the study period. A total number of 342 patients were included with 6 access-related problems (1.8%) and conversion to open surgery was necessary in 16 patients (4.7%). Most reported access-related problem was failure to establish a pneumoperitoneum secondary to insufflation of the omentum. There were no major access-related complications. There was no conversion in the group of patients who had an access-related problem. Conclusion: VN entry to create a pneumoperitoneum is safe. In a short study period, gathering data by surgeons willing to participate in a snapshot study is easy and facilitated by a web-based application.
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Affiliation(s)
- Albert M Wolthuis
- Department of Abdominal Surgery, University Hospital Leuven, Leuven, Belgium
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Anderson SJ, Fransson BA. Complications related to entry techniques for laparoscopy in 159 dogs and cats. Vet Surg 2019; 48:707-714. [PMID: 31087681 DOI: 10.1111/vsu.13230] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/24/2019] [Accepted: 04/14/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To report the frequency and risk factors of complications related to 3 entry techniques for laparoscopy in small animals. STUDY DESIGN Single-institution retrospective case series. ANIMALS 159 client-owned dogs and cats. METHODS Medical records were reviewed for dogs and cats undergoing laparoscopic surgery with carbon dioxide (CO2 ) insufflation between 2006 and 2018. Data including entry site, entry technique, signalment, body conformation, complications, and operating surgeon/resident were analyzed by univariate regression analysis. Factors with P < .25 were included in multivariate regression analysis. RESULTS Complications occurred in 33 of 159 (21%) surgeries and were considered minor (CO2 leaks, omental insufflation, repeated entry) in 30 of 33 (91%) cases. The Ternamian visual entry, modified Hasson, and Veress needle entry techniques were associated with complications in 7 (9%), 17 (26%), and 9 (60%) surgeries, respectively. Major complications occurred in 3 of 159 (2%) surgeries, in which entry-related hemorrhage prompted conversion to an open technique (2 [13%] entries with Veress needle) and 1 [1%] with the Ternamian visual). Entry location and entry technique remained significant in the final multivariate model. Complications were 11.7 times more likely after a paramedian entry than after a midline entry; the odds ratio of complications were 5 and 28 times higher after modified Hasson and Veress needle entries, respectively, than after Ternamian visual entry. CONCLUSION In this study, a Ternamian visual entry technique and midline entry site appeared associated with fewer complications than 2 other techniques. CLINICAL SIGNIFICANCE The findings in this study are preliminary, and superiority of any entry technique must be reevaluated in a prospective randomized controlled study.
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Affiliation(s)
- Scott J Anderson
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington
| | - Boel A Fransson
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington
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Primary unilateral not complicated inguinal hernia: our choice of TAPP, why, results and review of literature. Hernia 2019; 23:417-428. [PMID: 31069580 DOI: 10.1007/s10029-019-01959-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 04/21/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND Currently, three different techniques are favored for repair of an inguinal hernia: (1) The suture repair described by Shouldice. (2) An open mesh repair according to Lichtenstein. (3) Laparo-endoscopic techniques TAPP and TEP. The aim of the presented paper was to describe the ranking of the Transabdominal Preperitoneal Patch Plasty (TAPP) in comparison to the other techniques for inguinal hernia repair. METHODS The manuscript is based on the experiences gained in more than 15,000 TAPPs and numerous own studies as well. The technique of TAPP is described in detail and also the results which can be achieved with special reference to primary unilateral inguinal hernias in male patients. Moreover, a systematic review of the literature is done for the comparison with the other techniques. RESULTS According to own experiences, 98% of all patients with an inguinal hernia admitted for surgery to Marienhospital Stuttgart could be operated on using the TAPP technique. The recurrence rate and the rate of severe chronic pain in this setting were below 1%. Due to the limited quality of most of the published studies an evidence-based comparison which is the best of the currently most recommended techniques is questionable. Therefore, when comparing TAPP with TEP, no definite conclusion about superiority of one technique over the other is possible. Both techniques are safe and effective if properly performed. The guidelines recommend that the surgeon should use the technique he had learned best and is familiar with. The comparison between TAPP and the Shouldice repair shows less pain and a higher effectivity after TAPP. The recurrence rate after Lichtenstein repair and after TAPP is similar, but pain and recovery time are significantly less after TAPP. CONCLUSION Analyzing the own abundant experiences and the reports in the literature, the TAPP technique has the potential to become the standard operative technique for repair of inguinal hernias in future. However, due to the low level of evidence of most of the studies definite conclusions are difficult to draw at this point of time.
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Jung JJ, Adams-McGavin RC, Grantcharov TP. Underreporting of Veress Needle Injuries: Comparing Direct Observation and Chart Review Methods. J Surg Res 2018; 236:266-270. [PMID: 30694765 DOI: 10.1016/j.jss.2018.11.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 10/11/2018] [Accepted: 11/20/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Adverse events in surgery occur frequently, increase likelihood of postoperative morbidity, and mostly take place in the operating rooms. Several surgeons have advocated for learning from adverse events and near misses to help improve patient safety. To do so, one must first understand how to accurately identify and report intraoperative events. MATERIALS AND METHODS Consecutive laparoscopic cases performed in a referral center were included in the cohort. Veress needle (VN) injuries were characterized according to a priori established criteria. Two methods were used to identify VN injuries: direct observation and patient chart review. For direct observation, trained surgeon assessors identified the outcomes using a comprehensive data capture platform called the operating room black box. On the other hand, operative reports and patient charts were reviewed by trained assessors to identify reported VN injuries. RESULTS Hundred thirty-one cases were analyzed. There were 12 (9%) VN injuries identified by direct observation compared to 3 (2%) identified in patient chart review method. Injuries to the liver and stomach were identified by both methods, whereas injuries to the omentum were not reported in patient charts even if they required rectification. There were seven VN injuries that required rectification, lasting up to 12% of the operating time. There were 47 (35%) near misses identified through direct observation, whereas none was reported in patient charts. CONCLUSIONS Direct observation enables characterization of VN injury and near misses with far greater detail and accuracy than patient chart review.
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Affiliation(s)
- James J Jung
- International Centre for Surgical Safety, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
| | - Robert Chris Adams-McGavin
- International Centre for Surgical Safety, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Teodor P Grantcharov
- International Centre for Surgical Safety, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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22
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Mohammadi M, Shakiba B, Shirani M. Comparison of two methods of laparoscopic trocar insertion (Hasson and Visiport) in terms of speed and complication in urologic surgery. Biomedicine (Taipei) 2018; 8:22. [PMID: 30474603 PMCID: PMC6254099 DOI: 10.1051/bmdcn/2018080422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 07/23/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Nowadays, diverse approaches have been existed for laparoscopic procedures. The most common laparoscopic entry methods included close and direct entry laparoscopy and open (Hasson) laparoscopy. There is no evidence regarding the superiority in safety and initial speed for the use of open and optical laparoscopic entry. Therefore, the sight of current study was to evaluate comparative survey of two methods of laparoscopic trocar insertion (Hasson and VisiportTM) in terms of speed and complications in urologic surgery. METHODS This expertized base clinical trial study was conducted on 100 patients who underwent urological laparoscopy in Alzahra Hospital, Isfahan, Iran. These patients were randomly divided to two groups (n = 50). One group underwent open laparoscopy and another group Visiport optical trocar. Speed and Complications of urologic surgery was extracted from medical records. Independent T test was used for doing of analysis. RESULTS The mean age of patients in Hasson and Visiport laparoscopic group was 41.4 ± 11.2 and 41.6 ± 15 years old, respectively (p = 0.91). The mean time for initial trocar placement in patients who underwent Visiport trocar system and Hasson laparoscopic technique was 37.7 ± 15.59 and 95.4 ± 31.75 seconds. There was gratifying difference between two techniques of laparoscopic trocar insertion (Hasson and Visiport) in terms of speed (p = 0.000). In addition, complications were observed in 8% of patients who underwent Visiport trocar system. However, no complications were observed in Hasson laparoscopy group. CONCLUSION Visiport optical trocar technique is faster for initial trocar placement than open laparoscopy. However it is associated with complications compared to open laparoscopy. Therefore, there is evidence of benefit in terms of speed for initial trocar placement and harm based on complications in Visiport trocar system.
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Affiliation(s)
- Mehrdad Mohammadi
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Department of Urology, Isfahan University of Medical Sciences Isfahan Iran
| | - Behnam Shakiba
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Department of Urology, Isfahan University of Medical Sciences Isfahan Iran
| | - Matin Shirani
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Department of Urology, Isfahan University of Medical Sciences Isfahan Iran
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Leschnik K, Bockstahler B, Katic N, Schramel JP, Dupré G. Influence of 2 Veress needles and 4 insertion sites on Veress needle penetration depth: A comparative study in cadaveric dogs. Vet Surg 2018; 47:1094-1100. [PMID: 30246303 PMCID: PMC6220826 DOI: 10.1111/vsu.12956] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 01/02/2018] [Accepted: 02/14/2018] [Indexed: 11/28/2022]
Abstract
Objective To evaluate the penetration depth (VNPD) of 2 disposable Veress needles (VN) at 4 insertion sites in the abdomen. Study design Descriptive study. Sample population Canine cadavers (n = 22, 6 for confirmation of the test methods and 16 for the comparative study). Methods Two disposable VN (VN A and VN B) were inserted at 4 sites (9th intercostal space [ICS] and preumbilical, paraumbilical, and subumbilical sites) in dorsally recumbent dogs by using a hand‐cranked jig. The VNPD was measured as the distance traveled by the VN between the subcutaneous tissue and the perforation of the peritoneum on the basis of audible clicks and visible feedback from the VN. The effects of the VN type and insertion site on the VNPD were analyzed by using a linear mixed‐effects model. Results VNPD varied between insertion sites (P = .01) and VN (P < .01). The VNPD was less at the 9th ICS than at the preumbilical, paraumbilical, and subumbilical sites. The maximal magnitude of change was 7.4 mm. Veress needle B (with a low spring rate, lower forces, and a back‐cut bevel design) penetrated farther than VN A (with a high spring rate, high forces, and a lancet‐type bevel) at 3 of 4 insertion sites. The maximal magnitude of change was 6.8 mm. Conclusion Veress needle penetration depth varied between VN designs but was the least at the 9th ICS in canine cadavers. Clinical significance Insertion of a VN at the 9th ICS is recommended to minimize its penetration into the abdomen. Associations between VNPD and mechanical factors, such as the sharpness and spring rate of VN, warrant additional research.
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Affiliation(s)
- Katharina Leschnik
- University Clinic of Small Animal Surgery, Department for Companion Animals and Horses, University of Veterinary Medicine, Vienna, Austria
| | - Barbara Bockstahler
- University Clinic of Small Animal Surgery, Department for Companion Animals and Horses, University of Veterinary Medicine, Vienna, Austria
| | - Nikola Katic
- University Clinic of Small Animal Surgery, Department for Companion Animals and Horses, University of Veterinary Medicine, Vienna, Austria
| | - Johannes P Schramel
- Department for Companion Animals and Horses, University of Veterinary Medicine, Vienna, Austria
| | - Gilles Dupré
- University Clinic of Small Animal Surgery, Department for Companion Animals and Horses, University of Veterinary Medicine, Vienna, Austria
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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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Sundbom M, Ottosson J. Trocar Injuries in 17,446 Laparoscopic Gastric Bypass-a Nationwide Survey from the Scandinavian Obesity Surgery Registry. Obes Surg 2018; 26:2127-2130. [PMID: 26839110 DOI: 10.1007/s11695-016-2080-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Although, the vast majority of bariatric procedures worldwide are performed laparoscopically, there is no consensus on the best technique to enter the first trocar, a potentially dangerous maneuver. Three principally different techniques exist: initial pneumoperitoneum by Verres needle, open Hasson technique, and direct placement of an optical trocar. In this nationwide survey, we have studied the presently used technique to place the first trocar and identified any intraabdominal injuries in 2012-2014. METHODS A questionnaire concerning techniques for placing the first trocar and identified intraabdominal injuries was sent to all 41 centers performing laparoscopic Roux en-Y gastric bypass (LRYGB) in Sweden. Total number of procedures were collected from the national quality registry, Scandinavian Obesity Surgery Registry (SOReg), also searched for reports on intraabdominal injuries. RESULTS During the present study period, 17,446 LRYGBs were performed. Twelve intraabdominal injuries (0.07 %) were found: bleedings from the omentum, small bowel mesentery and liver (n = 8), and gastric or small bowel perforation (n = 4). The injuries were evenly distributed between the Veress technique and direct placement of an optical trocar, while no injuries occurred with the Hasson technique. Concerning placement of the first trocar, initial pneumoperitoneum with Veress needle was most common (59 %), followed by direct placement of an optical trocar (30 %). This indicates a switch from 2009-2010 (Veress 45 % and optical trocar 45 %, p < 0.001). CONCLUSIONS Twelve intraabdominal injuries (0.07 %) were found in this nationwide survey. The most common technique for placing the first trocar had switched from directly placing an optical trocar to prior establishment of pneumoperitoneum.
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Affiliation(s)
- Magnus Sundbom
- Deparment of Surgical Sciences, Uppsala University, Uppsala, Sweden.
| | - Johan Ottosson
- Deparment of Surgery, Örebro University Hospital, Örebro, Sweden
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Abstract
Background Bowel injury remains a serious complication of gynecological laparoscopic surgery. We aimed to review the literature on this topic, combined with personal experiences, so as to give recommendations on how to avoid and manage this complication. Methods We performed a narrative review on bowel injury following gynecological laparoscopic surgery using PubMed covering prevention, diagnosis, and management. Search terms used were laparoscopy, gynaecology, injury, bowel, prevention, treatment. Results Important principles of prevention include proper pre-operative evaluation and increased laparoscopic surgical skills and knowledge. High clinical suspicion is crucial for early diagnosis. Diagnostic workup of suspected cases includes serial abdominal examination, measuring inflammatory markers, and performing imaging studies including abdominal ultrasound and CT scan. When bowel injury is recognized during the first laparoscopic procedure then laparoscopic primary suturing could be tried although laparotomy may be needed. When diagnosis is delayed, then laparotomy is the treatment of choice. The role of robotic surgery and three-dimensional laparoscopic gynecological surgery on bowel injury needs to be further assessed. Conclusion Early recognition of bowel injury is crucial for a favorable clinical outcome. A combined collaboration between gynecologists and general surgeons is important for timely and proper decisions to be made.
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Affiliation(s)
- Hassan M Elbiss
- Department of Obstetrics and Gynaecology, College of Medicine and Health Sciences, UAE University, 17666 Al-Ain, United Arab Emirates.
| | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University,17666 Al-Ain, United Arab Emirates.
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Pratap A, Oleynikov D, Kothari V. Real time ultrasound guided insertion of Veress needle in obese patients. Ann R Coll Surg Engl 2017; 100:158-159. [PMID: 29022813 DOI: 10.1308/rcsann.2017.0135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- A Pratap
- University of Nebraska Medical Center , Omaha, NE , US
| | - D Oleynikov
- University of Nebraska Medical Center , Omaha, NE , US
| | - V Kothari
- University of Nebraska Medical Center , Omaha, NE , US
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Laparoscopic Major Vascular Injury Simulation Using a Synthetic Compared With Porcine Model. Obstet Gynecol 2017; 130 Suppl 1:24S-28S. [PMID: 28937515 DOI: 10.1097/aog.0000000000002255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Major vascular injury training may improve clinical skills and reduce patient morbidity during gynecologic laparoscopy; thus, reliable models for simulation should be identified. METHOD Two laparoscopic major vascular injury simulations using synthetic or live porcine models were constructed. The primary surgeon was given the opportunity to complete both simulations. After obtaining peritoneal access, the surgeon quickly encountered a major vascular injury. Degrading vital signs and estimated blood loss coupled with the replay of a human heartbeat that increased in volume and intensity were provided to heighten tension during the synthetic simulation. EXPERIENCE Twenty-two gynecologic surgery educators evaluated the simulations. Educators considered the porcine model superior to the synthetic model with regard to tissue handling. The synthetic model simulation was found to be equivalent to the porcine model on how likely the simulation would be able to improve performance in a clinical setting. Educators were more likely to implement the synthetic simulation over the porcine simulation. CONCLUSION The synthetic model was found to be more feasible and as effective as the porcine model to simulate and teach the initial management steps of major vascular injury at laparoscopy by gynecologic educators.
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Schramel JP, Kindslehner A, Bockstahler BA, Dupré GP. Comparison of design features and mechanical properties of commercially available Veress needles. Vet Surg 2017; 46:994-1001. [DOI: 10.1111/vsu.12690] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 03/28/2017] [Accepted: 04/04/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Johannes P. Schramel
- Clinical Unit of Small Animal Surgery; University of Veterinary Medicine Vienna; Vienna Austria
| | - Angelika Kindslehner
- Clinical Unit of Small Animal Surgery; University of Veterinary Medicine Vienna; Vienna Austria
| | - Barbara A. Bockstahler
- Clinical Unit of Small Animal Surgery; University of Veterinary Medicine Vienna; Vienna Austria
| | - Gilles P. Dupré
- Clinical Unit of Small Animal Surgery; University of Veterinary Medicine Vienna; Vienna Austria
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He J, Jin X, Zhang X, Kong J, Lin Y, Wu Z, Zhang X. Use of Pneumoperitoneal Puncture for Peritoneal Catheter Placement in Lumboperitoneal Shunt Surgery: Technical Note. World Neurosurg 2017; 103:391-394. [PMID: 28433843 DOI: 10.1016/j.wneu.2017.04.058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 04/05/2017] [Accepted: 04/07/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND In hydrocephalus shunt surgery, a peritoneal catheter is traditionally inserted with laparotomy incision. The abdominal incision length will not be shorter than 3 cm in most cases. A longer incision has to be made in obese patients. The lateral position in lumboperitoneal shunt (LPS) surgery also increases the difficulty of laparotomy. This report introduces a simple technique of pneumoperitoneal puncture for peritoneal catheter placement in LPS surgery. METHODS Twenty-eight communicating hydrocephalus cases underwent pneumoperitoneal puncture in an LPS operation. Abdominal incision length, time for peritoneal catheter placement, and postoperative complications were recorded. RESULTS The length of the abdominal incision was 1 cm, and the average time for peritoneal catheter placement was 3.5 minutes. No patient suffered from infection and obstruction. Two cases of subdural hematoma because of cerebrospinal fluid overdrainage occurred. CONCLUSIONS The pneumoperitoneal puncture technique has proven, in our experience, to be a minimally invasive, simple, and reliable method in a peritoneal catheter placement procedure. This technique, which needs to be assessed further by larger case series, may be considered a new method of choice for peritoneal catheter placement in LPS surgery.
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Affiliation(s)
- Junhua He
- Department of Neurosurgery, Tongde Hospital of Zhejiang Province, HangZhou, China.
| | - Xin Jin
- Department of Neurosurgery, Tongde Hospital of Zhejiang Province, HangZhou, China
| | - Xianghua Zhang
- Department of Neurosurgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jun Kong
- Department of Neurosurgery, Tongde Hospital of Zhejiang Province, HangZhou, China
| | - Yihai Lin
- Department of Neurosurgery, Tongde Hospital of Zhejiang Province, HangZhou, China
| | - Zhangyi Wu
- Department of Neurosurgery, Tongde Hospital of Zhejiang Province, HangZhou, China
| | - Xinwen Zhang
- Department of Neurosurgery, Tongde Hospital of Zhejiang Province, HangZhou, China
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Abstract
The management of blunt abdominal trauma has evolved over time. While laparotomy is the standard of care in hemodynamically unstable patients, stable patients are usually treated by non-operative management (NOM), incorporating adjuncts such as interventional radiology. However, although NOM has shown good results in solid organ injuries, other lesions, namely those involving the hollow viscus, diaphragm, and mesentery, do not qualify for this approach and need surgical exploration. Laparoscopy can substantially reduce additional surgical aggression. It has both diagnostic and therapeutic potential and, when negative, may reduce the number of unnecessary laparotomies. Although some studies have shown promising results on the use of laparoscopy in blunt abdominal trauma, randomized controlled studies are lacking. Laparoscopy requires adequate training and experience as well as sufficient staffing and equipment.
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Affiliation(s)
- Viktor Justin
- Section for Surgical Research, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria
| | - Abe Fingerhut
- Section for Surgical Research, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria
| | - Selman Uranues
- Section for Surgical Research, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria
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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: 1.6] [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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Fatal Cerebral Air Embolism: A Case Series and Literature Review. Case Rep Crit Care 2016; 2016:3425321. [PMID: 27635266 PMCID: PMC5011199 DOI: 10.1155/2016/3425321] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 08/02/2016] [Indexed: 11/29/2022] Open
Abstract
Cerebral air embolism (CAE) is an infrequently reported complication of routine medical procedures. We present two cases of CAE. The first patient was a 55-year-old male presenting with vomiting and loss of consciousness one day after his hemodialysis session. Physical exam was significant for hypotension and hypoxia with no focal neurologic deficits. Computed tomography (CT) scan of head showed gas in cerebral venous circulation. The patient did not undergo any procedures prior to presentation, and his last hemodialysis session was uneventful. Retrograde rise of venous air to the cerebral circulation was the likely mechanism for venous CAE. The second patient was a 46-year-old female presenting with fever, shortness of breath, and hematemesis. She was febrile, tachypneic, and tachycardic and required intubation and mechanical ventilation. An orogastric tube inserted drained 2500 mL of bright red blood. Flexible laryngoscopy and esophagogastroduodenoscopy were performed. She also underwent central venous catheter placement. CT scan of head performed the next day due to absent brain stem reflexes revealed intravascular air within cerebral arteries. A transthoracic echocardiogram with bubble study ruled out patent foramen ovale. The patient had a paradoxical CAE in the absence of a patent foramen ovale.
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Gaunay GS, Elsamra SE, Richstone L. Trocars: Site Selection, Instrumentation, and Overcoming Complications. J Endourol 2016; 30:833-43. [DOI: 10.1089/end.2016.0128] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
- Geoffrey S. Gaunay
- The Smith Institute for Urology, Hofstra University School of Medicine, Northwell Health, New Hyde Park, New York
| | - Sammy E. Elsamra
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Lee Richstone
- The Smith Institute for Urology, Hofstra University School of Medicine, Northwell Health, New Hyde Park, New York
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Allen VB, Gurusamy KS, Takwoingi Y, Kalia A, Davidson BR. Diagnostic accuracy of laparoscopy following computed tomography (CT) scanning for assessing the resectability with curative intent in pancreatic and periampullary cancer. Cochrane Database Syst Rev 2016; 7:CD009323. [PMID: 27383694 PMCID: PMC6458011 DOI: 10.1002/14651858.cd009323.pub3] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Surgical resection is the only potentially curative treatment for pancreatic and periampullary cancer. A considerable proportion of patients undergo unnecessary laparotomy because of underestimation of the extent of the cancer on computed tomography (CT) scanning. Laparoscopy can detect metastases not visualised on CT scanning, enabling better assessment of the spread of cancer (staging of cancer). This is an update to a previous Cochrane Review published in 2013 evaluating the role of diagnostic laparoscopy in assessing the resectability with curative intent in people with pancreatic and periampullary cancer. OBJECTIVES To determine the diagnostic accuracy of diagnostic laparoscopy performed as an add-on test to CT scanning in the assessment of curative resectability in pancreatic and periampullary cancer. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via PubMed, EMBASE via OvidSP (from inception to 15 May 2016), and Science Citation Index Expanded (from 1980 to 15 May 2016). SELECTION CRITERIA We included diagnostic accuracy studies of diagnostic laparoscopy in people with potentially resectable pancreatic and periampullary cancer on CT scan, where confirmation of liver or peritoneal involvement was by histopathological examination of suspicious (liver or peritoneal) lesions obtained at diagnostic laparoscopy or laparotomy. We accepted any criteria of resectability used in the studies. We included studies irrespective of language, publication status, or study design (prospective or retrospective). We excluded case-control studies. DATA COLLECTION AND ANALYSIS Two review authors independently performed data extraction and quality assessment using the QUADAS-2 tool. The specificity of diagnostic laparoscopy in all studies was 1 because there were no false positives since laparoscopy and the reference standard are one and the same if histological examination after diagnostic laparoscopy is positive. The sensitivities were therefore meta-analysed using a univariate random-effects logistic regression model. The probability of unresectability in people who had a negative laparoscopy (post-test probability for people with a negative test result) was calculated using the median probability of unresectability (pre-test probability) from the included studies, and the negative likelihood ratio derived from the model (specificity of 1 assumed). The difference between the pre-test and post-test probabilities gave the overall added value of diagnostic laparoscopy compared to the standard practice of CT scan staging alone. MAIN RESULTS We included 16 studies with a total of 1146 participants in the meta-analysis. Only one study including 52 participants had a low risk of bias and low applicability concern in the patient selection domain. The median pre-test probability of unresectable disease after CT scanning across studies was 41.4% (that is 41 out of 100 participants who had resectable cancer after CT scan were found to have unresectable disease on laparotomy). The summary sensitivity of diagnostic laparoscopy was 64.4% (95% confidence interval (CI) 50.1% to 76.6%). Assuming a pre-test probability of 41.4%, the post-test probability of unresectable disease for participants with a negative test result was 0.20 (95% CI 0.15 to 0.27). This indicates that if a person is said to have resectable disease after diagnostic laparoscopy and CT scan, there is a 20% probability that their cancer will be unresectable compared to a 41% probability for those receiving CT alone.A subgroup analysis of people with pancreatic cancer gave a summary sensitivity of 67.9% (95% CI 41.1% to 86.5%). The post-test probability of unresectable disease after being considered resectable on both CT and diagnostic laparoscopy was 18% compared to 40.0% for those receiving CT alone. AUTHORS' CONCLUSIONS Diagnostic laparoscopy may decrease the rate of unnecessary laparotomy in people with pancreatic and periampullary cancer found to have resectable disease on CT scan. On average, using diagnostic laparoscopy with biopsy and histopathological confirmation of suspicious lesions prior to laparotomy would avoid 21 unnecessary laparotomies in 100 people in whom resection of cancer with curative intent is planned.
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Affiliation(s)
- Victoria B Allen
- Oxford University Hospitals NHS TrustOxford University Clinical Academic Graduate SchoolJohn Radcliffe HospitalOxfordUKOX3 9DU
| | - Kurinchi Selvan Gurusamy
- Royal Free Campus, UCL Medical SchoolDepartment of SurgeryRoyal Free HospitalRowland Hill StreetLondonUKNW3 2PF
| | - Yemisi Takwoingi
- University of BirminghamInstitute of Applied Health ResearchEdgbastonBirminghamUKB15 2TT
| | | | - Brian R Davidson
- Royal Free Campus, UCL Medical SchoolDepartment of SurgeryRoyal Free HospitalRowland Hill StreetLondonUKNW3 2PF
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Cesario E, Crochet P, Boyer de Latour FX, Eglin G, De Rochambeau B, Agostini A. [Bowel injuries after port insertion in laparoscopy. Gynerisq's database analysis]. ACTA ACUST UNITED AC 2016; 45:1083-1090. [PMID: 27318636 DOI: 10.1016/j.jgyn.2016.05.007] [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: 01/10/2016] [Revised: 05/10/2016] [Accepted: 05/13/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Port insertion is a high-risk period during laparoscopy. The French Gynecologist and Obstetricians College (CNGOF) published recommendations in 2010 to minimize those risks. The aim of our analysis was to establish the accidents' circumstances and consequences and to determine if those incidents could have been depending on whether recommendations had been respected or not. MATERIAL AND METHODS Gynerisq is an approved organism by the Haute Autorité de santé (HAS). Its mission is to evaluate and improve practices by a risk management centered approach. We analysed incidents reported by Gynerisq's adherents in an experience report database. RESULTS Above 114 incidents analysed in the Gynerisq's database, we reported 31 bowel injuries. Those injuries occurred for 77.4% (24/31) during planned interventions. For 32.3% of the cases (10/31), interventions were judged complex by the surgeons. A total of 54.8% (17/31) of the patients had a history of laparotomy. Above 27 injuries occurred during Veress needle or open laparoscopy, 17 could have been avoided regarding to the surgeon. The causes reported were in 10 cases that the recommendations had not been respected, in 2 cases another cause and in 5 cases no causes were given to explain the incident. CONCLUSION Our analysis shows that bowel injuries after port insertion, in open laparoscopy or Veress needle use, do not seem to occur only in an emergency context or during complicated interventions. However, most of the incidents occurred for patients with risk factors.
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Affiliation(s)
- E Cesario
- Service de gynécologie obstétrique, hôpital la Conception, 147, boulevard Baille, 13005 Marseille, France
| | - P Crochet
- Service de gynécologie obstétrique, hôpital la Conception, 147, boulevard Baille, 13005 Marseille, France
| | - F-X Boyer de Latour
- Polyclinique Saint-Claude, boulevard docteur Schweitzer, 02100 Saint-Quentin, France
| | - G Eglin
- Clinique Champeau, 34535 Béziers cedex, France
| | - B De Rochambeau
- Hôpital privé de Marne-Chantereine, rue Curie, 77177 Brou-sur-Chantereine, France
| | - A Agostini
- Service de gynécologie obstétrique, hôpital la Conception, 147, boulevard Baille, 13005 Marseille, France.
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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: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Simforoosh N, Basiri A, Ziaee SAM, Tabibi A, Nouralizadeh A, Radfar MH, Sarhangnejad R, Mirsadeghi A. Major vascular injury in laparoscopic urology. JSLS 2016; 18:JSLS-D-13-00283. [PMID: 25392667 PMCID: PMC4208903 DOI: 10.4293/jsls.2014.00283] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Major vascular injury is the most devastating complication of laparoscopy, occurring most commonly during the laparoscopic entry phase. Our goal is to report our experience with major vascular injury during laparoscopic entry with closed- and open-access techniques in urologic procedures. METHODS All 5347 patients who underwent laparoscopic urologic procedures from 1996 to 2011 at our hospital were included in the study. Laparoscopic entry was carried out by either the closed Veress needle technique or the modified open Hasson technique. Patients' charts were reviewed retrospectively to investigate for access-related major vascular injuries. RESULTS The closed technique was used in the first 474 operations and the open technique in the remaining 4873 cases. Three cases of major vascular injury were identified among our patients. They were 3 men scheduled for nephrectomy without any history of surgery. All injuries occurred in the closed-access group during the setup phase with insertion of the first trocar. The injury location was the abdominal aorta in 2 patients and the external iliac vein in 1 patient. Management was performed after conversion to open surgery, control of bleeding, and repair of the injured vessel. CONCLUSIONS Given the high morbidity and mortality rates associated with major vascular injury, its clinically higher incidence in laparoscopic urologic procedures with the closed-access technique leads us to suggest using the open technique for the entry phase of laparoscopy. Using the open-access technique may decrease laparophobia and encourage a higher number of urologists to enter the laparoscopy field.
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Affiliation(s)
- Nasser Simforoosh
- Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshty University of Medical Sciences, Tehran, Iran
| | - Abbas Basiri
- Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshty University of Medical Sciences, Tehran, Iran
| | - Seyed-Amir-Mohsen Ziaee
- Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshty University of Medical Sciences, Tehran, Iran
| | - Ali Tabibi
- Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshty University of Medical Sciences, Tehran, Iran
| | - Akbar Nouralizadeh
- Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshty University of Medical Sciences, Tehran, Iran
| | - Mohammad Hadi Radfar
- Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshty University of Medical Sciences, Tehran, Iran
| | - Reza Sarhangnejad
- Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshty University of Medical Sciences, Tehran, Iran
| | - Amin Mirsadeghi
- Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshty University of Medical Sciences, Tehran, Iran
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Evaluation of a Veress needle for the fluid egress system of stifle arthroscopy in toy dog breeds. Vet Comp Orthop Traumatol 2016; 29:149-55. [PMID: 26846402 DOI: 10.3415/vcot-15-04-0065] [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: 04/20/2015] [Accepted: 11/20/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the use of a Veress needle as a fluid egress system for stifle arthroscopy in toy dog breeds. METHODS Cadaveric canine stifle joints (n = 32) were prepared to induce an artificial intra-articular haemorrhagic effect, followed by stifle arthroscopy. The stifles were randomly assigned to one of three groups, and a fluid egress portal was established using a Veress needle (VN), a standard egress cannula (SE), or an intravenous catheter stylet (CS). Time to establish the egress portal, arthroscopic visibility, and egress portal performance were evaluated during the arthroscopy. After the arthroscopic examinations, iatrogenic cartilage lesions were identified and analysed using the percentage area of cartilage damage (%ACD). RESULTS The overall arthroscopic visibility and egress portal performance were not significantly different among the groups. The egress portal establishment was faster for the VN (33 sec) and the CS (34 sec) groups than for the SE (43 sec) group (p = 0.001). On gross joint examination, no iatrogenic laceration was found in the VN group, whereas four out of 10 of the SE and two out of 10 of the CS specimens had linear cartilage excoriation on the stifle joints. The %ACD score of the VN group was lower than those of the SE group (p = 0.009) and the CS group (p = 0.001). CLINICAL SIGNIFICANCE The Veress needle method used in this study was useful to establish a fluid egress system and limit iatrogenic cartilage excoriations. This technique could become the method of choice for stifle arthroscopy, especially in smaller dogs.
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[Specific complications of minimally invasive surgery]. Chirurg 2015; 86:1097-104. [PMID: 26541448 DOI: 10.1007/s00104-015-0105-x] [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: 10/22/2022]
Abstract
Minimally invasive surgery (MIS) is fundamentally different from open surgery regarding positioning of the patient, access routes and instrumentation. Each of these aspects is associated with its own specific morbidity, such as positioning-related complications, trocar-induced lesions, hypercapnia-associated phenomena and thermal damage. The growing experience of surgeons and technological progress have increased patient safety to a maximum and have resulted in an impressive spread of MIS in the various fields of surgery including the most common, such as cholecystectomy and hernia repair and special fields, such as bariatric, thoracic and oncological surgery. This narrative review summarizes the current knowledge on the inherent complications of MIS.
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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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Juo YY, Luka S, Obias V. Single-incision robotic colectomy (SIRC): Current status and future directions. J Surg Oncol 2015; 112:321-5. [PMID: 26133116 DOI: 10.1002/jso.23935] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 04/22/2015] [Indexed: 12/15/2022]
Abstract
By combining laparo-endoscopic single-site surgery (LESS) techniques with the da Vinci robotic platform, single-incision robotic colectomy (SIRC) aims to further minimize incision-related complications and improve cosmetic outcomes from the current standard of care, laparoscopic colectomy. While there is limited literature on SIRC, all available reports suggest SIRC to be a safe and feasible procedure in terms of perioperative outcomes. Future research should focus on further clarification of proposed benefits of SIRC such as cosmetics, ergonomics, incidence of incision-related complications, and long-term oncologic outcomes.
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Affiliation(s)
- Yen-Yi Juo
- Department of Surgery, George Washington University Hospital, Washington, District of Columbia
| | - Samuel Luka
- Department of Surgery, George Washington University Hospital, Washington, District of Columbia
| | - Vincent Obias
- Department of Surgery, George Washington University Hospital, Washington, District of Columbia
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43
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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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Cerebral Air Embolism After Hemodialysis. J Emerg Med 2015; 49:e27-8. [PMID: 25802160 DOI: 10.1016/j.jemermed.2014.12.071] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 12/16/2014] [Accepted: 12/22/2014] [Indexed: 12/31/2022]
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[Intraoperative complications of the lower gastrointestinal tract : Prevention, recognition and therapy]. Chirurg 2015; 86:319-25. [PMID: 25687814 DOI: 10.1007/s00104-014-2849-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Every surgical intervention is associated with the risk of intraoperative complications. These occur in approximately 2-12% of patients but significantly influence the postoperative outcome, overall complication and mortality rates. This article presents the treatment of typical intraoperative complications during surgery of the lower gastrointestinal tract with a focus on the prevention and identification of risk factors. Especially changes in the regular anatomy caused by previous surgery, inflammation, tumors and emergency situations carry the risk of iatrogenic injuries to the bowels, spleen, ureter and blood vessels. These risk factors must be considered when choosing a surgical procedure, a surgical approach or an appropriate surgeon. The early detection of complications with a definitive restoration is the essential step for a successful treatment without long-term sequelae. Every delay in therapy is associated with an increased morbidity and mortality and should be avoided.
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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: 1.2] [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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García-Alcázar D, García-Chapinal B, Batllori-Badia E, López-González G, Lorenzo-Hernando E, Jiménez-López JS, Muñoz-Hernando L, Muñoz-González JL. Psoas haematoma as a complication of Veress needle insertion: description of a case and literature review. BMC Surg 2014; 14:104. [PMID: 25488585 PMCID: PMC4268806 DOI: 10.1186/1471-2482-14-104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 12/05/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In terms of gynaecological laparoscopic surgery, major complications affecting great vessels, and especially the retroperitoneal ones, are unusual. CASE PRESENTATION We introduce a case of a retroperitoneal haematoma associated with psoas muscle pseudoaneurysm, as a side effect of Veress needle insertion, during laparoscopic surgery. Such complication was managed conservatively at first, requiring finally arterial embolisation. CONCLUSION Even though potential complications associated with laparoscopic surgery are infrequent, they must not be underestimated, and in some cases might need a multidisciplinary management.
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Affiliation(s)
| | | | | | | | | | - Jesús S Jiménez-López
- Gynecological Endoscopy Unit, Obstetrics and Gyneacology Service, University Hospital 12 de Octubre, Avda Cordoba s/n 28041, Madrid, Spain.
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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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Andersson RE. Short-term complications and long-term morbidity of laparoscopic and open appendicectomy in a national cohort. Br J Surg 2014; 101:1135-42. [PMID: 24979720 DOI: 10.1002/bjs.9552] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 04/14/2014] [Indexed: 12/22/2022]
Abstract
Abstract
Background
Laparoscopic appendicectomy has been proposed as the standard for surgical treatment of acute appendicitis, based on controversial evidence. This study compared outcomes after open and laparoscopic appendicectomy in a national, population-based cohort.
Methods
All patients who underwent open or intended laparoscopic appendicectomy in Sweden between 1992 and 2008 were identified from the Swedish National Patient Register. The outcomes were analysed according to intention to treat with multivariable adjustment for confounding factors and survival analytical techniques where appropriate.
Results
A total of 169 896 patients underwent open (136 754) or intended laparoscopic (33 142) appendicectomy. The rate of intended laparoscopic appendicectomy increased from 3·8 per cent (425 of 11 175) in 1992 to 32·9 per cent (3066 of 9329) in 2008. Laparoscopy was used most frequently in middle-aged patients, women and patients with no co-morbidity. The rate of conversion from laparoscopy to open appendicectomy decreased from 75·3 per cent (320 of 425) in 1992 to 19·7 per cent (603 of 3066) in 2008. Conversion was more frequent in women and those with perforated appendicitis, and the rate increased with age and increasing co-morbidity. After adjustment for co-variables, compared with open appendicectomy, laparoscopy was associated with a shorter length of hospital stay (by 0·06 days), a lower frequency of negative appendicectomy (adjusted odds ratio (OR) 0·59; P < 0·001), wound infection (adjusted OR 0·54; P = 0·004) and wound rupture (adjusted OR 0·44; P = 0·010), but higher rates of intestinal injury (adjusted OR 1·32; P = 0·042), readmission (adjusted OR 1·10; P < 0·001), postoperative abdominal abscess (adjusted OR 1·58; P < 0·001) and urinary infection (adjusted OR 1·39; P = 0·020). Laparoscopy had a lower risk of postoperative small bowel obstruction during the first 2 years after surgery, but not thereafter.
Conclusion
The outcomes of laparoscopic and open appendicectomy showed a complex and contrasting pattern and small differences of limited clinical importance. The choice of surgical method therefore depends on the local situation, the surgeon's experience and the patient's preference.
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Affiliation(s)
- R E Andersson
- Department of Surgery, County Hospital Ryhov, Jönköping, and Department of Clinical and Experimental Medicine, Surgery, Faculty of Health Sciences, Linköping University, Linköping, Sweden
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