Bowel and Related Injuries in Laparoscopic Urologic Surgery

Abstract

Introduction: Laparoscopy with low morbidity and rapid recovery process than open surgery is a preferred surgical technique.1,2 The aim of this video was to illustrate the points we should take care to avoid bowel injuries and treatment modalities in laparoscopic urological surgery. Materials and Methods: Bowel injuries and treatment options during two laparoscopic nephrectomies, one laparoscopic cyst decortication, and two laparoscopic prostatectomies are presented in this video. Results: In the first case, duodenal injury that occurred during laparoscopic right transperitoneal radical nephrectomy was presented. The use of scissor during the medial dissection of the kidney caused duodenal perforation, and the surgeon converted to open surgery. In the second case, serosal injury of colon that occurred during right transperitoneal laparoscopic cyst decortication was presented. To expose the cyst, dissection was performed, so medial from the white-line, close to the bowel, under poor image using bipolar energy and serosal injury of colon was occurred. Primer suturation of the lesion was performed laparoscopically. In the third case, colon injury during transperitoneal nephrectomy of nonfunctioned kidney with the history of multiple pyelonephritis and fistula to the skin was presented. Dissection was performed, so medial from the white-line and bipolar energy was used close to the bowel. This caused colon injury, which has not been noticed peroperatively. Open surgery was needed because of the ileus at postoperative 3rd day. Colon perforation was detected and repaired by primer suturing and temporary ileostomy. In the fourth case, injury of denonviller during laparoscopic retroperitoneal ascending radical prostatectomy was presented. While performing the dissection of right neurovascular bundle, denonviller injury occurred with right-angled forceps. Prostatectomy was completed, and then denonviller injury was repaired with two-layer continuous suture laparoscopically. In the last case, rectal injury during laparoscopic radical prostatectomy was presented. Bleeding occurred during the dissection of posterior urethra. Without identifying the source of bleeding, multiple bipolar coagulations were performed over denonviller that was close to the rectum. Rectal injury was detected after observing the air bubbles those insuflated from the rectal tube. Rectal injury was repaired with double-layer suturation laparoscopically. Conclusion: The surgeon must take care with the duodenum at right transperitoneal approaches, which is close to the kidney, and should not use sharp instruments during dissection. Dissection should be initiated at the layer of white-line, not medial to it, in transperitoneal laparoscopic kidney surgeries. We should avoid using bipolar energy close to the bowel and not forget the importance of clear image in laparoscopic surgery. When making dissection over denonviller, the surgeon must take care that he is at the true layer. In laparoscopic radical prostatectomy, we should avoid using electrosurgical energy over denonviller fascia, which can cause rectal injuries as well as rectal necrosis and fistulas at postoperative period. If there is any doubt about rectal injury, air insuflation through the rectal tube can show us any rectal injury, and can be repaired with double-layer suturation. Different preventions of these complications can be performed by surgeons, depending on their experience. Runtime of video: 9 mins 55 secs No competing financial interests exist.