Abstract
Carbon dioxide pneumothorax is a rare complication in laparoscopic urology, but with the widespread use of laparoscopy and the increasing surgical pathologies managed by this technique this infrequent complication has become a potential risk. A total of 786 laparoscopic transperitoneal urologic operations were reviewed at our institution. All procedures were performed by the same surgeon and included 213 adrenalectomies, 181 simple nephrectomies, 143 lymphadenectomies, 118 radical nephrectomies, 107 partial nephrectomies and 24 nephroureterectomies. Mean patient age was 53.2 years (range 24 to 70). Mean BMI was 28.15 Kg/m2 (range 20 to 48.9). A total of 6 cases (0.7%) of diaphragmatic injury were found. All reported patients had additional factors that may have contributed to diaphragmatic injury. Diaphragmatic repair was always carried out by intracorporeal suturing and only one case required chest tube placement. All patients evolved uneventfully. Repair of diaphragmatic injuries should always be attempted with intracorporeal suture since this is a feasible, reproducible and reliable technique.
Highlights
INTRODUCTIONThe clear advantages that laparoscopy provides over open surgery have made this technique very popular in the last decade
Carbon dioxide pneumothorax is a rare complication in laparoscopic urology, but with the widespread use of laparoscopy and the increasing surgical pathologies managed by this technique this infrequent complication has become a potential risk
With the widespread use of laparoscopy and the increasing surgical pathologies managed with this technique, there is a potential for an increased risk of carbon dioxide pneumothorax due to diaphragmatic injury
Summary
The clear advantages that laparoscopy provides over open surgery have made this technique very popular in the last decade. For urologist laparoscopy has gained wide acceptance only in recent years. Inadvertent diaphragmatic injury during transperitoneal laparoscopic surgery in urology is a rare occurrence [1]. With the widespread use of laparoscopy and the increasing surgical pathologies managed with this technique, there is a potential for an increased risk of carbon dioxide pneumothorax due to diaphragmatic injury. Capnothorax associated with laparoscopic surgery is different from air pneumothorax and may call for a different treatment. We report the laparoscopic management of six cases with iatrogenic diaphragmatic injury during laparoscopic urologic surgery
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