Complication Of Laparoscopic Procedures Research Articles

Behavior of the nurse to overcome the complications of laparoscopic and robotic surgery

Introduction: In order to monitor the patient's condition and timely behavior, it is essential in nursing practice to know the complications of laparoscopic procedures. Some authors divide the complications of laparoscopic surgery into two groups: • complications related to laparoscopy; • complications related to specific surgical interventions. According to Perugini and Calari, complications can be grouped into the following three categories: • complications at the access point; • physiological complications of the pneumoperitoneum; • complications of the operational procedure. Material and Methods: The methods used were analysis of documentary sources for the period September–October 2020 and a documentary method. Conclusion: All complications discussed in the report are possible, which changes the focus of nursing care postoperatively. There is a big difference in the period of care and their application, when there is a complication of septic origin or a combination of several different ones. Therefore, nursing care should be planned individually and after information from the course of the operation and the patient's condition during admission to the surgical sector and should be changed, where necessary, in accordance with changes in the patient's condition.

Small bowel obstruction in a lateral trocar site following laparoscopic bariatric surgery

One of the complications of laparoscopic surgery is incisional hernia at the port trocar site. It is a rare complication, with a reported incidence varying between 0.65% and 2.8%, and it is documented in both adults and children. An obese 62-year-old woman underwent a laparoscopic mini gastric bypass for body weight reduction at another hospital. On the third post-operative day, she developed abdominal pain with vomiting and was admitted to our hospital. Imaging studies confirmed a small bowel loop obstruction at the lateral 12mm trocar site and the patient was operated on immediately. The viability of the entrapped bowel was confirmed at the trocar site opening, the bowel loop was returned into the abdominal cavity and the defect was closed. Two days later, the patient was discharged in good condition. Trocar site or port site hernia is defined as an incisional hernia which occurs after minimal invasive surgery, at the trocar site incision. Following bariatric surgery its reported incidence is 1% - 1.6%. Its cause is multi-factorial, including obesity and old age, the size and site of the inserted trocar and the angle of insertion, and excessive manipulations. Although there is no clear consensus on closure at port sites, it is recommended that fascial defects of larger than 10mm in adults and 5mm in children should be closed. Trocar site hernia is a rare complication of laparoscopic procedures, and one that can be minimized. Viscus entrapment in a port site hernia should be suspected during the post-operative period whenever the patient presents with abdominal distension, pain and vomiting since, particularly in the case of bariatric surgery, the findings on physical examination may be inconclusive, due to obesity.

Short Bowel Syndrome after Laparoscopic Procedures

Short bowel syndrome (SBS) is a potential postoperative complication after intra-abdominal procedures. Whether the laparoscopic approach is as likely to result in SBS or the causative mechanisms are similar to open procedures is unknown. Our aim was to evaluate potential mechanisms of SBS after laparoscopic procedures. The records of 175 adult patients developing SBS as a postoperative complication were reviewed. One hundred forty-seven patients had open procedures and 28 laparoscopic. Colectomy (39%), hysterectomy (11%), and appendectomy (11%) were the most common open procedures. SBS followed laparoscopic gastric bypass (46%) and cholecystectomy (32%) most frequently. The mechanisms of SBS were different: adhesive obstruction (57 vs 22%, P < 0.05) was more common in the open group, whereas volvulus (18 vs 46%, P < 0.05) was more common after laparoscopy. Overall, ischemia (25 vs 32%) was similar but significantly more laparoscopic patients had postoperative hypoperfusion (32 vs 67%, P < 0.05). Eleven of the 13 laparoscopic bariatric procedures had internal hernias and volvulus. Of the nine patients undergoing cholecystectomy, four developed ischemia early postoperatively presumably secondary to pneumoperitoneum. SBS is an increasingly recognized complication of laparoscopic procedures. The mechanisms of intestinal injury differ from open procedures with a higher incidence of volvulus and more frequent ischemia from hypoperfusion.

What Are the Points That Should Be Considered When Performing Laparoscopic Upper Urinary Tract Surgery?

Abstract Introduction: It is essential to see and analyze the complications of laparoscopic procedures to minimize their occurrence. The objective of this video is to illustrate examples of areas i...

Postlaparoscopic Iatrogenic Pseudoaneurysms of the Arteries of the Peritoneal and Retroperitoneal Space

Laparoscopic surgery procedures are associated with a low percentage of cases of iatrogenic traumatic laceration of the arteries of the peritoneal and retroperitoneal space. These lesions rarely lead to pseudoaneurysm formation. In 1 case, we performed a meta-analytic review of the literature on postlaparoscopic iatrogenic pseudoaneurysms focusing on specific parameters: (1) artery involved, (2) type of laparoscopic operation, (3) time interval between the laparoscopic operation and the final diagnosis of the pseudoaneurysm, (4) clinical presentation, (5) diagnostic tools used, (6) mode of treatment applied, and (7) clinical outcome. We searched Medline for pseudoaneurysms developing as complications of laparoscopic procedures. The search terms used were "iatrogenic pseudoaneurysm," "complications after laparoscopic procedures," "traumatic arterial laceration," "pseudoaneurysm formation," and "postoperative hematoma" in various combinations. A total of 66 cases were retrieved. Postlaparoscopic iatrogenic pseudoaneurysms are late manifestations of arterial complications developing during routine laparoscopy. There are 66 reported cases of this type of complication in the literature. The majority occurs in the arteries of the operation field of the respective laparoscopic procedure. Distal vessels are involved less frequently. They usually present after a mean period of approximately 6 weeks. The hepatic and renal arteries are usually affected. The clinical picture includes upper and lower gastrointestinal bleeding, diffuse or localized abdominal pain, hematuria, and drain bleeding.

Idiopathic postoperative ascites after laparoscopic salpingectomy for ectopic pregnancy

Postoperative ascites is a rare and serious complication of laparoscopic procedures. Urinary tract injury, bowel injury, and lymph duct injury are the common causes; however, in some patients no definitive cause can be identified after an extensive diagnostic work-up. We present a case of postoperative ascites of unknown origin. The patient recovered with general treatments. We presume that diffuse peritoneal injury may have been caused by unidentified substances in our patient.

THE USE OF STAB INCISIONS FOR INSTRUMENT ACCESS IN LAPAROSCOPIC UROLOGICAL PROCEDURES

Traditional laparoscopic procedures use expensive cannulas to facilitate the insertion and removal of laparoscopic instruments. We report our experience with limited access stab incisions for the insertion of instruments into the peritoneal cavity during laparoscopic urological procedures to minimize the use of disposable cannulas. All patients undergoing laparoscopic urologic procedures using stab incisions, as performed by us, from November 1999 through March 2003 were included. Procedures included nephrectomy, partial nephrectomy, varicocelectomy, nephroureterectomy, orchiopexy and adrenal procedures. A single cannula was used for telescope access. In select cases additional cannulas were used for unique instruments or specimen manipulation/extraction. Abdominal wall stab incisions were used for the remaining instruments. Stab incisions were closed with a Steri-Strip (3M Healthcare, St. Paul, Minnesota) at the skin level only. A total of 53 procedures were performed during the study period. Pneumoperitoneum was maintained in all cases. There were no complications associated with the use of stab incisions. A total of 105 cannulas were saved using our technique. At a cost to the patient of dollars 140 per cannula the overall cost saving was dollars 14,700 with an average saving of dollars 277 per case. Laparoscopic urological procedures can be performed effectively and safely with stab incisions for instrument access. There are significant cost savings related to the elimination of cannulas. We believe that our technique of stab incisions for instrument access is equivalent to the traditional cannula approach and should be used when possible.

Complications of Pediatric Urological Laparoscopy: Mistakes and Risks

We evaluate the results and complications of laparoscopic urological procedures in children. In a 3-year period 4,350 laparoscopic procedures were performed at 8 Italian centers of pediatric surgery. We analyzed only the data of urological procedures for a total of 701 laparoscopic operations on patients 1 month to 14 years old. The indications for surgery were cryptorchidism in 414 cases, varicoceles in 159, ambiguous genitalia in 37, total nephrectomy in 34, partial nephrectomy in 4, adrenalectomy in 3 and other diagnostic procedures in 50. We adopted a retroperitoneoscopic approach in 72 cases (10.3%) and a laparoscopic approach in 629 (89.7%). Patient records were analyzed to search for any complication that may have occurred during the laparoscopic procedure and assess how they were managed. We recorded 19 complications (2.7%) in our series, of which 6 required conversion to open surgery and 13 did not. There was no mortality. At a maximum followup of 4 years all children were alive and had no problems related to the laparoscopic complications. Our study shows that pediatric laparoscopic urological surgery has an acceptable rate of complications with no mortality. We believe that routine use of open laparoscopy in pediatric patients is a key factor to help avoid complications. Most complications can be avoided with surgeon and team experience, together with proper compliance with the indications for surgery.

COMPLICATIONS OF LAPAROSCOPIC PROCEDURES AFTER CONCENTRATED TRAINING IN UROLOGICAL LAPAROSCOPY

To increase the safety and efficiency of laparoscopic surgery clinical training programs have been developed to increase the skill and efficiency of urological trainees. We evaluated the impact of dedicated laparoscopy training on the rate and type of complications after trainees entered clinical practice. Data were obtained from 13 centers where laparoscopy was performed by a single surgeon with at least 12 months of training in urological laparoscopy before clinical practice. Data included training experience, laparoscopic procedures performed after commencing clinical practice and associated complications. Procedures were classified as easy, moderate and difficult. During training each surgeon participated in a mean of 71 cases. In clinical practice a total of 738 laparoscopic cases were performed with the group reporting an overall complication rate of 11.9%. The rate was unchanged when the initial 20, 30 and 40 cases per surgeon were compared with all subsequent cases (12%, 11.9% and 12% versus 11.8 to 12%, respectively). The re-intervention rate was 1.1%. The complication rate increased with case difficulty. Overall and early complication rates attributable to laparoscopic technique in the initial 20, 30 and 40 cases were identical. The most common complications were neuropathy in 13 patients, urine leakage/urinoma in 9, transfusion in 7 and ileus in 5. The complication rate of surgeons who completed at least 12 months of laparoscopy training did not differ according to initial versus subsequent surgical experience. Intensive training seems to decrease the impact of the learning curve for laparoscopy.

Laparoscopic adrenalectomy in the elderly.

Laparoscopic adrenalectomy has recently been shown to be a safe and effective procedure for treating a variety of benign adrenal tumors. Advanced age, with its concomitant comorbid conditions, has been believed to be associated with more postoperative complications in laparoscopic procedures. The purpose of this study was to evaluate the outcome of laparoscopic adrenalectomy in patients age 65 and older. From June 1992 to February 1998, 14 patients (4 men and 10 women) with a mean age of 69 years underwent 17 laparoscopic adrenalectomies. In 12 procedures, a transperitoneal lateral decubitus flank approach was used. The lesion was a nonfunctioning adenoma in three patients, aldosterone adenoma in four, Cushing's syndrome in four, and pheochromocytoma in one. A retroperitoneal lateral decubitus approach was used in five procedures. The lesion was a nonfunctioning adenoma in one patient, aldosterone adenoma in one, Cushing's adenoma in one, and pheochromocytoma in two. Seventy-eight percent of these patients had comorbid conditions, including hypertension, diabetes, chronic obstructive airway disease, coronary artery disease, and cardiac dysrhythmia. The preoperative physical status was as ASA Class II in 11 patients and ASA III in 3. Two of the 17 laparoscopies were converted to open surgery (11%), in one because of difficulties in dissecting extraperitoneally a mass >8 cm, and in the other because of difficulties in localization of a 3-cm mass. The median surgical time was 95 +/- 33 minutes. The mean analgesia requirements were 3 doses of (range 2-7) ketorolac. There were no deaths. Postoperative morbidity consisted of pulmonary atelectasis in one patient and urinary tract infection in two patients. The median hospital stay was 3 days (range 2-4 days). We conclude that laparoscopic adrenalectomy in the elderly population is safe and offers low morbidity, fast recovery, and a short hospital stay. Age alone should not be a contraindication to treating adrenal tumors laparoscopically.

THE ROLE OF COMPUTERIZED TOMOGRAPHY IN THE EVALUATION OF COMPLICATIONS AFTER LAPAROSCOPIC UROLOGICAL SURGERY

Radiographic evaluation may be necessary to assess the possible complications of laparoscopic procedures. We undertook a retrospective review to determine the indications for and findings of computerized tomography (CT) in symptomatic patients after urologic laparoscopic surgery. Of 400 laparoscopic urological procedures performed between July 1993 and September 1996, 20 patients (5%) had postoperative symptomatology that could not be explained by physical exam or routine clinical studies. An abdominal CT scan was obtained (1 to 120 days after the procedure) to help determine a diagnosis. CT findings were correlated with the indication for the study and clinical followup. The indications for CT were unexplained pain, fever, leukocytosis or falling hematocrit. Thirteen patients had significant findings related to their surgery that were identified by CT. In 2 cases, we identified pathology unrelated to the surgery. Therefore, CT identified a symptom-related diagnosis in 75% of patients (15 of 20). Each scan for decreasing hematocrit demonstrated a hematoma. In all patients with unexplained fever or leukocytosis, CT revealed the cause. CT evaluation of atypical postoperative pain demonstrated a pathological cause in 58% (7 of 12). Percutaneous or laparoscopic surgical intervention was required in 4 of 20 patients. In 8 patients scanned by postoperative day 6, intraperitoneal or retroperitoneal gas was identified in 3 who had an abdominal incision made for intact specimen removal and in 1 with a perforated ulcer. CT after urologic laparoscopy is indicated in patients with significant clinical findings in whom routine examination and tests are not diagnostic. CT can reliably identify postoperative bleeding, urinary leak or obstruction and can also detect nonurinary pathology.