Complications Of Laparoscopic Surgery Research Articles

Systematic review of trocar-site hernia

Broad implementation of laparoscopic surgery has made trocar-related complications clinically important. Trocar-site hernia (TSH) is an uncommon, but potentially serious, complication that occasionally requires emergency surgery. This systematic review was conducted to establish the prevalence and risk factors for TSH. The review was conducted according to the PRISMA guidelines. MEDLINE, Embase, Web of Science and the Cochrane Library were searched to 7 June 2010 for studies on TSH. Twenty-two articles were included. One study was a randomized clinical trial, five were prospective cohort studies and 16 were retrospective cohort studies. The prevalence of TSH is low, with a median pooled estimate of 0·5 (range 0-5·2) per cent. No meta-analysis on risk factors could be performed. Pyramidal trocars, 12-mm trocars and a long duration of surgery were identified as the most important technical risk factors for TSH. Older age and a higher body mass index were observed to be patient-related risk factors. TSH is an uncommon complication of laparoscopic surgery. The most important technical risk factors are the design and size of the trocars. The scientific evidence for recommendations to avoid TSH is sparse.

Radiofrequency fulguration of␣the␣spleen under␣laparoscopy to␣stop iatrogenic hemorrhage

Iatrogenic splenic injury is a potentially serious complication of laparoscopic surgery associated with significant morbidity and mortality. It also has an impact on the prognosis of patients who undergo surgery for digestive cancer. For iatrogenic splenic injury, splenic salvage is the ultimate goal. Various surgical techniques have been developed to achieve hemostasis of the spleen. Radiofrequency fulguration (RF) is reported to be a safe method in an animal trauma model. However, only three articles report RF for the control of splenic hemorrhage in human patients. A bicentric, retrospective study was performed. From January 2009 to September 2010, all iatrogenic splenic hemorrhages uncontrolled by conventional hemostasis techniques were treated using RF. The splenic injuries were classified according to the Moore classification and a postoperative, abdominal computed tomography scan was performed for each patient. RF was performed with a straight electrode needle (Integra, Tuttlingen, Germany) introduced percutaneously into the spleen. The electrode was infused with isotonic saline and connected to a 500-kHz generator (Elektrotom 106 HFTT; Berchtold, Tuttlingen, Germany). During the high-frequency coagulation (375 kHz), electrode saline perfusion was automatically regulated from 30 to 110 ml/h according to the variation in tissue impedance, and the power of the generator was kept at 50 W. Three patients (2 men and 1 woman) with a median age of 58 years underwent splenic RF. The splenic injuries (grade 3, Moore classification) occurred during laparoscopic proctectomy in two cases and during laparoscopic gastrectomy in one case. It was possible to achieve complete hemostasis in all the patients during a median time of 10 min. The median blood loss was 100 ml, with no blood transfusion. No splenectomy was necessary, and no postoperative splenic infarction was diagnosed. No conversion was performed. There was no postoperative morbidity or mortality. No recurrent splenic hemorrhage occurred during the follow-up period. The financial cost was 350<euro> per RF. Although RF could potentially induce splenic infarction in the event of a large-scale fulguration, it is a safe, quick, and effective spleen-preserving technique for stopping an iatrogenic splenic hemorrhage when conventional hemostasis techniques fail. Furthermore, it is readily available and easy to set up in an emergency situation and can be performed easily by laparoscopy without an additional port.

Post TLH Ureteral Reimplantation and Burch

This video is meant to demonstrate the use of MIS to address a known serious complication of laparoscopic surgery, uretero-vaginal fistula after total laparoscopic hysterectomy. In this case a uretero-vaginal fistula and SUI are treated by Robotic ureteral dissection, bladder mobilization, ureteral reimplantation and then a Robotic Burch bladder neck retropubic urethropexy. Because of the need to fully mobilize the bladder, visualization of anatomic land marks is excellent and demonstrated in this video abstract.

Trocar Site Hernia- A Case Series

Trocar site hernias (TSH) is a rare but potentially dangerous complication of laparoscopic surgery. It’s incidence is approximately 0.477% [1]. Among TSH, omental herniation is very rare [2]. We report two cases of omental herniation through the laparoscopic port sites.

Skill qualifications in pediatric minimally invasive surgery

In 2006, The Japanese Society of Pediatric Endoscopic Surgeons devised a plan to develop a pediatric endoscopic surgical skill qualification (ESSQ) system. This system is controlled by The Japan Society for Endoscopic Surgery. The standard requirement for skills qualification is the ability of each applicant to complete common types of laparoscopic surgery. The main goal of the system is to decrease complications of laparoscopic surgery by evaluating the surgical skills of each applicant and subsequently certify surgeons with adequate skills to perform laparoscopic operations safely. A committee of pediatric ESSQ created a checklist to assess the applicant's laparoscopic surgical skills. Skills are assessed in a double-blinded fashion by evaluating an unedited video recording of a fundoplication for pediatric gastroesophageal reflux disease. The initial pediatric ESSQ system was started in 2008. In 2008 and 2009, respectively, 9 out of 17 (53%) and 6 out of 12 (50%) applicants were certified as expert pediatric laparoscopic surgeons. Our ultimate goal is to provide safe and appropriate pediatric minimally invasive procedures and to avoid severe complications. To prove the predictive validity of this system, a survey of the outcomes of operations performed by certified pediatric surgeons is required.

Eventración de los orificios de los trocares en cirugía laparoscópica

Trocar site incisional hernias (TSIH) are the most common complications in laparoscopic surgery. We have carried out a review of the literature with the aim of establishing their incidence, the reasons for them happening, and their prevention. After a search in the MEDLINE PubMed and PubMed CENTRAL data bases from 1991 to 2009, combining the words: «hernia», «laparoscopy» and «trocar», we obtained 545 articles, of which we analysed 60 of them. The incidence of TSIH varies between 0.18% and 2.8%. The diameter of the trocar, obesity and age play a fundamental role when proceeding to close the fascia, a closure which is the most important factor to prevent these incisional hernias appearing. The appearance of new laparoscopic material and the increasing more common closure of defects of the fascia means that new and more extensive prospective studies should be performed.

Laparoscopic 5-mm Trocar Site Herniation and Literature Review

To evaluate the evidence for fascial closure of 5-mm laparoscopic trocar sites. We conducted electronic database searches of PubMed and the Cochrane Library for articles published between November 2008 and December 2010. We used the keywords trocar hernia, trocar-site hernia, laparoscopic hernia, trocar port-site hernia, laparoscopic port-site hernia. Prospective and retrospective case series, randomized trials, literature reviews, and randomized animal studies of trocar hernias on abdominal wall defects from gynecologic, urologic, and general surgery literature were reviewed. The Cochrane Database was reviewed for pertinent studies. Metaanalysis was not possible due to the significant heterogeneity between studies and lack of randomized trials large enough to assess the incidence of this rare complication. Trocar-site hernias are a rare but known complication of laparoscopic surgery. Trocar size ≥10mm is associated with an increased rate of hernia development. Currently, the accepted gynecologic surgical practice is closure of fascial incisions ≥10mm, while incisions <10mm do not require closure. However, large prospective and retrospective case series reports from general surgery and urology literature support nonclosure of blunt or radially dilating trocars in paramedian sites. Expert opinion and small case reports suggest that in cases of prolonged manipulation of 5-mm trocar sites the surgeon should consider fascial closure, because extension of the initial incision may have occurred. There is no evidence to recommend routine closure of 5-mm trocar incisions; the choice should continue to be left to the discretion of the individual surgeon.

Risk factors for postoperative ileus after urologic laparoscopic surgery

PurposeAlthough its incidence has decreased with the widespread use of less invasive surgical techniques including laparoscopic surgery, postoperative ileus remains a common postoperative complication. In the field of urologic surgery, with the major exception of radical cystectomy, few studies have focused on postoperative ileus as a complication of laparoscopic surgery. The present study aims to offer further clues in the management of postoperative ileus following urological laparoscopic surgery through an assessment of the associated risk factors.MethodsThe medical records of 267 patients who underwent laparoscopic surgery between February 2004 and November 2009 were reviewed. After excluding cases involving radical cystectomy, combined surgery, open conversion, and severe complications, a total of 249 patients were included for this study. The subjects were divided into a non-ileus group and an ileus group. The gender and age distribution, duration of anesthesia, American Society of Anesthesiologists Physical Status Classification Score, body mass index, degree of operative difficulty, presence of complications, surgical procedure and total opiate dosage were compared between the two groups.ResultsOf the 249 patients, 10.8% (n = 27) experienced postoperative ileus. Patients with ileus had a longer duration of anesthesia (P = 0.019), and perioperative complications and blood loss were all correlated with ileus (P = 0.000, 0.004, respectively). Multiple linear regression analysis showed that the modified Clavien classification was an independent risk factor for postoperative ileus (odds ratio, 5.372; 95% confidence interval, 2.084 to 13.845; P = 0.001).ConclusionPostoperative ileus after laparoscopic urologic surgery was more frequent in patients who experienced more perioperative complications.

Leiomyoma mimicking an incarcerated inguinal hernia: A rare complication of laparoscopic hysterectomy

A 52-year-old, obese, female patient was referred for a right inguinal mass, which appeared seven months after a laparoscopic hysterectomy, which was performed because of myomatosis. Despite several examinations, including ultrasound, computed tomography (CT)-Scan, positron emission tomography (PET)-CT, and ultrasound-guided biopsy, the diagnosis remained unclear until surgical exploration, which disclosed a well-encapsulated solid tumour corresponding to a fibrotic leiomyoma. Spilling of leiomyoma cells is a rare and unusual complication of laparoscopic surgery. Tumour development in the inguinal canal after laparoscopic gynaecological surgery should be kept in mind in the differential diagnosis of inguinal hernia and other uncommon pathologies.

A case report of incisional hernia through a 5 mm lateral port site following laparoscopic cholecystectomy

INTRODUCTION:Less than 10 mm port-site herniation is a rare complication after laparoscopic surgery. We report a case of complicated herniation through the 5-mm lateral trocar port site.CASE REPORT:A 63-year old obese female was admitted due to intestinal obstruction. She has undergone the laparoscopic cholecystectomy 1 year ago. On examination, abdomen was bloated and roughly 10 cm size mass was palpable on the right subcostal area. Plane radiogram of the abdomen showed signs of intestinal obstruction. Since conservative treatment was ineffective, the patient was operated on. The laparotomy revealed a protrusion of a part of right large intestine and greater omentum into the subcutaneous space through the abdominal wall defect below right subcostal margin. There was a dilatation of intestines proximally incarcerated colon. It was released and a part of omentum was resected. The peritoneum and fascia-muscular defect was closed by interrupted vicryl sutures.CONCLUSION:Acute herniation through a 5 mm size most lateral trocar port site is a rare complication of laparoscopic surgery requiring prompt differential diagnosis.

A rare complication of laparoscopic surgery

Gallstone disease is one of the most common problems affecting the digestive tract. Symptomatic patients are advised to undergo laparoscopic cholecystectomy (LC), which is considered the gold standard of care in these patients. LC has clear advantages over traditional surgery such as a shorter hospital stay, an earlier return to work and better patient satisfaction. Despite LC being a common surgical procedure, it is not totally free from complications. These include cardiorespiratory problems, biliary leakage, peritonitis, hemorrhage and superior mesenteric artery (SMA) occlusion. We report an unusual and fatal complication of LC, being SMA thrombosis complicated by multiple intra-abdominal collections, abdominal compartment syndrome, multiorgan failure and septic shock.

Surgical Emphysema as a Cause of Severe Hypercapnia during Laparoscopic Surgery

Surgical emphysema is a well-recognised complication of laparoscopic surgery, but its impact on end-tidal carbon dioxide levels and carbon dioxide elimination is seldom reported and may not be fully appreciated by anaesthetists. Four cases are presented where extensive surgical emphysema occurred during laparoscopic surgery. The visual display of the anaesthetic record using the software program Monitor showed substantial rises in end-tidal carbon dioxide levels and allowed calculation of the carbon dioxide elimination, which increased two- to three-fold above normal levels. Having a visual record of carbon dioxide changes facilitated the recognition of surgical emphysema in three out of the four cases. Strategies such as estimating and tracking changes in carbon dioxide elimination from the minute ventilation and end-tidal carbon dioxide levels may assist in early identification, and palpating for surgical emphysema is recommended during laparoscopy if other causes of increased carbon dioxide levels are excluded.

Endometrial Carcinoma: 178 Patients Treated by Laparoscopy

Study Objective: To evaluate results and complications of laparoscopic surgery in patients with cancer of endometrium.Design: Descriptive retrospective study. Patients with incomplete data during the picking up or the follow-up as well as those with other synchronic cancers were excluded.Setting: Unit of Gynecologic Oncology and Endoscopy of the Hospital 12 de Octubre. Madrid. Spain.Patients: 178 patients diagnosed of endometrial cancer during the years 2001 to 2007.Intervention: Laparoscopic total extrafascial hysterectomy with bilateral anexectomy. Pelvic lymphadenectomy. Para-aortic lymphadenectomy. Omentectomy.Measurements and Main Results: Mean age was 63 years. Mean age of menopause was 51 years. Mean value of Body Mass Index was 30. 18 patients had previous treatment with tamoxifen for breast cancer. Mean value of the pre-surgical Ca125 was 31 UI/ml. 18% of the patients had any previous abdominal surgical procedure. Distribution for stages: IA=70,2%, IB=20,8%, IIA=1,7%, IIB=1,1%, IIIA=2,2%, IIIB=0%, IIIC=3,9% and IV=0 %. 51% of tumors were high differentiated, 27% moderate and 22% poorly. 88% of them corresponded to endometrial adenocarcinomas. Lymphadenectomy was practiced to the 58% of the patients. In 48% of the cases uterus was sent to intraoperatory study. Mean pre-surgical hemoglobine was 13.4gr/dl and post-surgical 11.3gr/dl. Ten patients (7,5 %) required blood transfusion. The mean duration of the procedure was 173 minutes (range 60-360 minutes). Intraoperatory complications were: significant hemorrhage in three patients, uterine perforation in three patients and difficulty for the uterine extraction in two cases because of myomas. 3,8% of the cases were reconverted into laparotomy. Postoperative complications were: Fever, haematoma of abdominal wall, paralytic ileus and re-intervention. The mean hospitalization was 5 days (range 2-24).Conclusion: The laparoscopic approach is adequate in the treatment of the cancer of endometrium, with the same level of radicality than laparotomy, and with a fall rate of complications. Study Objective: To evaluate results and complications of laparoscopic surgery in patients with cancer of endometrium. Design: Descriptive retrospective study. Patients with incomplete data during the picking up or the follow-up as well as those with other synchronic cancers were excluded. Setting: Unit of Gynecologic Oncology and Endoscopy of the Hospital 12 de Octubre. Madrid. Spain. Patients: 178 patients diagnosed of endometrial cancer during the years 2001 to 2007. Intervention: Laparoscopic total extrafascial hysterectomy with bilateral anexectomy. Pelvic lymphadenectomy. Para-aortic lymphadenectomy. Omentectomy. Measurements and Main Results: Mean age was 63 years. Mean age of menopause was 51 years. Mean value of Body Mass Index was 30. 18 patients had previous treatment with tamoxifen for breast cancer. Mean value of the pre-surgical Ca125 was 31 UI/ml. 18% of the patients had any previous abdominal surgical procedure. Distribution for stages: IA=70,2%, IB=20,8%, IIA=1,7%, IIB=1,1%, IIIA=2,2%, IIIB=0%, IIIC=3,9% and IV=0 %. 51% of tumors were high differentiated, 27% moderate and 22% poorly. 88% of them corresponded to endometrial adenocarcinomas. Lymphadenectomy was practiced to the 58% of the patients. In 48% of the cases uterus was sent to intraoperatory study. Mean pre-surgical hemoglobine was 13.4gr/dl and post-surgical 11.3gr/dl. Ten patients (7,5 %) required blood transfusion. The mean duration of the procedure was 173 minutes (range 60-360 minutes). Intraoperatory complications were: significant hemorrhage in three patients, uterine perforation in three patients and difficulty for the uterine extraction in two cases because of myomas. 3,8% of the cases were reconverted into laparotomy. Postoperative complications were: Fever, haematoma of abdominal wall, paralytic ileus and re-intervention. The mean hospitalization was 5 days (range 2-24). Conclusion: The laparoscopic approach is adequate in the treatment of the cancer of endometrium, with the same level of radicality than laparotomy, and with a fall rate of complications.

Impact of Smoking on Perioperative Pulmonary Complications in Laparoscopic Surgery

Impact of Smoking on Perioperative Pulmonary Complications in Laparoscopic Surgery

Pneumopericardium and Severe Subcutaneous Emphysema after Laparoscopic Surgery

Subcutaneous emphysema is a known complication of laparoscopic surgery. Occasionally, subcutaneous emphysema is severe enough to cause pneumopericardium. This case report describes a rare but potentially serious complication of pneumopericardium occurring after laparoscopy. Contributing factors and possible etiologies are discussed.

Management of major vascular complications of laparoscopic surgery

Management of major vascular complications of laparoscopic surgery

Direct Trocar Versus Veress Needle Entry for Laparoscopy: A Randomized Clinical Trial

None of the procedures currently used to achieve access to the abdomen in laparoscopic surgery is totally efficacious or free of complications. Accordingly, several approaches and techniques have been investigated. Two such methods are the standard technique of insufflation by insertion of the Veress needle (VN) and direct trocar (DT) entry without prior pneumoperitoneum. Several studies have suggested that DT entry is a safe alternative to VN entry, but few were prospective and only 3 were randomized. Although DT is faster than any other method of entry, it is the least performed laparoscopic technique. Complications of laparoscopic surgery appear to be primarily entry-related and independent of surgical complexity. Several studies have suggested that the initial trocar insertion is the most dangerous step in minimally invasive surgery. The aim of this randomized clinical trial was to compare DT to VN entry for the creation of pneumoperitoneum at laparoscopy with respect to the duration of the procedure, volume of gas used, ease of performance, and frequency of complications. A total of 1000 patients scheduled to undergo diagnostic laparoscopy were randomly assigned to receive DT (group A, n = 500) or VN (group B, n = 500) entry for pneumoperitoneum. The same surgeon performed the laparoscopic procedures. There was no difference between the groups in demographic characteristics. The mean duration of the procedure was significantly shorter in the DT group (2.2 ± 0.7 minute, 95% confidence interval [CI]: 2.14-2.26) compared to the VN group (8.2 ± 1.4 minute, 95% CI: 8.08-8.32; P < 0.0001). Similarly, the amount of gas consumed was significantly lower in the DT group (2.6 ± 0.9 L, 95% CI: 2.52-2.68) than in the VN group (8.4 ± 2.6 L, 95% CI: 8.17―8.63; P < 0.0001). There were no major complications in either group. Compared to the patients in the DT group, those in the VN group had a significantly higher rate of minor intraoperative complications (VN: 14%, 95% CI: 10.96-17.4 vs. DT: 0.4%, 95% CI: 0.15―0.95; P < 0.0001).

893 PORT-SITE HERNIAS OCCURRING AFTER THE USE OF BLADELESS RADIALLY EXPANDING TROCARS

You have accessJournal of UrologyTechnology & Instruments: Robotics/Laparoscopy/Ureteroscopy II1 Apr 2010893 PORT-SITE HERNIAS OCCURRING AFTER THE USE OF BLADELESS RADIALLY EXPANDING TROCARS Edmund Chiong, Paul K. Hegarty, John W. Davis, Ashish M. Kamat, Louis L. Pisters, and Surena F. Matin Edmund ChiongEdmund Chiong Singapore, Singapore More articles by this author , Paul K. HegartyPaul K. Hegarty London, United Kingdom More articles by this author , John W. DavisJohn W. Davis Houston, TX More articles by this author , Ashish M. KamatAshish M. Kamat Houston, TX More articles by this author , Louis L. PistersLouis L. Pisters Houston, TX More articles by this author , and Surena F. MatinSurena F. Matin Houston, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1649AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To compare and review the incidence of port-site hernias after use of bladeless radially dilating trocars after noticing a unique hernia entity developing in patients. METHODS We retrospectively identified patients who were diagnosed or treated for postoperative hernias at our institution between 2004 and 2007 using a departmental morbidity database. All patients had laparoscopic urologic surgery for malignant conditions using bladeless radially dilating trocars. RESULTS Of 1055 consecutive patients who underwent laparoscopic urologic oncology surgery between 2004 and 2007, a total of 7 patients (0.66%) were identified with trocar-site hernias. All hernias occurred in port sites using 12-mm bladeless radially dilating trocars without fascial closure. All hernias were confirmed by computed tomography of the abdomen and 6 by surgical findings. Of the 7 patients, 4 had an intrafascial incisional hernia; the small bowel herniated through a defect in the transversalis and internal oblique fasciae, but the external oblique fascia was intact. The intrafascial hernias were not evident on physical examination owing to an intact external oblique fascia. CONCLUSIONS While rare, trocar-site herniation after use of bladeless radially dilating trocars is a potentially serious complication of laparoscopic surgery. A large proportion of these may be partial-wall or intrafascial hernias. It is important to increase awareness among laparoscopic surgeons of the possibility of intrafascial incisional hernias, as physical findings are subtle and early computed tomography diagnosis is necessary for timely surgical intervention. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e349 Peer Review Report Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Edmund Chiong Singapore, Singapore More articles by this author Paul K. Hegarty London, United Kingdom More articles by this author John W. Davis Houston, TX More articles by this author Ashish M. Kamat Houston, TX More articles by this author Louis L. Pisters Houston, TX More articles by this author Surena F. Matin Houston, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Postoperative Bowel Herniation in a 5-mm Nonbladed Trocar Site

Incisional hernias are a rare complication of laparoscopic surgery, with a reported incidence of <1%. We describe a case of bowel herniation and strangulation involving a 5-mm trocar site. Although there is growing literature supporting fascial closure of abdominal port sizes ≥ 10 mm, there is sparse data to suggest closure of 5-mm port sites. Our case illustrates that in appropriate clinical scenarios, the possibility of a strangulated hernia involving a 5-mm port site warrants consideration.

The use of chest band to prevent CO2subcutaneous emphysema expansion -Two case reports-

CO2 subcutaneous emphysema is one of the complications of laparoscopic surgery using CO2 gas. During laparoscopic surgery, CO2 gas can spread to the entire body surface through the subcutaneous tissue layer. Extensive CO2 subcutaneous emphysema results in hypercarbia and acute respiratory acidosis. Hypercarbia and acidosis can lead to decreased cardiac contractility and arrhythmia. A cloth band, 5 cm in width and 120 cm in length, was made with Velcro tape at both tips, and placed on the patient's xyphoid process level and inframammary fold to prevent CO2 subcutaneous emphysema. This report describes two successful cases using a chest band to prevent the expansion of CO2 subcutaneous emphysema.