Laparoscopic Complication Rates Research Articles

The Gynecologic Laparoscopic Surgery: Experience of Center of Fertility and Reproductive Medicine at St. Paul’s Hospital Millennium Medical College

Background: Recent data suggests that up to 80% of gynecologic surgeries can be accomplished laparoscopically. However, laparoscopy does not come without risks – specifically risks of injury to the bowel, urinary tract, and vasculature. This study assesses the indications for, as well as the complications and outcomes of laparoscopic surgery at the Center of Fertility and Reproductive Medicine at St Paul’s Hospital Millennium Medical College. Methods and Materials: This is a cross sectional retrospective study using data abstracted from medical records between April 2019 to September 2020. We included all gynecologic laparoscopies done during this date range. The data was collected with Open Data Kit (ODK) software and then transferred to Microsoft Excel for analysis. We set statistical significance at P <0.05. Results: There were 135 gynecologic surgeries performed, with a mean patient age of 32.4 years. About two-thirds of them presented with primary infertility, and 30% had a previous laparotomy or laparoscopy. Twenty percent had previously been diagnosed with tuberculosis. The main indication for laparoscopy was hydrosalpinx which accounted for 51.1% of surgeries. For patients who underwent surgery for a diagnosis of hydrosalpinx, the majority (54%) underwent bilateral salpingectomy. Our complication rate was 3.7% and rate of conversion to laparotomy was 5.2%. Conclusion: Our complication rate was higher than previously published laparoscopic complication rates from Asia and Europe. The majority of our complications were bladder and bowel injuries. Complications were managed predominately by conversion to laparotomy. Keywords: gynecology, laparoscopy, complications, Saint Paul’s Hospital Millennium Medical College.

Gynaecological laparoscopic injuries: a 10-year retrospective review at a District General Hospital NHS Trust

Worldwide, increasingly complex surgery is being performed laparoscopically; thus, laparoscopic complication rates may be increasing. Reported risks from all complications of laparoscopic surgery are between 1 and 12.5/1000 cases and serious complications in 1/1000 cases. Accurate complication rates of surgery are difficult to obtain as most data are from retrospective studies and may be incomplete. This paper is a 10-year retrospective review of gynaecological laparoscopic complications from 1 January 2003 to 31 December 2012. Data sources are SEMAHELIX Hospital Database, Gynaecology Complications Register, Clinical Governance Records, Complaints and Legal Cases. Recorded complications were classified as diagnostic, sterilisations and therapeutic laparoscopies. Further classifications are as follows: major complications and type of injury (bowel, urological, vascular, other), minor complications and failed sterilisations. Twenty-nine complications were identified from 5128 laparoscopies; total complication rate is 5.7/1000 procedures. Major complication rates are as follows: diagnostic, 2.2/1000; sterilisations, 3.3/1000; and therapeutic, 3.1/1000, subcategorised into bowel 1.4/1000, urological 0.2/1000 and vascular 1.2/1000. Our total complication rate lies within published national rates. Compared to published standards of major complications, diagnostic laparoscopy and laparoscopic sterilisation rates were comparable. Conversely, our therapeutic laparoscopy complication rate was much lower. The highest complication rate was in the failed sterilisation group; however, this rate is within published sterilisation failure rates. Bowel and vascular complications were comparable; minor complication rates were low in all groups.

Surgical Treatment of Diverticulitis: Hand-Assisted Laparoscopic Resection Is Predominantly Used for Complex Cases and Is Associated With Increased Postoperative Complications and Prolonged Hospitalization.

Introduction Laparoscopic (LAP) colectomy is now the "gold" standard for diverticulitis; the role of hand-assisted LAP (HAL) and Open methods today is unclear. This study assessed the elective use of these methods for diverticulitis. Methods A retrospective review of demographic, comorbidity (Carlson Comorbidity Index [CCI]), resection type, and short-term outcomes was carried out. Results There were 125 (44.5%) LAP, 125 (44.5%) HAL, and 31 (11%) Open cases (overall N = 281). The mean age, body mass index, and percentage of high-risk patients (CCI score >2) of the HAL group were greater (P < .05) than the LAP group (vs Open, P = ns). The Open group's mean age and percent with CCI >2 was greater when compared with the LAP group (P < .05). More Open (P < .05) and HAL patients had complex disease (Open, 63%; HAL, 40%, LAP, 22%) and were diverted (Open, 35%; HAL, 10%; LAP, 3%). Time to bowel movement was not different; however, there was a stepwise increase in median length of stay (LOS; days) from the LAP (5 days) to HAL (6 days) to Open group (7 days) (P < .05 for all). The LAP complication rate (22.4%) was lower (P < .05) than the HAL (42.4%) or Open groups' (45.2%) rates. The LAP surgical site infection rate (5.6%) was lower (P < .05) than the HAL (12.8%) or Open groups (19.6%). Conclusion The HAL and Open groups had more high risk, complex disease, diverted, and older patients than the LAP group; likewise, the overall complication rate and LOS was higher in the HAL and Open groups. Use of HAL methods likely contributed to the high minimally invasive surgery utilization rate (89%).

Gynaecological laparoscopic surgery: eight years experience in the Yaoundé Gynaeco-Obstetric and Paediatric Hospital, Cameroon

This is a retrospective analysis of eight years of gynaecological laparoscopic surgery in a resource-limited setting. All gynaecological patients managed by laparoscopy at the Yaoundé Gynaeco-Obstetric and Paediatric Hospital from 1 January 2004 to 30 November 2011 were included. Amongst the 9194 gynaecological surgeries performed during the study period, 6.9% (633) were done by laparoscopy. Most of the women underwent an operative laparoscopy (568/592; 95.9%). The most common indication was infertility (415/592; 70.1%). Diagnostic laparoscopies were mostly indicated for chronic pelvic pain (18/24; 75%). The most common surgical finding was tubo-peritoneal adhesions (412/592; 69.6%). A total of 35 patients (35/592; 5.9%) had at least one complication. The mean duration of hospitalization was 3.4 ±1.8 days. The general uptake of gynaecological laparoscopic surgery is low in our setting. The laparoscopic complication rate of 5.9% is encouraging.

Surgical Cost of Care in Crohn’s Disease

The aim of the study was to evaluate the cost of surgical care and short-term outcomes of Crohn's disease(CD) in the era of laparoscopy and biologic therapy. Review of a prospective database identified CD patients that underwent surgical management. Patients were stratified into laparoscopic, open, and converted approaches. Main outcome measures were short-term patient outcomes and cost of care by approach. 92 patients were analyzed- 63.1% laparoscopic, 32.6% open, 4.3% converted. The majority was elective (100% converted, 94.8% laparoscopic, 90% open) and segmental resections (75% converted, 70.7% laparoscopic, 43.3% open). Operative times were similar between laparoscopic and open (152 minutes and 138 minutes, respectively). More open patients required ICU care (20% versus 12.1% laparoscopic and 0% converted). The median LOS was 3 (1-25) days laparoscopic, 4 (1-29) open and 4 (3-8) converted. The laparoscopic complication rate was 15.5%, readmission rate 12.1%, and reoperation rate 8.6%. The mean total hospital cost was $9,702 laparoscopic, $10,782 open, and $13,293 for converted cases (US Dollars). Laparoscopy is appropriate for most CD cases. When necessary to combine with open surgery, this results in efficient and effective patient outcomes and healthcare utilization. These results are important when weighing the cost of ongoing medical therapy versus surgical intervention.

P-266. Effect of previous lower abdominal surgical intervention on laparoscopic complication rate

P-266. Effect of previous lower abdominal surgical intervention on laparoscopic complication rate

Intraoperative laparoscopic complications. Are we getting better?

The aim of this study was to assess various intraoperative and postoperative complications associated with laparoscopic colorectal surgery. Specifically, the impact of surgical experience and procedure type on complications was analyzed. All patients who underwent laparoscopic surgery were analyzed by age, sex, surgical indications, procedure performed, procedure length, intraoperative and postoperative complications, incidence and causes for conversion, duration of postoperative ileus, and length of hospital stay. Patients were classified for type of procedure and chronologically into four consecutive groups. Procedures were also categorized into four different groups: GI, total abdominal colectomies; GII, segmental resections; GIII, diverting procedures; GIV, others (abdominoperineal resection, Hartmann's creation or closure, anterior resection, and rectopexy). Between August 1991 and October 1995, 167 patients of a mean age of 49.6 (15-88) years underwent laparoscopic colorectal procedures. All procedures were electively performed. Common indications for surgery included inflammatory disease in 70 (42 percent), neoplasia in 56 (33 percent), functional bowel disorders in 30 (18 percent), and other forms of colorectal disorders in 11 (7 percent) patients. The most significant variable affecting intraoperative laparoscopic complication rate was surgical experience measured as the time interval during which surgery was performed (P = 0.02). Total complication rate decreased from 29 percent during the first period to 11 percent by the second period (P < 0.04) and 7 percent during the third period (P < 0.005). Thus, the learning curve appeared to have required more than 50 cases to achieve. Moreover, even after performance of 94 (1991-1993) procedures in GI and GIV, these procedures were associated with higher complication rates than were those procedures in GII and GIII (P = 0.04). Surgical experience and case selection are the most critical variables by which the surgeon can decrease the intraoperative laparoscopic complication rate.

Predictors of Laparoscopic Complications After Formal Training in Laparoscopic Surgery

To evaluate the relationship between laparoscopic complication rates and surgeon-dependent variables following a laparoscopic training course. Participants were surveyed regarding their interval laparoscopic experience 3 months and 12 months after the course. Course participants/survey respondents represented a cross section of urologic surgeons in the United States. A total of 181 individuals (61% of 297 participants) completed and returned the 3-month questionnaire. A total of 128 surgeons responded to the 12-month questionnaire (78.5% of 163 participants). Logistic regression analysis tested the relationship between surgeons' complication rates and study variables. At 3 months, surgeons who performed clinical procedures without additional training were 3.39 times more likely to have at least one complication compared with surgeons who sought additional training (P = .03). At 12 months, surgeons who had attended the training course alone, were in solo practice, or performed laparoscopic surgery with a variable assistant were 4.85, 7.74, and 4.80 times more likely, respectively, to have had a complication than their counterparts who attended the course with a partner, were in group practice, or operated with the same assistant (P = .004, P = .0008, and P = .0015, respectively). At both 3 and 12 months, laparoscopic complication rates of individual surgeons demonstrated a significant inverse correlation with the number of laparoscopic procedures performed. The rate of complications associated with the clinical learning curve can be decreased by additional education following an initial course in laparoscopy. An ongoing clinical association with surgeons performing similar procedures decreases long-term complication rates.

Predictors of laparoscopic complications after formal training in laparoscopic surgery

<h3>Objective.</h3> —To evaluate the relationship between laparoscopic complication rates and surgeon-dependent variables following a laparoscopic training course. <h3>Design.</h3> —Participants were surveyed regarding their interval laparoscopic experience 3 months and 12 months after the course. <h3>Participants.</h3> —Course participants/survey respondents represented a cross section of urologic surgeons in the United States. A total of 181 individuals (61% of 297 participants) completed and returned the 3-month questionnaire. A total of 128 surgeons responded to the 12-month questionnaire (78.5% of 163 participants). <h3>Main Outcome Measure.</h3> —Logistic regression analysis tested the relationship between surgeons' complication rates and study variables. <h3>Results.</h3> —At 3 months, surgeons who performed clinical procedures without additional training were 3.39 times more likely to have at least one complication compared with surgeons who sought additional training (<i>P</i>=.03). At 12 months, surgeons who had attended the training course alone, were in solo practice, or performed laparoscopic surgery with a variable assistant were 4.85, 7.74, and 4.80 times more likely, respectively, to have had a complication than their counterparts who attended the course with a partner, were in group practice, or operated with the same assistant (<i>P</i>=.004,<i>P</i>=.0008, and<i>P</i>=.0015, respectively). At both 3 and 12 months, laparoscopic complication rates of individual surgeons demonstrated a significant inverse correlation with the number of laparoscopic procedures performed. <h3>Conclusions.</h3> —The rate of complications associated with the clinical learning curve can be decreased by additional education following an initial course in laparoscopy. An ongoing clinical association with surgeons performing similar procedures decreases long-term complication rates. (<i>JAMA</i>. 1993;270:2689-2692)