Management Of Intraoperative Complications Research Articles

Prevention and management of intra-operative complications in maxillary sinus augmentation: A review.

Maxillary sinus floor elevation is usually performed in two different ways: the lateral approach involves the creation of a bony window on the maxillary sinus lateral wall, providing direct access to the sinus cavity for membrane elevation and subsequent graft placement, and the transcrestal approach is considered less invasive. The aim of this article is to describe, based on the literature, how to anticipate, avoid, and manage the intraoperative complications that can occur with both approaches. For both approaches, the most common complication is the sinus membrane perforation. For the lateral approach, an average frequency ranging from 15.7% to 23.1% is reported, but because of the better visibility, their management will be easier compared to the transcrestal approach. Mean perforation rate reported for the transcrestal approach is lower (3.1%-6.4%), but it should be noted that a significant number of perforations cannot be detected and managed given the blind nature of this technique. Anatomical parameters such as sinus width and buccal wall thickness may be a risk factor for one approach and not the other. As it is impossible to assess the resistance of the Schneiderian membrane, the transcrestal approach is more likely to lead to infectious complications in the event of perforation. Others, such as the risk of vascular damage, are encountered only with the lateral approach, which can be prevented easily by dissecting the alveolo-antral artery. For both approaches, prevention is essential and consists in analyzing the anatomy, mastering the surgical technique, and collaborating with the ENT to manage the essentially infectious consequences of intraoperative complications.

Simulation training of intraoperative complication management in laparoscopic cholecystectomy for novices—A randomized controlled study

BackgroundIntraoperative complications occur more often in laparoscopic cholecystectomies (LCs) than in open cholecystectomies. Since LC is a frequent training procedure, surgical residents should be trained to deal with intraoperative complications in a safe and controlled environment. This study aimed to determine whether structured training in coping mechanisms in complication management in LC benefits novices compared to no training in complication management. MethodsThe study included sixty medical students without prior experience in minimally invasive surgery. They were randomly assigned to the intervention or control group and worked in teams of two. Both groups completed multimodal skill training, including one ex-vivo porcine LC. The intervention group (n=30) was then informed about the complications that can occur during an LC and how to manage them using the Coping Mechanisms for Intraoperative Complication Management in Laparoscopic Cholecystectomy (COMIC-LC) tool specially developed for this study. Afterward, they performed two LCs receiving structured training in coping mechanisms for intraoperative complication management. The control group (n=30) performed two LCs, receiving no information about managing complications. Both groups performed two postinterventional LCs. Complication management of the two groups was evaluated using the COMIC-LC assessment score. ResultsThe intervention group demonstrated better management of intraoperative complications in LCs compared to the control group (gallbladder perforation: 8.5 vs. 3.0 points, p<0.001; injury to the liver parenchyma: 7.0 vs. 2.0 points, p<0.001; cystic artery injury: 8.0 vs. 5.0 points, p<0.001; cystic duct injury: 6.0 vs. 1.0, p<0.001). ConclusionStructured training in coping mechanisms for managing intraoperative complications during LC can improve complication handling and potentially reduce adverse events. Translation to clinical practice should be evaluated.

The impact of endovascular stents types on perioperative outcomes of ruptured abdominal aortic aneurysms: a single-center experience.

Ruptured abdominal aortic aneurysm (rAAA) represents a critically urgent vascular surgical condition, and endovascular aneurysm repair (EVAR) is a clinically effective treatment option. This study aims to investigate whether the type of intravascular graft used for ruptured abdominal aortic aneurysms has an impact on perioperative outcomes of EVAR. A retrospective analysis was conducted on patients who underwent EVAR for ruptured abdominal aortic aneurysm at a single medical center from 2019 to 2022. Patients who required simultaneous stent implantation in the renal arteries or visceral arteries, as well as those with ruptured aneurysms located in the para-renal, supra-renal, or thoracoabdominal regions, were excluded from the analysis. Additionally, patients who underwent open surgery during the initial procedure or converted to open repair were excluded. The primary endpoint was perioperative mortality rate. Other study outcomes included perioperative complications, reoperation rates, and length of hospital stay. Characteristics and corresponding outcomes of patients receiving different endovascular stent treatments were compared using SPSS software. A total of 58 patients received treatment with two types of endovascular stents: Gore Excluder (n = 29) and Microport Hercules (n = 29). The number of other endografts was too small for statistical analysis. Compared to patients treated with Hercules, those treated with Excluder had a significantly increased likelihood of concomitant coronary atherosclerosis (P = 0.009) and potentially higher creatinine levels (P = 0.014). Additionally, Excluder was more commonly used in patients with shorter aneurysm necks (P < 0.001). There was a statistically significant difference in overall mortality between the two groups (Hercules 27.6%, Excluder 6.9%, P = 0.037). Furthermore, patients who received Excluder treatment had lower mortality rates in subgroups of non-alcohol users (P = 0.028), non-diabetic patients (P = 0.027), and patients with dispersed thrombosis at the proximal neck (P = 0.046). In the multivariate analysis, the type of stent used (OR 0.06, 95% CI 0.00-1.31) and the occurrence of intraoperative complications (OR 20.70, 95% CI 1.14-76.70) in patients with rAAA was identified as an independent risk factor for perioperative mortality. Our study suggests that the management of intraoperative complications may be a modifiable factor that can improve outcomes. Patients receiving Excluder treatment demonstrated better performance in EVAR for single-center rAAA patients compared to other endovascular stents, and this difference warrants further investigation.

Visual and Anatomical Outcomes of Pars Plana Vitrectomy for Dropped Nucleus

Objective: To evaluate the visual and anatomical outcomes of pars plana vitrectomy (PPV) in patients with dropped nucleus following complicated phacoemulsification (PE).&#x0D; Materials and Methods: A retrospective study was conducted at the Ophthalmology Department of Lahore General Hospital, Lahore between 2017 and 2022. The study included 51 patients (33 males and 18 females) between the age 35 to 85 years who were referred after a complicated phacoemulsification with dropped nucleus.&#x0D; Results: This study included 51 patients in which 33 were males (64.71%) and 18 were females (35.29%). All patients underwent 23-gauge pars plana vitrectomy. Posterior chamber phacofragmentation was carried out in 32 (62.75%) eyes while in remaining 19 (37.25%) patients vitrectomy cutter was used for the dropped nucleus. Out of 51, 06 (11.76%) patients received an anterior chamber IOL at the time of cataract surgery, 21 (41.18%) eyes had IOL in the ciliary sulcus, 07 (13.73%) had a posterior chamber IOL, and the remaining 17 (33.33%) patients were aphakic. Of these 17 aphakic patients, an anterior chamber IOL was placed at the time of vitrectomy in 07 (41.18%) patients who were judged to have inadequate capsular support for a posterior chamber lens. In the remaining 10 (58.82%) eyes, where capsular support was deemed adequate, a posterior chamber IOL was inserted. Final visual acuity was 20/40 or better in 34 (66.67%) eyes and 20/50 in 06 (11.76%) patients.&#x0D; Conclusion: Poor visual outcome after dropped nucleus at phacoemulsification cataract extraction can be avoided if managed by prompt pars plana vitrectomy as it offers the advantages of a closed system for vitrectomy and manipulation of the nucleus, an improved view of the posterior segment and facilitated recognition and management of intraoperative complications with better visual and anatomical outcomes with low rate of postoperative complications.

Lessons learned from early experience of per oral endoscopic myotomy in children

Background/AimsAchalasia cardia (AC) is rare in children, and the standard treatment is open or Laparoscopic Heller's myotomy with or without fundoplication if pneumatic dilatation has failed. Per oral endoscopic myotomy (POEM) is a novel technique for management of achalasia with good results in adults. We report POEM in four children and the outcome with special emphasis on the technique and management of intra-operative complications. MethodFour children aged 7–15 years presenting with progressive dysphagia, cough, night-time aspirations, and weight loss of six months to one year were investigated with upper GI contrast study, flexible endoscopy and biopsy, oesophageal manometry, and a diagnosis of Type 1 & 2 AC was made. An experienced adult endoscopist in collaboration with the paediatric surgical team performed POEM. ResultsPOEM was performed successfully using ERBE HYBRID knife setup and waterjet injection for the submucosal tunnelling. Operative time was 25–40 min (mean 31 min). The hospital stay was 3–8 days with last 3 patients discharged on day three. No major intraoperative or post-operative complications were seen. The Eckardt score changed from above 4 to 0 at one-month follow-up. All four are well at one year post-operatively and beyond. Two patients had subcutaneous emphysema post-operatively. One developed pneumoperitoneum intra-operatively. ConclusionPOEM was successfully performed with only minor adverse events in experienced hands. Anticipation and preparation for potential intraoperative complications and assigned responsibilities to each team helped the safe completion in the shortest time. Rectifying pneumoperitoneum concurrently without interruption of the operation exemplified teamwork. Level of EvidenceIII

Rare Complications in Chondrolaryngoplasty: Preparation for Safe Outcomes.

Chondrolaryngoplasty ("tracheal shave") is a common procedure requested by transgender women as well as cisgender men and women. Management of intraoperative complications is crucial given the risk of damage to the vocal cords and loss of the airway in patients who are not intubated. We present two rare complications of chondrolaryngoplasty and their management.

Causes and management of intraoperative complications in robot-assisted anatomical pulmonary resection for lung cancer.

BackgroundTo perform safe robot-assisted anatomical lung resections, the details of intraoperative complications need to be shared among thoracic surgeons. However, only limited data are available.MethodsThis retrospective, single-institutional study evaluated 134 patients who underwent robot-assisted anatomical lung resection. We examined the causes, management, and outcomes of all intraoperative complications.ResultsOf the 134 eligible patients, 118 (88%) underwent lobectomy and 16 (12%) underwent segmentectomy. Intraoperative complications occurred in 17 (12.7%) patients. These complications included pulmonary artery (PA) injuries in seven patients, pulmonary vein (PV) injuries in three, azygos vein (AV) injury in one, superior vena cava (SVC) injury in one, bronchial injuries in three, and lung injuries in four. Most PA injuries were at a distal side and controlled by pressure, fibrin sealant, or stapling of the proximal side. In the three PV injuries, right upper PV was sandwiched by robotic instruments, V6 was punctured by the tip of the Maryland bipolar forceps, and the distal side of V2t was injured during tunneling of a minor interlobar fissure. These were controlled the same way as the PA injuries. The AV injury occurred during hilar lymph node (LN) dissection and was controlled by suturing. The SVC injury was caused by interference of the robotic forceps and the suction tube outside the field of view during upper mediastinal LN dissection. The injury was controlled by continuous pressure while layering polyglycolic acid sheets and fibrin glue. In the three bronchial injuries, B10 was injured during subcarinal LN dissection, right main bronchus was injured during upper bronchus dissection and the stapling failure of the bronchus occurred by strong traction. They were all repaired by suturing. All lung parenchymal injuries were caused by manipulation of robotic instruments outside the field of view. The lung injuries were repaired by suturing with pledgets. No cases were converted to thoracotomy. The 30-day mortality rate was 0.7%. The cause of mortality was pneumonia.ConclusionsIn robot-assisted anatomical pulmonary resection for lung cancer, most major intraoperative complications can be safely managed robotically without conversion to thoracotomy.

V15 - Endoneedle laser lithotripsy during percutaneous nephrolitotomy: The advantage of ecirs in the management of intra-operative complications

V15 - Endoneedle laser lithotripsy during percutaneous nephrolitotomy: The advantage of ecirs in the management of intra-operative complications

The Impact of a TAVR Program on a Vascular Surgery Practice

<h3>Background</h3> Transcatheter aortic valve replacement (TAVR) is a less invasive alternative to surgical aortic valve repair offering treatment to candidates who may not tolerate a more robust surgical intervention. Five years ago, the cardiology group in our rural community initiated a TAVR program to further address the need for cardiac care. Operating under the heart team model our vascular surgery group has worked alongside interventional cardiologists and cardio-thoracic surgeons to ensure safe interventions. To date, over 300 patients within this community have undergone this procedure. <h3>Objective</h3> The purpose is to observe the role of the vascular surgeon in management of patients undergoing TAVR in a rural hospital setting. <h3>Methods</h3> Clinical data from a multi-specialty practice database was used for this study of 292 TAVR patients from 2016 through 2021. Patients were treated in a multidisciplinary approach with involvement of vascular surgeons, interventional cardiologists and cardio-thoracic surgeons. <h3>Results</h3> Of the 292 TAVR patients 275 (94.2%) were over the age of 65. Multiple patients required alternative access other than the standard transfemoral approach including 8 axillary, 2 trans-aortic, 1 each trans-apical and trans-septal. Vascular surgeons have been invaluable in management of intra-procedure and post-procedure complications. A dislodged aortic valve was deployed in the thoracic aorta and covered with aortic stent graft. For calcified access, vascular surgery has provided shock wave lithotripsy treatment to aid large sheath introduction. Other complications encountered include aortic dissection, acute limb ischemia, distal embolization and major access related hemorrhage. <h3>Conclusions</h3> Vascular surgery will continue to be an important partner in the care of TAVR patients in this medium sized rural health care setting. Vascular surgical assistance has aided in stabilization of concurrent disease, management of intraoperative complications and emergencies, and obtaining complex vascular access.

Management of intraoperative complications during laparoscopic right colectomy.

Minimally invasive right colectomy is increasingly performed as standard treatment for diseases of right colon. Complete mesocolic excision has been introduced for cancer treatment to improve oncological results. Both standard and complete mesocolic excision techniques are associated with intraoperative complications. The purpose of this study was to analyze incidence and management of intraoperative complications in patients who underwent laparoscopic right colectomy with complete mesocolic excision in a single institution. This is a retrospective study conducted in a single Italian Center from April 2017 to October 2020. Data of non-metastatic cancer patients who underwent laparoscopic right colectomy were collected to analyze onset of intraoperative complications, their management and rate of conversion to open surgery. A total of 92 patients were included in this study. The 1.09% of patients were converted to open surgery due to adhesions and bowel occlusion. The 5.43% of patients had intraoperative complications: bleeding from Henle's trunk, prepancreatic plane and ileocolic artery stump account for 3.26%, gonadal vessel injury for 1.09% and bowel lesion for 1.09%. Despite the limits of this study, it showed that bleeding is one of the most frequent complications in laparoscopic right colectomy. Bleeding, occlusion and adhesions are most common reasons for conversion to open surgery.

Management of intraoperative complications during laparoscopic left colectomy.

Minimally invasive surgery has gained a major role in the current management of colorectal disease since the introduction of laparoscopy in the early 1990s for colorectal procedures. The laparoscopic approach, in fact, is not exempt from the risk of intraoperative complications, some of which can occur outside the field of view. The aim of this chapter was to review the different types of complications that can happen during left colectomy, analyzing the causes, how to prevent them and what to do in case they occur. A literature search was carried out using the MEDLINE and PubMed databases for studies published between January 1980 and October 2020. The following terms were used for the search: "complications," "risk factors," "colorectal surgery," "colorectal resection," "laparoscopy," "left colectomy," "intraoperative complications," "splenic injury," and "intraoperative bleeding." From our literature search we identified twenty-four studies, including two systematic reviews and metanalyses, that were the most pertinent to the subject. Many different complications can occur during laparoscopic left colectomy. Maintaining control of the situation is important to provide a prompt solution to the occurred injury. Increasing the reporting rate of complications may help, in the future, to analyze the causes and improve management strategies, keeping in mind that the only surgeon who does not have complications is the one who does not operate.

The third arm: the surgeon's friend in the management of intraoperative complications in robotic-assisted rectal surgery.

The third arm: the surgeon's friend in the management of intraoperative complications in robotic-assisted rectal surgery.

Intraoperative Decision Making in Parathyroid Surgery.

This article reviews intraoperative decision making related to several important aspects of parathyroid surgery. These include how to systematically identify a missing gland, when to perform a unilateral versus bilateral exploration for cure, approaches to secondary hyperparathyroidism, management of familial hyperparathyroidism, and the treatment of parathyroid cancer. The management of intraoperative complications, such as recurrent laryngeal nerve injury and devascularization of parathyroid glands, also is discussed.

Incidence and management of intraoperative complications during small-incision lenticule extraction in 3004 cases

To assess the intraoperative complications during small-incision lenticule extraction (SMILE) for myopia and myopic astigmatism correction and evaluate visual outcomes 6months postoperatively. Tianjin Eye Hospital, Tianjin, China. Retrospective case series. Patients who had small-incision lenticule extraction surgery were examined 1day, 7days, 1month, 3months, and 6months postoperatively. Demographic characteristics, visual outcomes, and intraoperative complications were recorded. Moreover, the incidence and management of the complications and the potential factors were analyzed. Of the 3004 eyes (1511 patients), 134 (4.46%) had intraoperative complications, including suction loss (28 cases [0.93%]), incisional bleeding (28 cases [0.93%]), opaque bubble layer (22cases [0.73%]), subconjunctival hemorrhage (20 cases [0.67%]), black areas (10 cases [0.33%]), unintended posterior plane dissection (10 cases [0.33%]), tearing of the lenticule (8 cases [0.27%]), abrasion at the incision (5 cases [0.17%]), and inaccurate laser pulse placement due to eye movement (3 cases [0.10%]). The complications were resolved instantaneously using appropriate management procedures; all cases had good visual outcomes. Six months postoperatively, 99.80% of cases had an uncorrected distance visual acuity better than 20/25 and the mean corrected distance visual acuity was -0.06 logarithm of the minimum angle of resolution ± 0.07 (SD). Although small-incision lenticule extraction shows promising outcomes for correction of myopia and myopic astigmatism, intraoperative complications still inevitably occur. However, satisfactory visual outcomes may be achieved using appropriate management techniques.

Analysis and management of intraoperative complications during small-incision lenticule extraction.

Analysis and management of intraoperative complications during small-incision lenticule extraction.

Study of Intraoperative Complications in Small Incision Cataract Surgery, its Management and Visual Outcome

Aims: To study the intraoperative complications in small incision cataract surgery and its management and to study the visual outcome following the management of intraoperative complications. Material and Methods: A total of 250 cases studied from who underwent SICS. Intraoperative complications were studied and managed. Visual outcome following these complications were studied by noting the best corrected visual acuity after day 1, 1&lt;sup&gt;st&lt;/sup&gt; week, 3&lt;sup&gt;rd&lt;/sup&gt; week, 6&lt;sup&gt;th&lt;/sup&gt; week following surgery. Results: The total intraoperative complications were seen in 22 (8.8%) patients. Posterior capsule rent was seen in 6 eyes (2.4%). Iris prolapse in 5 eyes (2%). Descemet detachment was seen in 3 eyes (1.2%). Premature entry was seen in 3 eyes (1.2%). Capsulorrhexis extension was seen in 2 eyes (0.8%). Zonular dialysis was seen in 2 eyes (0.8%). Superior iridodialysis was seen in only one eye (0.4%). Out of 250 cases, 246 came for follow up till 6th week. 214 (85.6%) patients had post operative BCVA 6/6 at the end of 6&lt;sup&gt;th&lt;/sup&gt; week, 25(10%) patients had 6/9, 5 patients (2%) had 6/12-6/18 and remaining 2 patients (0.8%) had 6/24-6/36 BCVA. Conclusion: The study results shows that in high quality cataract surgery (91.2% without intraoperative complications) 99% BCVA 6/18 or better can be attained. In our study incidence of intraoperative complications was 8.8% in which posterior capsular rent and iris prolapse were the common intraoperative complications.

Management of intraoperative complications in arthroscopic primary anterior cruciate ligament reconstruction.

Arthroscopic anterior cruciate ligament reconstruction is a commonly performed procedure which is technically demanding and involves multiple surgical steps with the potential for a wide range of intraoperative complications. In this article, we review these potential complications and give algorithms for dealing with them based on our experience and published evidence. We discuss the use of both bone-patellar tendon-bone and hamstring grafts and examine complications associated with suspensory button and interference screw fixation.

Quand la fibromyalgie n’en est pas une : douleurs neuropathiques généralisées

More than half of intraoperative complications occur during dilatation of the corpora cavernosa, a critical step in the placement of any type of penile prosthesis, which can be especially difficult in a patient with corporal fibrosis. A late manifestation of cylinder placement can be impending erosion with lateral extrusion or medial deviation (into the urethra) of the distal tips. There are many different approaches to try and fix these surgical issues.The review article evaluates the many different surgical techniques prosthetic surgeons use in the management of intraoperative complications and lateral extrusion.A review of the literature was preformed with published results being evaluated to try to help guide the management of intraoperative complications and impending distal erosion. There is a special focus on dilation of the corpora cavernosa.The article reviews and evaluates the outcomes of the landmark papers in the management of intraoperative complications and impending distal erosion.Intraoperative complications of penile implant placement can be distressing for the prosthetic surgeon, but with proper recognition, most of these complications can be navigated with excellent postoperative results.This review article summarizes many of the techniques, outcomes, and new developments in the complicated field of penile prosthetic surgery to help guide the implanting surgeon. Henry GD and Laborde E. A review of surgical techniques for impending distal erosion and intraoperative penile implant complications: Part 2 of a three‐part review series on penile prosthetic surgery. J Sex Med 2012;9:927–936.

A Review of Surgical Techniques for Impending Distal Erosion and Intraoperative Penile Implant Complications: Part 2 of a Three‐part Review Series on Penile Prosthetic Surgery

More than half of intraoperative complications occur during dilatation of the corpora cavernosa, a critical step in the placement of any type of penile prosthesis, which can be especially difficult in a patient with corporal fibrosis. A late manifestation of cylinder placement can be impending erosion with lateral extrusion or medial deviation (into the urethra) of the distal tips. There are many different approaches to try and fix these surgical issues. The review article evaluates the many different surgical techniques prosthetic surgeons use in the management of intraoperative complications and lateral extrusion. A review of the literature was preformed with published results being evaluated to try to help guide the management of intraoperative complications and impending distal erosion. There is a special focus on dilation of the corpora cavernosa. The article reviews and evaluates the outcomes of the landmark papers in the management of intraoperative complications and impending distal erosion. Intraoperative complications of penile implant placement can be distressing for the prosthetic surgeon, but with proper recognition, most of these complications can be navigated with excellent postoperative results. This review article summarizes many of the techniques, outcomes, and new developments in the complicated field of penile prosthetic surgery to help guide the implanting surgeon.

Intraoperative complications of endovascular management for intracranial aneurysms

Objective To summarize the clinical experience of endovascular intervention for intra-cranial aneurysms, especially in the respect of the technique and management of intra-operative complications. Method The clinical data of 60 patients with intra-cranial aneurysms treated with endovascular intervention in the past 3 years were analyzed. The relevant literature especially with regard to the practical technique described was reviewed so as to potentiall minimize and properly manage the intra-operative complications. Results A total of 69 sacciform aneurysms and one dissecting aneurysm located at left vertebral artery (VA) were detected by using digital subtraction angiography (DSA) in 60 patients. There were 65 saccular aneurysms obliterated with constructive approach, and five of them treated with stent-assisted technique and four of them treated with ballon-assisted technique. The VA dissecting aneurysm was obliterated with coils by deconstructive approach with complete occlusion of its parent vessel. There were a total of 53 complete occlusions of aneurysms accounted for 76.81% of 69 sacciform aneurysms in 51 patients ( 85 % ) and eight subtotal occlusion of aneurysms (95 % ～ 99 % occlusion) accounted for 13.56% of total sacciform aneurysms in five patients (8.47%) and four incomplete occlusion of aneurysms ( ＜ 95% occlusion) accounted for 6.78% of total sacciform aneurysms in three patients (5.08%), and one was failure in operation. The rupture of aneurysms occurred during operation in4 patients (6.78%). Two senile patients suffered from intra-opeartive symptomatic thromboembolisn. One patient had stent shifting and spring coil dislocated and moved into the M3 segment of the ipsilateral MCA. Vasospasm occurred in 15 patients during operation, and most of them received endovascular intervention 3 days after the initial ictus. The rate of good recovery was 93.3% at discharge from hospital (the modified Rankin Scales, mRS＜ 2). There were 55 patients followed up for up 24 months after discharge, and excellent recovery rate was found in 51 patients ( mRS ＜ 2), and 3 died.During the follow-up period, no aneurismal recanalization or rupture was noticed in all patients. Conclusions The endovascular intervention is a safe and effective approach to the intra = cranial aneurysms. Advances in the skill of technique and proper management will decrease the complications during operation and improve the prognosis of patients. Key words: Intracranial aneurysm; Endovascular treatment; Coil; Embolization; Subarachnoid hemorrhage; Intraoperative complication; Aneurysm, ruptured; Vasospasm