Management Of Intraoperative Complications Research Articles

Intraoperative Complications of LASIK Flaps Using the Intralase Femtosecond Laser in 3009 Cases

To report the incidence and management of intraoperative complications while using the IntraLase FS femtosecond laser (Abbott Medical Optics) for flap creation during LASIK. A prospective log of intraoperative flap creation complications using the femtosecond laser was maintained over 3009 consecutive LASIK surgeries from August 2002 through July 2009. Eleven (0.37%) intraoperative complications occurred. Eight suction breaks occurred, seven of which were treated with reapplication of the laser, the other by completing the side-cut with surgical dissection. One case of incomplete flap creation was treated with surgical dissection. Two cases of adherent flap were treated with reapplication of laser energy and surgical dissection. All surgeries were completed successfully during the same operative session. Intraoperative complications during flap creation are minor, infrequent, and can be managed effectively within the same surgical session.

Natural orifice transluminal endoscopic surgery: Where are we going?

The foundation for natural orifice transluminal endoscopic surgery (NOTES) is to access the peritoneal and other body cavities through the wall of the alimentary tract via natural orifices, with the goal of performing procedures within the peritoneum and other cavities, without the need to make incisions in the abdominal wall. We have made great progress in the field of NOTES since the publication of the White Paper in 2006. There are still major fundamental goals as outlined by the Society of American Gastrointestinal and Endoscopic Surgeons/American Society for Gastrointestinal Endoscopy joint committee that need to be evaluated and answered before NOTES is ready for widespread clinical use. These include prevention of infection, instrument development, creation of a multitasking platform, and the ability to recognize and treat intraperitoneal complications such as hemorrhage and other physiological adverse events. In response to this need, recent abstracts and papers have focused on the management of intraoperative complications. The next phase is to focus on controlled prospective multicenter clinical trials that compare defined NOTES procedure to standard laparoscopy. The goal is to produce reliable and convincing data for the United States Food and Drug Administration, insurance companies, the physician community and the general public. At the present time, we still have many important milestones that still need to be met. Most investigators agree that a hybrid technique and not a pure NOTES practice should be advocated until devices can meet the current and new challenges in this field.

Transperitoneal Laparoscopic Adrenalectomy: Outline of the Preoperative Management, Surgical Approach, and Outcome

The laparoscopic approach to the adrenal gland has evolved to be the gold standard for most cases of adrenal conditions requiring surgical treatment. There is general consent about the safety, efficacy, and reproducibility of laparoscopic adrenal surgery. Compared to the open surgery, significant advantages with regard to shorter hospitalization time, decreased postoperative morbidity, improved cosmetics, and quicker convalescence are evident. The anatomic location of the adrenal gland led to the development of various approaches, including lateral transperitoneal, anterior transperitoneal, lateral retroperitoneal, posterior retroperitoneal, and even transthoracic approaches. The lateral transperitoneal approach is the technique most frequently used for laparoscopic adrenalectomy. A large operative field provides good orientation and visualization of familiar landmarks known from open surgery. In particular in the early learning curve this represents an advantage of the transperitoneal laparoscopic approach. This article describes in detail the indications, contraindications, preoperative evaluation, surgical technique, management of intraoperative complications, and outcome after lateral transperitoneal adrenalectomy.

Dealing with Intra-Op Complications: A Trip Through Neverland

Although studies of glenohumeral arthroplasty have reported good to excellent results in >90% of shoulders, complications with shoulder replacement are inevitable, and have been reported to occur at a rate of 14%. Some of these complications are unavoidable, however, a significant number occur intraoperatively, and may be a result of errors in surgical technique or judgment. Depending on their severity, all of these complications can lead to poor outcomes. Effective management of intraoperative complications requires early recognition and prompt treatment. The aim of this review is to discuss the avoidance, early detection, and proper management of intraoperative complications related to total shoulder arthroplasty.

Management of Intraoperative Complications During Middle Ear Surgery

Die komplexe Topographie und die Verletzlichkeit empfindlicher Strukturen birgt bei Eingriffen am Mittelohr eine Fülle an Komplikationsmöglichkeiten.

Advanced Laparoscopy

Laparoscopy will play a significant role in urologic practice in the 21st century. In addition to the standardised procedures of benign nephrectomy, nephroureterectomy, cryptorchidism, adrenalectomy, renal cysts, lymphocele and varicocele, indications and techniques now include laparoscopic radical prostatectomy, pyeloplasty, living donor nephrectomy and retroperitoneal lymph node dissection. Endoscopic suturing and laparoscopic dissection techniques are central to all procedures, together with the management of intra-operative complications. As is the case with open surgery, a variety of technical approaches are emerging from which the individual laparoscopist may choose.

Management of intraoperative complications

Management of intraoperative complications

Transesophageal echocardiography and orthotopic liver transplantation: general concepts.

T ransthoracic echocardiography is used extensively in the preoperative evaluation of patients undergoing liver transplantation and provides information about global cardiac function, valvular function, and presence of pericardial effusion. Dobutamine stress echocardiography and contrast-enhanced echocardiography are evolving into essential tools in the screening and/or evaluation of patients with possible coronary artery disease,1,2 pulmonary hypertension, or hepatopulmonary syndrome. Because of the potential for damage to esophageal varices with subsequent severe bleeding, transesophageal echocardiography (TEE) initially was used very reluctantly, but luckily this complication seems to be very uncommon, and, if it occurs, it is mild and self-limiting. Today, TEE is used more commonly in patients undergoing liver transplantation and has been helpful in the diagnosis and management of many conditions and complications.3 Patients with severe liver disease have a hyperdynamic hemodynamic system; most anesthesiologists believe high cardiac output has to be maintained perioperatively to maintain adequate perfusion of the tissues in the presence of peripheral shunting. Maintaining this high cardiac output can only be accomplished by maintaining preload. However, liver transplantation is associated with major changes in cardiac preload and afterload. Blood loss can be very significant, requiring the infusion of large amounts of fluids and blood products, potentially resulting in citrate toxicity. Graft reperfusion may lead to severe hypotension, usually the result of dramatic vasodilation, but in some patients, contractility changes are suspected to occur.4-6 Echogenic contrast material is seen entering the heart from the inferior vena cava on reperfusion in every patient,4 but clinically significant air embolism after reperfusion is uncommon. Although the interpretation of TEE remains mostly subjective, TEE has been helpful by providing additional information regarding preload and contractility. Filling pressures are not always reflective of preload because of significant changes in compliance.7 TEE may also help in the identification of the exact hemodynamic changes during postreperfusion syndrome.8,9 In addition, TEE has been used in the diagnosis and management of intraoperative complications, such as air embolism,10 thromboembolism,4,11,12 and the management of patients with unrelated cardiopulmonary disease, such as coronary artery disease, valvular pathological states, or idiopathic hypertrophic subaortic stenosis.13-15 Other patients with alcoholinduced cardiomyopathy, hemochromatosis, amyloidosis, or Wilson’s disease may benefit from intraoperative TEE monitoring. Pulmonary hypertension occurs more frequently in patients with severe liver disease; if it is decided to proceed with liver transplantation, TEE has proven to be an essential monitoring tool.16,17 TEE also allows the intraoperative diagnosis of hepatopulmonary syndrome in patients in whom the diagnosis was missed preoperatively.18-21 TEE has shown the presence of direct communications between portal vein and pulmonary veins.22 Finally, TEE allows for the intraoperative evaluation of the major vessels, including the suprahepatic inferior vena cava anastomosis; patients with previous LeVeen shunts may have narrowing or occlusion of the superior vena cava.23,24

Management of Intraoperative Complications in Combined Resection of Vessels for Pancreatic Cancer

Management of Intraoperative Complications in Combined Resection of Vessels for Pancreatic Cancer

Management of Intraoperative Complications in Peptic Ulcer

Management of Intraoperative Complications in Peptic Ulcer

Management of Intraoperative Complications in Orthognathic Surgery

Orthognathic surgery produces relatively few intraoperative complications when the procedure is well planned and precisely executed. The majority of problems that occur intraoper- atively result, either directly or indirectly, from inadequate or careless preoperative planning or from technical errors during surgery.