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Rizzuto A, Bozzarello C, Andreuccetti J, Amaddeo A, Iannello AM, Sagnelli C, Cirocchi R, Cuccurullo D, Pignata G, Corcione F. Transumbilical laparoscopy for pneumoperitoneum establishment: a comprehensive multicentre evaluation affirming safety, feasibility, and a range of clinical benefits. Front Surg 2024; 11:1390038. [PMID: 38712337 PMCID: PMC11070471 DOI: 10.3389/fsurg.2024.1390038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/08/2024] [Indexed: 05/08/2024] Open
Abstract
Introduction Transumbilical laparoscopy (TUL) has emerged as a promising technique for establishing pneumoperitoneum in laparoscopic cholecystectomy, offering potential safety, feasibility, and clinical benefits. This retrospective multicentre study aims to evaluate the efficacy and outcomes of TUL in the management of gallbladder diseases. Methods A retrospective analysis was conducted on a cohort of 2,543 patients who underwent TUL between 2011 and 2021 across various medical institutions in Italy. Data collection included demographic, clinical, intraoperative, and postoperative parameters. Standardized protocols were followed for preoperative and postoperative management. The TUL technique involved precise anatomical incision and trocar placement. Results The study demonstrated favorable outcomes associated with TUL, including a low conversion rate to open surgery (0.55%), minimal intraoperative complications (0.16%), and short hospital stays (average 2.4 days). The incidence of incisional hernias was notably low (0.4%). Comparison with existing literature revealed consistent findings and provided unique insights into the advantages of TUL. Discussion Despite limitations, such as the absence of a control group and the retrospective nature of the study, the findings contribute valuable insights to the literature. They inform surgical decision-making and advance patient care in laparoscopic cholecystectomy for gallbladder diseases. Conclusion Transumbilical laparoscopy shows promise as a safe and feasible technique for establishing pneumoperitoneum in laparoscopic cholecystectomy. The study's findings support its clinical benefits, including low conversion rates, minimal complications, and short hospital stays. Further research, including prospective studies with control groups, is warranted to validate these results and optimize patient outcomes.
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Affiliation(s)
- Antonia Rizzuto
- Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy
| | - Cristina Bozzarello
- Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy
| | | | - Angela Amaddeo
- Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy
| | | | - Carlo Sagnelli
- Department of General, Mininvasive and Robotic Surgery, Colli Monaldi Hospital, Naples, Italy
| | - Roberto Cirocchi
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Diego Cuccurullo
- Department of General, Mininvasive and Robotic Surgery, Colli Monaldi Hospital, Naples, Italy
| | - Giusto Pignata
- Department of General Surgery, Civil Hospital of Brescia, Brescia, Italy
| | - Francesco Corcione
- Department of General Surgery, Federico II University Hospital, Naples, Italy
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Gaia G, Sighinolfi MC, Rocco B, Cannoletta M, Sampogna V, Lamarca A, Alboni C. Learning curve of optical trocar access during laparoscopic pelvic surgery: A prospective study. Actas Urol Esp 2023; 47:675-680. [PMID: 37442225 DOI: 10.1016/j.acuroe.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/27/2023] [Accepted: 05/31/2023] [Indexed: 07/15/2023]
Abstract
INTRODUCTION The optical trocar access (OTA) is a modified closed technique that aims to minimize the risk of vascular or bowel injuries while reducing the likelihood of gas leakage. A learning curve (LC) effect for OTA has been invoked with n = 30 procedures being considered as a threshold to define expertise. We aim to evaluate the impact of the LC within the first thirty cases of OTA performed by a trainee. METHODS This is a prospective randomized study on 60 patients elected to laparoscopic gynecological surgery. Patients were randomized to have OTA insertion by a junior surgeon or by an expert. LC was evaluated by: 1) insertion time; number of: 2) corrections by the senior; 3) times the tip of the trocar stopped in the preperitoneal layer; 4) mistakes of skin incision; 5) times the tip of the trocar ends under the omentum; 6) complications. To analyze the LC within the first 30 cases, procedures were stratified in 3 groups (cases 1-10; 11-20; 21-30) for both trainee and expert and LC variables were compared. RESULTS Overall, mean OTA insertion time was 56 s. No major intra- and post-operative complications were recorded. Mean insertion time was statistically significantly longer for the trainee compared to the expert within the first 10 cases (91 vs 33 s respectively, P = .01). For cases 11-20 and 21-30, time advantage of the senior surgeon is less evident (P = .05). The number of times the tip of the trocar stopped in the preperitoneal layer was similar between groups, as well as times the tip of the trocar ends under the omentum. CONCLUSIONS OTA is a fast and simple way to achieve the pneumoperitoneum and first trocar insertion as a single step. The current series confirms the effectiveness of the technique since the beginning of the LC.
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Affiliation(s)
- G Gaia
- Servicio de Obstetricia y Ginecología, ASST Santi Paolo e Carlo, Italy
| | | | - B Rocco
- Servicio de Urología, ASST Santi Paolo e Carlo, Italy
| | - M Cannoletta
- Departamento de Obstetricia y Ginecología, Universidad de Módena y Reggio Emilia, Italy
| | - V Sampogna
- Departamento de Obstetricia y Ginecología, Universidad de Módena y Reggio Emilia, Italy
| | - A Lamarca
- Departamento de Obstetricia y Ginecología, Universidad de Módena y Reggio Emilia, Italy
| | - C Alboni
- Departamento de Obstetricia y Ginecología, Universidad de Módena y Reggio Emilia, Italy
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Elnaggar AA, Diab KR, El-Hangour BA, Kamel IS, Farhat AM, Abdelsattar AT, Zarad MS. Direct trocar insertion vs. Veress needle technique in laparoscopic surgeries. A systematic review and meta-analysis. J Visc Surg 2023; 160:337-345. [PMID: 36842955 DOI: 10.1016/j.jviscsurg.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
AIM To compare the safety and efficacy between Veress needle insertion and direct trocar insertion in laparoscopic surgeries. METHODS Relevant clinical trials were retrieved from major databases; Web of Science, Cochrane CENTRAL, PubMed, and SCOPUS. The following outcomes were pooled for analysis: failed entry, extraperitoneal insufflation, vascular lesion, omental lesion and visceral lesion, site bleeding, reintervention, subcutaneous emphysema, solid organ lesion, and infection of the trocar site. A fixed-effects model was used to analyze homogeneous outcomes, whereas random-effects models were used to analyze heterogeneous outcomes. RESULTS We included a total of twelve clinical trials. The pooled analysis showed that the Veress needle was accompanied by a significant increase in the incidences of extraperitoneal insufflation (RR = 0.204; 95% Cl [0.136, 0.307], P=0.001), omental lesion (RR=0.444 95% Cl [0.239, 0.825], P=0.01), and failed entry (RR=0.169 95% Cl [0.101, 0.284], P=0.001). There is no significant difference between both cohort regarding the vascular lesion (RR=0.847 95% Cl [0.259, 2.777), P=0.7), infection of the trocar site (RR=0.583 95%Cl [0.106, 3.216], P=0.5, and visceral lesion (RR=1.308 95% Cl [0.314, 5.438], P=0.7. CONCLUSION The DTI was accompanied by a significantly lower incidence of complications such as extraperitoneal insufflation, failed entry, omental lesion, and subcutaneous emphysema. On the other hand, both cohorts showed similar results regarding; vascular lesions, visceral lesions, reintervention, site bleeding, and solid organ lesion.
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Affiliation(s)
- A A Elnaggar
- Department of General Sugery, Faculty of medicine, Fayoum University, Fayuom, Egypt
| | - K R Diab
- Department of General Sugery, Faculty of medicine, Fayoum University, Fayuom, Egypt
| | - B A El-Hangour
- Department of General Sugery, Faculty of medicine, Al-Azhar University, Cairo, Egypt
| | | | - A M Farhat
- Faculty of Medicine, Fayoum University, Fayoum, Egypt.
| | | | - M S Zarad
- Department of General Sugery, Faculty of medicine, Al-Azhar University, Cairo, Egypt
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Taliento C, Pontrelli G, Rondoni A, Desgro M, Steinkasserer M, Scutiero G, Vizzielli G, Greco P. Major and minor complications in Veress needle (VN) and direct trocar insertion (DTI) for laparoscopic closed-entry techniques: an updated systematic review and meta-analysis. Langenbecks Arch Surg 2023; 408:152. [PMID: 37069276 DOI: 10.1007/s00423-023-02891-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/09/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVE Direct insertion of the trocar is an alternative method to Veress needle insertion for the creation of pneumoperitoneum. We conducted a systematic review and meta-analysis to compare these two entry closed techniques. DATA SOURCE A systematic review of the literature was done on PubMed, MEDLINE, Embase, Scopus, and EBSCO. METHODS The literature search was constructed until May 01, 2022, around search terms for "Veress," "direct trocar," "needle," "insertion," and "laparoscopic ways of entry." This systematic review was reported according to the PRISMA Statement 2020. RESULTS Sixteen controlled trials (RCTs) and 5 observational studies were included in the systematic review. We found no significant differences in the risk of major complication during the access manoeuvres between DTI and VN: bowel injuries (OR = 0.76, 95% CI: 0.24-2.36, P = 0.63), major vascular injuries (OR = 1.74, 95% CI 0.56-5.38, P = 0.34), port site hernia (OR = 2.41, 95% CI: 0.28-20.71, P = 0.42). DTI has a lower risk of minor complications such as subcutaneous emphysema (OR = 5.19 95% CI: 2.27-11.87, P < 0.0001), extraperitoneal insufflation (OR = 5.93 95% CI: 1.69-20.87, P = 0.006), omental emphysema (OR = 18.41, 95% CI: 7. 01-48.34, P < 0.00001), omental bleeding (OR = 2.32, 95% CI: 1.18-4.55, P = 0.01), and lower number of unsuccessful entry or insufflation attempts (OR = 2.25, 95% CI: 1.05-4.81, P = 0.04). No significant differences were found between the two groups in terms of time required to achieve complete insufflation (MD = - 15.53, 95% CI: - 91.32 to 60.27, P = 0.69), trocar site bleeding (OR = 0.66, 95% CI, 0.25-1.79, P = 0.42), and trocar site infection (OR = 1.19, 95% CI, 0.34-4.20, P = 0.78). CONCLUSION There were no statistically significant differences in the risk of major complications during the access manoeuvres between DTI and VN. A lower number of minor complications were observed in DTI compared with those in Veress access.
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Affiliation(s)
- C Taliento
- Department of Medical Sciences, Institute of Obstetrics and Gynecology, University of Ferrara, Ferrara, Italy.
| | - G Pontrelli
- Policlinico Abano Terme, Abano Terme, Padua, Italy
| | - A Rondoni
- Department of Medical Sciences, Institute of Obstetrics and Gynecology, University of Ferrara, Ferrara, Italy
| | - M Desgro
- Policlinico Abano Terme, Abano Terme, Padua, Italy
| | - M Steinkasserer
- Department of Obstetrics and Gynecology, Bolzano Hospital, Bolzano, Italy
| | - G Scutiero
- Department of Medical Sciences, Institute of Obstetrics and Gynecology, University of Ferrara, Ferrara, Italy
| | - G Vizzielli
- Department of Medical Area (DAME), Clinic of Obstetrics and Gynecology, University of Udine, Santa Maria Della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - P Greco
- Department of Medical Sciences, Institute of Obstetrics and Gynecology, University of Ferrara, Ferrara, Italy
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Agarwal PK, Golmei J, Goyal R, Maurya AP. Comparison Between Closed and Open Methods for Creating Pneumoperitoneum in Laparoscopic Cholecystectomy. Cureus 2023; 15:e35991. [PMID: 36911586 PMCID: PMC10004421 DOI: 10.7759/cureus.35991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2023] [Indexed: 03/12/2023] Open
Abstract
Background: To study the efficacy of closed and open methods for creating pneumoperitoneum in laparoscopic cholecystectomy by comparing the two in terms of their outcome and complication. Study Design: Single-centre, prospective, observational study. Materials and study: Purposive sampling method where the inclusion criteria were all patients with cholelithiasis who were advised and consented to laparoscopic cholecystectomy of age 18-70 years were included in the study group. Exclusion criteria include patients with a paraumbilical hernia, a history of upper abdominal surgery, uncontrolled systemic illness, and local skin infection. Sixty cases of cholelithiasis satisfying exclusion and inclusion criteria who underwent elective cholecystectomy during the study period were included. Thirty-one of these cases underwent the closed method, while in the remaining 29 patients open method was adopted. Cases in which pneumoperitoneum created by closed technique were grouped as group A and those by open technique as group B. Parameters comparing the safety and efficacy of the two methods were studied. The parameters were access time, gas leak, visceral injury, vascular injury, need for conversion, umbilical port site hematoma, umbilical port site infection, and hernia. Patients were assessed on the first postoperative day, the seventh postoperative day, and then two months after surgery. Some follow-ups were done telephonically. Results: Out of 60 patients, 31 underwent the closed method, while 29 underwent the open method. Minor complications like gas leak during the procedure was observed more in the open method. The mean access time in the open-method group was less than in the closed-method group. Other complications like visceral injury, vascular injury, need for conversion, umbilical port site hematoma, umbilical port site infection, and hernia were not observed in either group during the allocated follow-up period in the study. Conclusion: Open technique for pneumoperitoneum is as safe and effective as the closed technique.
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Affiliation(s)
- Puneet K Agarwal
- General Surgery, All India Institute of Medical Sciences Bhopal, Bhopal, IND
| | - Jason Golmei
- General Surgery, All India Institute of Medical Sciences Bhopal, Bhopal, IND
| | - Richa Goyal
- Obstetrics and Gynecology Surgery, Dr. Agarwal Clinic, Jalesar, IND
| | - Ajeet P Maurya
- General Surgery, All India Institute of Medical Sciences Bhopal, Bhopal, IND
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Spiller M, Bruennel M, Grosse V, Sühn T, Esmaeili N, Stockheim J, Turial S, Croner R, Boese A, Friebe M, Illanes A. Surgeons' requirements for a surgical support system to improve laparoscopic access. BMC Surg 2022; 22:279. [PMID: 35854297 PMCID: PMC9297603 DOI: 10.1186/s12893-022-01724-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 07/11/2022] [Indexed: 11/12/2022] Open
Abstract
Creating surgical access is a critical step in laparoscopic surgery. Surgeons have to insert a sharp instrument such as the Veress needle or a trocar into the patient’s abdomen until the peritoneal cavity is reached. They solely rely on their experience and distorted tactile feedback in that process, leading to a complication rate as high as 14% of all cases. Recent studies have shown the feasibility of surgical support systems that provide intraoperative feedback regarding the insertion process to improve laparoscopic access outcomes. However, to date, the surgeons’ requirements for such support systems remain unclear. This research article presents the results of an explorative study that aimed to acquire data about the information that helps surgeons improve laparoscopic access outcomes. The results indicate that feedback regarding the reaching of the peritoneal cavity is of significant importance and should be presented visually or acoustically. Finally, a solution should be straightforward and intuitive to use, should support or even improve the clinical workflow, but also cheap enough to facilitate its usage rate. While this study was tailored to laparoscopic access, its results also apply to other minimally invasive procedures.
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Affiliation(s)
- Moritz Spiller
- INKA-Innovation Laboratory for Image Guided Therapy (IGTLAB), Medical Faculty, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany.
| | | | | | - Thomas Sühn
- INKA-Innovation Laboratory for Image Guided Therapy (IGTLAB), Medical Faculty, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Nazila Esmaeili
- INKA-Innovation Laboratory for Image Guided Therapy (IGTLAB), Medical Faculty, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Jessica Stockheim
- Department of General, Visceral, Vascular and Transplantation Surgery, Medical Faculty, University Hospital Magdeburg, Magdeburg, Germany
| | - Salmai Turial
- Department of Pediatric Surgery, Department of General, Visceral, Vascular and Transplantation Surgery, Medical Faculty, University Hospital Magdeburg, Magdeburg, Germany
| | - Roland Croner
- Department of General, Visceral, Vascular and Transplantation Surgery, Medical Faculty, University Hospital Magdeburg, Magdeburg, Germany
| | - Axel Boese
- INKA-Innovation Laboratory for Image Guided Therapy (IGTLAB), Medical Faculty, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Michael Friebe
- Otto-von-Guericke-University Magdeburg, Magdeburg, Germany.,Department of Measurement and Electronics, AGH University of Science and Technology, Kraków, Poland
| | - Alfredo Illanes
- INKA-Innovation Laboratory for Image Guided Therapy (IGTLAB), Medical Faculty, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
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Marchand GJ, Masoud A, King A, Brazil G, Ulibarri H, Parise J, Arroyo A, Coriell C, Goetz S, Moir C, Christensen A, Alexander T, Govindan M. Systematic review and meta-analysis of Veress needle entry versus direct trocar entry in gynecologic surgery. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2022; 4:e000121. [PMID: 35865828 PMCID: PMC9240888 DOI: 10.1136/bmjsit-2021-000121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 05/31/2022] [Indexed: 11/07/2022] Open
Abstract
Objective Although many studies have been performed, no consensus exists as to the ideal entry for laparoscopic gynecologic surgery. We sought out to compare the safety of direct trocar insertion with that of the Veress needle entry technique in gynecologic laparoscopic surgery. Design Systematic review with meta-analysis. Setting We searched Medline, ClinicalTrials.Gov, PubMed, Cochrane CENTRAL, SCOPUS, and Web of Science from their inception through 31 July 2021 for relevant studies. We included only controlled trials and ultimately seven trials were included in our meta-analysis. Participants Inclusion criteria included women undergoing gynecological laparoscopic surgery. Intervention The intervention of direct trocar insertion technique compared with Veress needle entry technique. Main outcome measures We compared five different outcomes associated with the efficacy and complications of laparoscopic entry. Results The pooled analysis showed that Veress needle entry was associated with a significant increase in the incidences of extraperitoneal insufflation (RR=0.177, 95% Cl (0.094 to 0.333), p<0.001), omental injury (RR=0.418, 95% Cl (0.195 to 0.896), p<0.001), failed entry (RR=0.173, 95% Cl (0.102 to 0.292), p<0.001), and trocar site infection (RR=0.404, 95% Cl (0.180 to 0.909), p<0.029). There was no significant difference between the two groups regarding the visceral injury (RR=0.562, 95% Cl (0.047 to 6.676), p<0.648). Conclusions When excluding all data apart from gynecologic surgery, the Veress needle entry technique may have an increased incidence of some, but not all complications of laparoscopic entry. It may also have a higher incidence of failed entry compared with direct entry techniques. Care should be taken in extrapolating these general results to specific surgeon experience levels. Trial registration number CRD42021273726
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Affiliation(s)
- Greg J Marchand
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Ahmed Masoud
- Fayoum University Faculty of Medicine, Fayoum, Egypt
| | - Alexa King
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Giovanna Brazil
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Hollie Ulibarri
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Julia Parise
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Amanda Arroyo
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Catherine Coriell
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Sydnee Goetz
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Carmen Moir
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Ashley Christensen
- Midwestern University College of Osteopathic Medicine, Glendale, California, USA
| | - Tia Alexander
- Midwestern University College of Osteopathic Medicine, Glendale, California, USA
| | - Malini Govindan
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
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A negative pressure-based visualization technique for abdominal Veress needle insertion. Langenbecks Arch Surg 2022; 407:2105-2113. [PMID: 35355106 DOI: 10.1007/s00423-022-02504-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/22/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Abdominal Veress needle insertion is commonly performed to generate a pneumoperitoneum during laparoscopy. Various safety tests are conducted to confirm accurate needle tip positioning into the abdominal cavity. However, these occasionally yield unclear results and do not help directly visualize the peritoneum puncture. We validated a negative pressure-based technique that helps instantly visualize the moment of the Veress needle entry into the abdominal cavity. METHODS This study included 761 patients who underwent laparoscopic hernioplasty between 2003 and 2021 that entailed pneumoperitoneum creation using a Veress needle. They were divided into conventional technique (CON) and negative pressure visualization technique (NPV) groups. The patients were propensity score-matched (1:1) to minimize selection bias. To determine whether the technique gave a clear result to the surgeon and precisely informed the moment of entry, failed entry and emphysematous complications were compared between the groups. RESULTS The propensity score-matching yielded 105 pairs in the matched CON and NPV groups. Failed entry did not occur in the NPV group, whereas it occurred in 8 patients (7.6%) in the CON group (p = 0.004). No patient experienced extraperitoneal emphysema in the matched NPV group, whereas 7 patients (6.7%) in the CON group did (p = 0.007). The groups did not differ in the incidence of omental or mesenteric emphysema. CONCLUSION The NPV eliminated the incidence of failed entry and decreased the incidence of extraperitoneal emphysema, indicating that it could simply and adequately inform the moment of needle entry into the abdominal cavity.
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Watrowski R, Kostov S, Alkatout I. Complications in laparoscopic and robotic-assisted surgery: definitions, classifications, incidence and risk factors - an up-to-date review. Wideochir Inne Tech Maloinwazyjne 2021; 16:501-525. [PMID: 34691301 PMCID: PMC8512506 DOI: 10.5114/wiitm.2021.108800] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 06/30/2021] [Indexed: 11/26/2022] Open
Abstract
Almost all gynecological and general-surgical operations are - or can be - performed laparoscopically. In comparison to an abdominal approach, the minimally invasive access offers several advantages; however, laparoscopy (both conventional and robotic-assisted) can be associated with a number of approach-specific complications. Although the majority of them are related to the laparoscopic entry, adverse events may also occur due to the presence of pneumoperitoneum or the use of laparoscopic instruments. Unfortunately, a high proportion of complications (especially affecting the bowel and ureter) remain unrecognized during surgery. This narrative review provides comprehensive up-to-date information about definitions, classifications, risk factors and incidence of surgical complications in conventional and robotic-assisted laparoscopy, with a special focus on gynecology. The topic is discussed from various perspectives, e.g. in the context of stage of surgery, injured organs, involved instruments, and in relation to malpractice claims.
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Affiliation(s)
- Rafał Watrowski
- St. Josefskrankenhaus, Teaching Hospital of the University of Freiburg, Freiburg, Germany
| | - Stoyan Kostov
- Department of Gynecology, Medical University Varna, Varna, Bulgaria
| | - Ibrahim Alkatout
- Department of Gynecology and Obstetrics, Kiel School of Gynecological Endoscopy, University Hospitals Schleswig-Holstein, Kiel, Germany
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Shimbo M, Endo F, Tominaga K, Sano M, Nishino T, Kyono Y, Komatsu K, Ohyama T, Sakurai M, Narimoto K, Matsushita K, Hattori K. Optimizing first trocar access for robot-assisted radical prostatectomy: Optical trocar access through the upper abdominal quadrant using the Kii Fios First Entry trocar. Asian J Endosc Surg 2021; 14:443-450. [PMID: 33145955 DOI: 10.1111/ases.12889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/01/2020] [Accepted: 10/14/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES A pre-equipped metal trocar is required to use as a camera trocar due to a specification change in the da Vinci X/Xi system (Intuitive Surgical). We observed slight slippage of a trocar placed by the open method. With optical trocar access (OTA), the initial trocar is viewed directly with a laparoscope during placement. Reports regarding OTA for robotic surgery are limited, particularly for robot-assisted radical prostatectomy (RARP). We modified the OTA procedure such that it was appropriate for RARP. PATIENTS AND METHODS A total of 158 patients were enrolled in this study. The first trocar placement time (FTPT) was compared between the open and OTA groups. In the OTA group, the trocar was mainly placed through the upper abdominal quadrant. We also analyzed the differences between the conventional and modified OTA procedures using the Kii Fios First Entry trocar (Applied Medical). We examined the factors affecting the FTPT using linear regression models. A P value <.05 was considered significant. RESULTS The FTPT was significantly shorter in the OTA group than the open group (P < .0001). The modified method was associated with a shorter FTPT (P = .0001). None of the patient characteristics affected the FTPT in either group. No major complications were observed. CONCLUSIONS OTA was applied successfully during RARP. Use of the Kii Fios First Entry trocar with upper abdominal quadrant placement was suitable for RARP.
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Affiliation(s)
- Masaki Shimbo
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Fumiyasu Endo
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Koki Tominaga
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Masayuki Sano
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Takato Nishino
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Yoko Kyono
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Kenji Komatsu
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Takehiro Ohyama
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Masato Sakurai
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Kazutaka Narimoto
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | | | - Kazunori Hattori
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
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Vilos GA, Ternamian A, Laberge PY, Vilos AG, Abu-Rafea B, Scattolon S, Leyland N. Directive clinique n° 412: Entrée laparoscopique en chirurgie gynécologique. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 43:390-405.e1. [PMID: 33373696 DOI: 10.1016/j.jogc.2020.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Vilos GA, Ternamian A, Laberge PY, Vilos AG, Abu-Rafea B, Scattolon S, Leyland N. Guideline No. 412: Laparoscopic Entry for Gynaecological Surgery. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 43:376-389.e1. [PMID: 33373697 DOI: 10.1016/j.jogc.2020.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the benefits and risks of laparoscopic surgery and provide clinical direction on entry techniques, technologies, and their associated complications in gynaecological surgery. TARGET POPULATION All patients, including pregnant women and women with obesity, undergoing laparoscopic surgery for various gynaecological indications. OPTIONS The laparoscopic entry techniques and technologies reviewed in formulating this guideline included the closed (Veress needle-pneumoperitoneum-trocar) technique, direct trocar insertion, open (Hasson) technique, visual entry systems, and disposable shielded and radially expanding trocars. OUTCOMES Implementation of this guideline should optimize decision-making in the selection of entry technique for laparoscopic surgery. EVIDENCE We searched English-language articles from September 2005 to December 2019 in PubMed/MEDLINE, Embase, Science Direct, Scopus, and Cochrane Library using the following MeSH search terms alone or in combination: laparoscopic entry, laparoscopy access, pneumoperitoneum, Veress needle, open (Hasson), direct trocar, visual entry, shielded trocars, radially expanded trocars, and laparoscopic complications. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Canadian Task Force on Preventive Health Care approach (Appendix A). INTENDED AUDIENCE Surgeons performing laparoscopic gynaecological surgery. SUMMARY STATEMENTS RECOMMENDATIONS.
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Joo P, Guilbert L, Sepúlveda EM, Ortíz CJ, Donatini G, Zerrweck C. Unexpected Intraoperative Findings, Situations, and Complications in Bariatric Surgery. Obes Surg 2020; 29:1281-1286. [PMID: 30610676 DOI: 10.1007/s11695-018-03672-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Bariatric surgery is considered a safe therapy to treat obesity. Postoperative complications are well known; however, there is a lack of data describing intraoperative complications and/or unexpected findings, and if there is further impact on outcomes. METHODS Retrospective study with patients operated between 2013 and 2016 at a single institution. All operative information was collected prospectively and aimed to analyze the incidence and causes of unexpected intraoperative findings, complications, change in surgical plan, extra surgeries, and procedure interruption in patients submitted to bariatric surgery. Secondarily, a morbidity analysis was performed, correlating intraoperative complications with postoperative complications and length of stay. RESULTS Four-hundred and five patients were included. Female sex comprised 82% of cases, and a median age of 38 years old was observed; almost 90% were gastric bypass. In 29.3% of cases, there were intraoperative findings, mainly adhesions, abdominal wall hernias, positive methylene blue test, hiatal hernias, and gastrointestinal stromal tumors. Associated surgeries were performed in 8.6% cases, and intraoperative adverse events reported in 7.1%, where organ injury and anastomosis problems were the most frequent. A change in the operative plan was done in 0.9% and surgery interruption in 1.2% of the cases. Early complications were observed in 6.6%. There was no correlation between intraoperative complications and length of stay or early complications. CONCLUSION Unexpected intraoperative findings/complications are common in bariatric surgery, but without increasing morbidity or length of stay. Surgery suspension, change in the planned technique, or adding extra (non-bariatric) procedures may occur.
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Affiliation(s)
- Paul Joo
- The Obesity Clinic at Hospital General Tláhuac, Avenida la Turba # 655, Col. Villa Centroamericana y del Caribe, Delegación Tláhuac, Zip 13250, México City, Mexico
| | - Lizbeth Guilbert
- The Obesity Clinic at Hospital General Tláhuac, Avenida la Turba # 655, Col. Villa Centroamericana y del Caribe, Delegación Tláhuac, Zip 13250, México City, Mexico
| | - Elisa M Sepúlveda
- The Obesity Clinic at Hospital General Tláhuac, Avenida la Turba # 655, Col. Villa Centroamericana y del Caribe, Delegación Tláhuac, Zip 13250, México City, Mexico
| | - Cristian J Ortíz
- The Obesity Clinic at Hospital General Tláhuac, Avenida la Turba # 655, Col. Villa Centroamericana y del Caribe, Delegación Tláhuac, Zip 13250, México City, Mexico
| | - Gianluca Donatini
- Digestive and Endocrine Surgery Department, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Carlos Zerrweck
- The Obesity Clinic at Hospital General Tláhuac, Avenida la Turba # 655, Col. Villa Centroamericana y del Caribe, Delegación Tláhuac, Zip 13250, México City, Mexico.
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Vilos GA, Ternamian A, Dempster J, Laberge PY. No. 193-Laparoscopic Entry: A Review of Techniques, Technologies, and Complications. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019. [PMID: 28625296 DOI: 10.1016/j.jogc.2017.04.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To provide clinical direction, based on the best evidence available, on laparoscopic entry techniques and technologies and their associated complications. OPTIONS The laparoscopic entry techniques and technologies reviewed in formulating this guideline include the classic pneumoperitoneum (Veress/trocar), the open (Hasson), the direct trocar insertion, the use of disposable shielded trocars, radially expanding trocars, and visual entry systems. OUTCOMES Implementation of this guideline should optimize the decision-making process in choosing a particular technique to enter the abdomen during laparoscopy. EVIDENCE English-language articles from Medline, PubMed, and the Cochrane Database published before the end of September 2005 were searched, using the key words laparoscopic entry, laparoscopy access, pneumoperitoneum, Veress needle, open (Hasson), direct trocar, visual entry, shielded trocars, radially expanded trocars, and laparoscopic complications. VALUES The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on the Periodic Health Examination. RECOMMENDATIONS AND SUMMARY STATEMENT.
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Wolthuis AM. Veress Needle Creation of a Pneumoperitoneum: Is It Risky? Results of the First Belgian Group for Endoscopic Surgery-Snapshot Study. J Laparoendosc Adv Surg Tech A 2019; 29:1023-1026. [PMID: 31140894 DOI: 10.1089/lap.2019.0243] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Every laparoscopic procedure starts with the creation of a pneumoperitoneum. The open trocar introduction and the use of a Veress needle (VN) are the two most frequent techniques used. The aim of this study was to evaluate safety of the techniques used to create pneumoperitoneum in laparoscopic abdominal surgery by Belgian minimally invasive surgeons. Materials and Methods: This is a prospective study including all consecutive patients undergoing a laparoscopic surgical procedure for a 2-month period. Primary endpoint was access-related problems during creation of a pneumoperitoneum. Access-related problems were registered using a special smartphone application, facilitating data recording and patient registration. Results: Overall, 9 out of 212 invited surgeons (4.2%) actively registered patients during the study period. A total number of 342 patients were included with 6 access-related problems (1.8%) and conversion to open surgery was necessary in 16 patients (4.7%). Most reported access-related problem was failure to establish a pneumoperitoneum secondary to insufflation of the omentum. There were no major access-related complications. There was no conversion in the group of patients who had an access-related problem. Conclusion: VN entry to create a pneumoperitoneum is safe. In a short study period, gathering data by surgeons willing to participate in a snapshot study is easy and facilitated by a web-based application.
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Affiliation(s)
- Albert M Wolthuis
- Department of Abdominal Surgery, University Hospital Leuven, Leuven, Belgium
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Tanaka C, Fujiwara M, Kanda M, Murotani K, Iwata N, Hayashi M, Kobayashi D, Yamada S, Kodera Y. Optical trocar access for initial trocar placement in laparoscopic gastrointestinal surgery: A propensity score-matching analysis. Asian J Endosc Surg 2019; 12:37-42. [PMID: 29673123 DOI: 10.1111/ases.12484] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 02/07/2018] [Accepted: 02/22/2018] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Optical trocar access is a technique to place the initial trocar in laparoscopic surgery. With optical trocar access, each tissue layer can be visualized before insertion, which can help prevent organ injury, and air leaks at the trocar site can be minimized even in obese patients. The aim of this study was to compare the time needed for trocar insertion using optical trocar access and an open method in patients who underwent laparoscopic gastrointestinal surgery. METHODS We reviewed our prospectively collected database and identified 384 patients who underwent laparoscopic gastrointestinal surgery involving initial trocar insertion near the umbilicus by either the optical trocar access or the open method. Before the two methods were compared, propensity score matching was used to adjust for essential variables between the optical trocar access and open groups. RESULTS Patients categorized in the optical trocar access and open groups were matched one-to-one by propensity score matching, and 137 pairs of patients were generated. The time needed for trocar insertion was significantly shorter in the optical trocar access group than in the open group (36.6 vs 209.8 s, P < 0.01). The multivariable analysis identified an inexperienced surgeon as the only independent risk factor for prolonged time for initial trocar insertion using the optical trocar access. CONCLUSIONS This study indicated that optical trocar access may be recommended for inserting the initial trocar in laparoscopic gastrointestinal surgery.
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Affiliation(s)
- Chie Tanaka
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Michitaka Fujiwara
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mitsuro Kanda
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenta Murotani
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Iwata
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masamichi Hayashi
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Daisuke Kobayashi
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Suguru Yamada
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Şentürk MB, Doğan O, Polat M, Kılıçcı Ç, Pulatoğlu Ç, Tayyar AT. Cosmetic outcomes of infraumbilical, supraumbilical, and transumbilical entry routes in laparoscopic surgery. Turk J Surg 2018; 34:290-294. [PMID: 30216176 DOI: 10.5152/turkjsurg.2018.4025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 03/20/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of the present study was to determine which of the umbilical entry routes for intraperitoneal access has a better cosmetic result. MATERIAL AND METHODS This was a prospective study (Canadian Task Force classification II-1). In total, 105 patients who underwent laparoscopic surgery were included. A vertical or transverse umbilical incision is appropriately made for the trocar to be inserted, and an infraumbilical, supraumbilical, or transumbilical route was preferred for initial intraperitoneal access. Demographic data of patients, body mass indices, entry point of the trocars (infraumbilical-transumbilical-supraumbilical), type of incision (vertical-transverse), duration of the operation, and scar properties at postoperative week 12 were prospectively collected and analyzed. The Vancouver scar scale was used to evaluate the cosmetic results. RESULTS Cosmetic results did not differ statistically between the transumbilical-infraumbilical-supraumbilical groups. The variables, such as vascularity, height, and total score, of the Vancouver scar scale were significantly higher in patients who had transverse incisions. There was no statistically significant effect of using a Veress needle with the cosmetic results. There was no statistically significant correlation between age, gravida, body mass indices, skin thickness, time of entry, duration of the operation, and cosmetic results in terms of vascularity, height, and total score. CONCLUSION During laparoscopic surgery, each patient should be assessed individually for the satisfaction of the patient and, thereby, of the surgeon in terms of cosmetic outcomes. Vertical incision offers superior cosmetic effects than transverse incision. Further research is required to define long-term scar-related outcomes of the laparoscopic intraperitoneal access techniques.
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Affiliation(s)
- Mehmet Baki Şentürk
- Department of Obstetrics and Gynecology, İstanbul Medeniyet University School Of Medicine, İstanbul, Turkey
| | - Ozan Doğan
- Department of Obstetrics and Gynecology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Mesut Polat
- Department of Obstetrics and Gynecology, İstanbul Medeniyet University School Of Medicine, İstanbul, Turkey
| | - Çetin Kılıçcı
- Department of Obstetrics and Gynecology, Zeynep Kamil Training and Research Hospital, İstanbul, Turkey
| | - Çiğdem Pulatoğlu
- Department of Obstetrics and Gynecology, Bayburt Government Hospital, İstanbul, Turkey
| | - Ahter Tanay Tayyar
- Department of Obstetrics and Gynecology, Zeynep Kamil Training and Research Hospital, İstanbul, Turkey
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Conrad C, Wakabayashi G, Asbun HJ, Dallemagne B, Demartines N, Diana M, Fuks D, Giménez ME, Goumard C, Kaneko H, Memeo R, Resende A, Scatton O, Schneck AS, Soubrane O, Tanabe M, van den Bos J, Weiss H, Yamamoto M, Marescaux J, Pessaux P. IRCAD recommendation on safe laparoscopic cholecystectomy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2017; 24:603-615. [PMID: 29076265 DOI: 10.1002/jhbp.491] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
An expert recommendation conference was conducted to identify factors associated with adverse events during laparoscopic cholecystectomy (LC) with the goal of deriving expert recommendations for the reduction of biliary and vascular injury. Nineteen hepato-pancreato-biliary (HPB) surgeons from high-volume surgery centers in six countries comprised the Research Institute Against Cancer of the Digestive System (IRCAD) Recommendations Group. Systematic search of PubMed, Cochrane, and Embase was conducted. Using nominal group technique, structured group meetings were held to identify key items for safer LC. Consensus was achieved when 80% of respondents ranked an item as 1 or 2 (Likert scale 1-4). Seventy-one IRCAD HPB course participants assessed the expert recommendations which were compared to responses of 37 general surgery course participants. The IRCAD recommendations were structured in seven statements. The key topics included exposure of the operative field, appropriate use of energy device and establishment of the critical view of safety (CVS), systematic preoperative imaging, cholangiogram and alternative techniques, role of partial and dome-down (fundus-first) cholecystectomy. Highest consensus was achieved on the importance of the CVS as well as dome-down technique and partial cholecystectomy as alternative techniques. The put forward IRCAD recommendations may help to promote safe surgical practice of LC and initiate specific training to avoid adverse events.
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Archivée: No 193-Entrée laparoscopique : Analyse des techniques, de la technologie et des complications. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017. [DOI: 10.1016/j.jogc.2017.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Loureiro M, Ramadan M, Skalli EM, Blanc P, Fabre JM, Nocca D. A multicentric prospective study evaluating the safety and efficacy of Kii ® Fios ® First Entry Trocar in laparoscopic bariatric surgery. Surg Endosc 2017; 31:4680-4687. [PMID: 28389805 DOI: 10.1007/s00464-017-5536-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 03/20/2017] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Laparoscopic surgery has evolved as an important field of surgery due to its clear benefits when compared to open laparotomy surgery. However, specific complications of laparoscopic surgery have been reported, of which the majority are complications associated with first entry to the abdominal cavity. The emergence of bariatric surgery, combined with the special considerations of the abdominal wall and cavity of obese patients, leads to seeking new modalities of access to the abdominal cavity in this specific population.Kii Fios First Entry Bladeless Trocar (Applied) is a new device that may allow surgeons to facilitate the creation of pneumoperitoneum. This prospective multicenter nonrandomized trial aims to evaluate the safety and efficacy of Kii Fios First Entry Bladeless Trocar in laparoscopic bariatric surgery. METHODS In the period between December 2013 and June 2014, 588 patients were included by 18 surgeons from several French hospitals to undergo laparoscopic surgery using Kii Fios First Entry Trocar as a first-entry trocar. The surgeons filled out a questionnaire assessing the safety and efficacy of the trocar for every patient. RESULTS There were no mortality and no major complications. However, 11 cases (1.87%) of minor complications (liver and greater omentum injuries) were reported. The surgeons reported successful entry in less than 1 min for 70.58% of the cases. CONCLUSIONS Kii Fios First Entry Trocar (Applied) is a safe and efficient method to establish first entry in laparoscopic bariatric surgery when all the recommendations are followed and respected.
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Affiliation(s)
- Marcelo Loureiro
- CHU de Montpellier, Montpellier, France.
- University Montpellier 1, Montpellier, France.
- Universidade Positivo, Rua Angelo Bom 315 casa 1, Curitiba, 81210340, Brazil.
| | | | | | | | - Jean Michel Fabre
- CHU de Montpellier, Montpellier, France
- University Montpellier 1, Montpellier, France
| | - David Nocca
- CHU de Montpellier, Montpellier, France
- University Montpellier 1, Montpellier, France
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Passerotti CC, Cruz JA, Reis ST, Okano MT, Duarte RJ, Srougi M, Nguyen HT. The Effectiveness of a Systematic Algorithm for the Management of Vascular Injuries during the Laparoscopic Surgery. Curr Urol 2016; 9:138-142. [PMID: 27867331 DOI: 10.1159/000442868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 04/28/2016] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Currently, there is no standardized training protocol to teach surgeons how to deal with vascular injuries during laparoscopic procedures. The purpose of this study is to develop and evaluate the effectiveness of a standardized algorithm for managing vascular injury during laparoscopic nephrectomies. MATERIALS AND METHODS The performance of 6 surgeons was assessed during 10 laparoscopic nephrectomies in a porcine model. During the first and tenth operations, an injury was made in the renal vein without warning the surgeon. After the first procedure, the surgeons were instructed on how to proceed in dealing with the vascular injury, according to an algorithm developed by the designers of this study. The performance of each surgeon before and after learning the algorithm was assessed. RESULTS After learning the algorithm there was a decreased blood loss from 327 ± 403.11 ml to 37 ± 18.92 ml (p = 0.031) and decreased operative time from 43 ± 14.53 min to 27 ± 8.27 min (p = 0.015). There was also improvement in the time to start lesion repair from 147 ± 117.65 sec to 51 ± 39.09 sec (p = 0.025). There was a trend toward improvement in the reaction time to the injury (22 ± 21.55 sec vs. 14 ± 6.39, p = 0.188), the time required to control the bleeding (50 ± 94.2 sec vs. 14 ± 6.95 sec, p = 0.141), and the total time required to completely repair of the vascular injury (178 ± 170.4 sec vs. 119 ± 183.87 sec, p = 0.302). CONCLUSION A standardized algorithm may help to reduce the potential risks associated with laparoscopic surgery. Further studies will help to refine and determine the benefits of standardized protocols such as that developed in this study for the management of life-threatening laparoscopic complications.
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Affiliation(s)
- Carlo C Passerotti
- Urology Department, College of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil; Center for Robotic Surgery, German Hospital Oswaldo Cruz, São Paulo, Brazil
| | - José A Cruz
- Urology Department, College of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil; Center for Robotic Surgery, German Hospital Oswaldo Cruz, São Paulo, Brazil
| | - Sabrina T Reis
- Urology Department, College of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil
| | - Marcelo T Okano
- Urology Department, College of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil
| | - Ricardo J Duarte
- Urology Department, College of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil
| | - Miguel Srougi
- Urology Department, College of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil
| | - Hiep T Nguyen
- Urology Department, Cardon Children Medical Center, Mesa, Ariz., USA
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Laparoscopic access overview: Is there a safest entry method? Actas Urol Esp 2016; 40:386-92. [PMID: 26922517 DOI: 10.1016/j.acuro.2015.11.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 11/26/2015] [Accepted: 11/27/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Laparoscopy is a minimally invasive technique to access the abdominal cavity, for diagnostic or therapeutic applications. Optimizing the access technique is an important step for laparoscopic procedures. The aim of this study is to assess the outcomes of different laparoscopic access techniques and to identify the safest one. METHODS Laparoscopic access questionnaire was forwarded via e-mail to the 60 centers who are partners in working group for laparoscopic and robotic surgery of the Italian Urological Society (SIU) and their American and European reference centers. RESULTS The response rate was 68.33%. The total number of procedures considered was 65.636. 61.5% of surgeons use Veress needle to create pneumoperitoneum. Blind trocar technique is the most commonly used, but has the greatest number of complications. Optical trocar technique seems to be the safest, but it's the less commonly used. The 28,2% of surgeons adopt open Hasson's technique. Total intra-operative complications rate was 3.3%. Open conversion rate was 0.33%, transfusion rate was 1.13%, and total post-operative complication rate was 2.53%. CONCLUSION Laparoscopic access is a safe technique with low complication rate. Most of complications can be managed conservatively or laparoscopically. The choice of access technique can affect the rate and type of complications and should be planned according to surgeon experience, safety of each technique and patient characteristics. All access types have perioperative complications. According with our study, optical trocar technique seems to be the safest.
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Djokovic D, Gupta J, Thomas V, Maher P, Ternamian A, Vilos G, Loddo A, Reich H, Downes E, Rachman IA, Clevin L, Abrao MS, Keckstein G, Stark M, van Herendael B. Principles of safe laparoscopic entry. Eur J Obstet Gynecol Reprod Biol 2016; 201:179-88. [DOI: 10.1016/j.ejogrb.2016.03.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Taye MK, Fazal SA, Pegu D, Saikia D. Open Versus Closed Laparoscopy: Yet an Unresolved Controversy. J Clin Diagn Res 2016; 10:QC04-7. [PMID: 27042535 DOI: 10.7860/jcdr/2016/18049.7252] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 01/13/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Safe placement of the Verres needle or the primary trocar for establishment of pneumoperitoneum is the most critical step in laparoscopic procedure as it is associated with bowel, bladder and life threatening vascular injuries and embolism. In the last few decades many techniques and guidelines have been introduced to eliminate complications in creation of pneumoperitoneum. Classical closed technique (Verres needle) and the open classic technique (Hasson) are the most commonly used techniques for creation of pneumoperitoneum. AIM To compare the rate of occurrence and nature of complications in open and closed laparoscopy during establishment of pneumoperitoneum in different surgical and gynaecological procedures. MATERIALS AND METHODS This was a comparative study conducted at three hospitals in Dibrugarh district, Assam, India from January 2012 to December 2014. Total 3000 cases were included in the study with 1500 cases of open laparoscopy and 1500 cases of closed laparoscopy. Complications occurring in both the groups were compared by using Fisher's-exact test. RESULTS In closed laparoscopy group minor complications occurred in 80 (5.33%) and major complications in 20 (1.33%) cases. In open laparoscopy group minor complications were observed in 60 (4%) and major complications in 2 (0.13%). The p-value of the difference between the two groups for minor complications was 0.0834 and for major complications was 0.0001(significant). CONCLUSION Open laparoscopy was seen to be better than closed laparoscopy in terms of not only the rate of occurrence of complications but also the nature and severity of the complications. This study is clinically relevant as there is no consensus for a particular method of safe entry in to the peritoneal cavity warranting the need for more research. Open technique can be performed in all cases irrespective of previous operative scar, suspected intra peritoneal adhesions or obesity. Favourable outcome may be achieved in closed technique in cases of normal BMI, absence of postoperative scar in the abdomen, absence of abdominal and genital tuberculosis and pelvic inflammatory disease.
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Affiliation(s)
- Milan Kumar Taye
- Assistant Professor, Department of Obstetrics and Gynaecology, Assam Medical College & Hospital , Dibrugarh, Assam, India
| | - Syed Abul Fazal
- Associate Professor, Department of Surgery, Assam Medical College & Hospital , Dibrugarh, Assam, India
| | - David Pegu
- Assistant Professor, Department of Surgery, Assam Medical College & Hospital , Dibrugarh, Assam, India
| | - Dayanada Saikia
- Registrar, Department of Obstetrics and Gynaecology, Assam Medical College & Hospital , Dibrugarh, Assam, India
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Sotelo RJ, Haese A, Machuca V, Medina L, Nuñez L, Santinelli F, Hernandez A, Kural AR, Mottrie A, Giedelman C, Mirandolino M, Palmer K, Abaza R, Ghavamian R, Shalhav A, Moinzadeh A, Patel V, Stifelman M, Tuerk I, Canes D. Safer Surgery by Learning from Complications: A Focus on Robotic Prostate Surgery. Eur Urol 2015; 69:334-44. [PMID: 26385157 DOI: 10.1016/j.eururo.2015.08.060] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 08/31/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND The uptake of robotic surgery has led to changes in potential operative complications, as many surgeons learn minimally invasive surgery, and has allowed the documentation of such complications through the routine collection of intraoperative video. OBJECTIVE We documented intraoperative complications from robot-assisted radical prostatectomy (RARP) with the aim of reporting the mechanisms, etiology, and necessary steps to avoid them. Our goal was to facilitate learning from these complications to improve patient care. DESIGN, SETTING, AND PARTICIPANTS Contributors delivered videos of complications that occurred during laparoscopic and robotic prostatectomy between 2010 and 2015. SURGICAL PROCEDURE Surgical footage was available for a variety of complications during RARP. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Based on these videos, a literature search was performed using relevant terms (prostatectomy, robotic, complications), and the intraoperative steps of the procedures and methods of preventing complications were outlined. RESULTS AND LIMITATIONS As a major surgical procedure, RARP has much potential for intra- and postoperative complications related to patient positioning, access, and the procedure itself. However, with a dedicated approach, increasing experience, a low index of suspicion, and strict adherence to safety measures, we suggest that the majority of such complications are preventable. CONCLUSIONS Considering the complexity of the procedure, RARP is safe and reproducible for the surgical management of prostate cancer. Insight from experienced surgeons may allow surgeons to avoid complications during the learning curve. PATIENT SUMMARY Robot-assisted radical prostatectomy has potential for intra- and postoperative complications, but with a dedicated approach, increasing experience, a low index of suspicion, and strict adherence to safety measures, most complications are preventable.
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Affiliation(s)
- René J Sotelo
- Center of Robotics and Minimally Invasive Surgery, Instituto Médico La Floresta, Caracas, Venezuela; University of Southern California, Los Angeles, CA, USA.
| | - Alexander Haese
- Martini Clinic Prostate Cancer Center, University Clinic Eppendorf, Hamburg, Germany
| | - Victor Machuca
- Center of Robotics and Minimally Invasive Surgery, Instituto Médico La Floresta, Caracas, Venezuela
| | - Luis Medina
- Center of Robotics and Minimally Invasive Surgery, Instituto Médico La Floresta, Caracas, Venezuela
| | - Luciano Nuñez
- Center of Robotics and Minimally Invasive Surgery, Instituto Médico La Floresta, Caracas, Venezuela
| | | | | | | | | | | | | | | | - Ronney Abaza
- Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Arieh Shalhav
- Duchossois Center for Advanced Medicine, Chicago, IL, USA
| | - Alireza Moinzadeh
- Lahey Hospital and Medical Center Institute of Urology, Burlington, MA, USA
| | - Vipul Patel
- Global Robotics Institute, Celebration, FL, USA
| | | | - Ingolf Tuerk
- St. Elizabeth's Medical Center, Brighton, MA, USA
| | - David Canes
- Lahey Hospital and Medical Center Institute of Urology, Burlington, MA, USA
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[Complicated course of a laparoscopic cholecystectomy]. Chirurg 2015; 86:893-6. [PMID: 26315012 DOI: 10.1007/s00104-015-0055-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The case presented deals with the complicated course of a laparoscopic cholecystectomy in a 45-year-old female patient due to cholecystolithiasis. The patient complained that during the operation an injury to the small intestine occurred, which was only operatively treated at midday of the despite massive pain and insufficient pain treatment. The intervention was claimed to have resulted in mental and physical suffering. The case is assessed by two independent experts in the sense of a "scientifically founded comment" with respect to the decision of the arbitration board and taking the surgical standards into consideration.
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Montes SFP, Rodríguez IG, Ugarteburu RG, Villamil LR, Mendez BD, Gil PS, Madera JM. Intraoperative laparoscopic complications for urological cancer procedures. World J Clin Cases 2015; 3:450-456. [PMID: 25984519 PMCID: PMC4419108 DOI: 10.12998/wjcc.v3.i5.450] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 01/30/2015] [Accepted: 04/09/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To structure the rate of intraoperative complications that requires an intraoperative or perioperative resolution.
METHODS: We perform a literature review of Medline database. The research was focused on intraoperative laparoscopic procedures inside the field of urological oncology. General rate of perioperative complications in laparoscopic urologic surgery is described to be around 12.4%. Most of the manuscripts published do not make differences between pure intraoperative, intraoperative with postoperative consequences and postoperative complications.
RESULTS: We expose a narrative statement of complications, possible solutions and possible preventions for most frequent retroperitoneal and pelvic laparoscopic surgery. We expose the results with the following order: retroperitoneal laparoscopic surgery (radical nephrectomy, partial nephrectomy, nephroureterectomy and adrenalectomy) and pelvic laparoscopic surgery (radical prostatectomy and radical cystectomy).
CONCLUSION: Intraoperative complications vary from different series. More scheduled reports should be done in order to better understand the real rates of complications.
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Cuss A, Bhatt M, Abbott J. Coming to terms with the fact that the evidence for laparoscopic entry is as good as it gets. J Minim Invasive Gynecol 2014; 22:332-41. [PMID: 25460522 DOI: 10.1016/j.jmig.2014.10.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 10/27/2014] [Accepted: 10/30/2014] [Indexed: 02/07/2023]
Abstract
Entry to the peritoneal cavity for laparoscopic surgery is associated with defined morbidity, with all entry techniques associated with substantial complications. Debate over the safest entry technique has raged over the last 2 decades, and yet, we are no closer to arriving at a scientifically valid conclusion regarding technique superiority. With hundreds of thousands of patients required to perform adequately powered studies, it is unlikely that appropriately powered comparative studies could be undertaken. This review examines the risk of complications related to laparoscopic entry, current statements from examining bodies around the world, and the medicolegal ramifications of laparoscopic entry complications. Because of the numbers required for any complications study, with regard to arriving at an evidence-based decision for laparoscopic entry, we ask: is the current literature perhaps as good as it gets?
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Affiliation(s)
- Amanda Cuss
- Royal Hospital for Women, Sydney, Australia and University of New South Wales, Sydney, Australia
| | | | - Jason Abbott
- Royal Hospital for Women, Sydney, Australia and University of New South Wales, Sydney, Australia.
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Single-incision laparoscopic cholecystectomy: a systematic review of methodology and outcomes. Surg Today 2014; 45:537-48. [PMID: 24845737 DOI: 10.1007/s00595-014-0908-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 04/01/2014] [Indexed: 12/22/2022]
Abstract
PURPOSE (1) To survey the dissemination of SILC; (2) to determine which SILC method has become mainstream; (3) to determine whether the characteristic complications vary according to the type of procedure. METHODS An electronic search of PubMed, Databases@Ovid, and SciVerse Scopus between 2003/01/01 and 2012/12/31 was performed. RESULTS The peak number of annually published articles was 70 in 2011. The most common procedures were single skin incision, the use of a SILS Port(®), suture suspension and a 5-mm oblique scope. The intraoperative complications rate was 1.69 %. Postoperative complications occurred in 213/5283 cases. According to the surgical procedure, five factors (approach; P = 0.0017, gallbladder anchorage; P < 0.001, size; P = 0.049 and type; P < 0.001 of the scope, and size of the clip applier; P = 0.074) significantly affected the incidence of wound infection. The incidence of wound seroma/bleeding was significantly influenced by gallbladder anchorage (P = 0.009), the use of curved/articulated instruments (P = 0.048), and the diameter of the clip applier (P < 0.001). CONCLUSION To determine the best operative procedure for SILC, an analysis of uniform operative procedures is needed.
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Thepsuwan J, Huang KG, Wilamarta M, Adlan AS, Manvelyan V, Lee CL. Principles of safe abdominal entry in laparoscopic gynecologic surgery. Gynecol Minim Invasive Ther 2013. [DOI: 10.1016/j.gmit.2013.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Abstract
Robotic actuators have revolutionized surgery for urologic disorders in pediatric patients. Robotic procedures have become widely available for several different ablative and reconstructive operations in children. The success rates have paralleled those of open surgical techniques and provide the benefit of smaller incisions and less manipulation of tissue during the procedures. Robotics employs increased dexterity, better visualization, and less fatigue, allowing greater precision. We must continue to evolve with the ever-changing advancements in technology and take a keen interest in maintaining our skills to ensure excellent outcomes and patient safety.
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Affiliation(s)
- Jason P Van Batavia
- Morgan Stanley Children's Hospital, Columbia University Medical Center, 3959 Broadway, 11th Floor, New York, NY 10032, USA
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Comparison of two entry methods for laparoscopic port entry: technical point of view. DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2012; 2012:305428. [PMID: 22761542 PMCID: PMC3384909 DOI: 10.1155/2012/305428] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 04/05/2012] [Indexed: 01/30/2023]
Abstract
Laparoscopic entry is a blind procedure and it often represents a problem for all the related complications. In the last three decades, rapid advances in laparoscopic surgery have made it an invaluable part of general surgery, but there remains no clear consensus on an optimal method of entry into the peritoneal cavity. The aim of this paper is to focus on the evolution of two used methods of entry into the peritoneal cavity in laparoscopic surgery.
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Abstract
BACKGROUND The Veress needle (VN) technique for establishing pneumoperitoneum in laparoscopic surgery is widely used and yet is associated with slow insufflation rates and potentially life-threatening complications. Although these complications have been rarely reported, they represent a major source of morbidity and mortality from laparoscopic procedures and a major reason for conversion to open surgery. The open laparoscopy (OL) is an alternative to the VN technique, being relatively safer, even if considered cumbersome by many authors. Recently, the direct trocar insertion (DTI) technique of establishing pneumoperitoneum has been reported as an alternative to both techniques, but it is largely confined to gynecologic procedures. We report a case-series study where we evaluate the patients who underwent a DTI entry for laparoscopy during a recent 5-year period, focusing attention on feasibility, safety, and the benefits of DTI. METHODS This is a case series of 2175 different laparoscopic procedures (1456 [66.9%] scheduled cases and 719 [33%] emergencies). In 2091 (96.1%) of them (1425 [68.1%] scheduled cases and 666 [31.8%] emergencies), pneumoperitoneum was established with DTI, either in the umbilicus or in Palmer's point. RESULTS There were no injuries, either minor or major. Peritoneal access and the creation of a laparoscopic workplace were obtained quickly and efficiently by DTI. CONCLUSION Our results suggest that DTI is a fast, safe, and reliable alternative to traditional techniques for pneumoperitoneum establishment and should be regarded as a part of the surgical armamentarium of a trained laparoscopic surgeon.
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Affiliation(s)
- F Agresta
- Unità Operativa Complessa di Chirurgia Generale, Ospedale Civile, Via Forlanini 71, Vittorio Veneto (TV), Italy.
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Jiang X, Anderson C, Schnatz PF. The safety of direct trocar versus Veress needle for laparoscopic entry: a meta-analysis of randomized clinical trials. J Laparoendosc Adv Surg Tech A 2012; 22:362-70. [PMID: 22423957 DOI: 10.1089/lap.2011.0432] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE This study assessed the safety of direct trocar insertion (DTI) versus Veress needle followed by primary trocar insertion (VN). METHODS Ovid MEDLINE(®), Cochrane Library, Google Scholar, Scopus, and the reference lists of published articles were searched up to September 2011 to identify randomized clinical trials comparing DTI with VN. This meta-analysis was restricted to randomized studies comparing the safety of these two laparoscopic entry techniques. RESULTS Seven randomized studies consisting of 2940 women (VN, n=1525; DTI, n=1415) were identified. The data on the safety of two entry techniques were abstracted, integrated, and analyzed with the meta-analysis method and are presented as pooled relative risk (RR) with 95% confidence intervals (CI). There were 4 cases of a major complication in the VN group in contrast to none in the DTI group. Pooled results failed to show a statistically significant difference in the risk of major complications between the two groups. A significantly higher risk of minor complications was detected in the VN group (RR [95% CI]=10.78 [6.27-18.51]). Among minor complications, preperitoneal injuries (46.73 [11.55-189.10]) and omental injuries (4.51 [2.12-9.62]) were the two most common complications in the VN group. There were significantly increased risks of multiple insertions (more than two attempts) (2.99 [2.11-4.23]) and failed entry (2.21[1.07-4.56]) in the VN group. CONCLUSION This meta-analysis suggests that the commonly used VN entry technique carries a significantly increased risk of minor complications. In addition, the likelihood of multiple insertions and failed entry are significantly higher in the VN group.
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Affiliation(s)
- Xuezhi Jiang
- Department of Obstetrics and Gynecology, The Reading Hospital and Medical Center, Reading, Pennsylvania 19612-6052, USA.
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Compeau C, McLeod NT, Ternamian A. Laparoscopic entry: a review of Canadian general surgical practice. Can J Surg 2011; 54:315-20. [PMID: 21774882 DOI: 10.1503/cjs.011210] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Laparoscopic surgery has gained popularity over open conventional surgery as it offers benefits to both patients and health care practitioners. Although the overall risk of complications during laparoscopic surgery is recognized to be lower than during laparotomy, inadvertent serious complications still occur. Creation of the pneumoperitoneum and placement of laparoscopic ports remain a critical first step during endoscopic surgery. It is estimated that up to 50% of laparoscopic complications are entry-related, and most injury-related litigations are trocar-related. We sought to evaluate the current practice of laparoscopic entry among Canadian general surgeons. METHODS We conducted a national survey to identify general surgeon preferences for laparoscopic entry. Specifically, we sought to survey surgeons using the membership database from the Canadian Association of General Surgeons (CAGS) with regards to entry methods, access instruments, port insertion sites and patient safety profiles. Laparoscopic cholecystectomy was used as a representative general surgical procedure. RESULTS The survey was completed by 248 of 1000 (24.8%) registered members of CAGS. Respondents included both community and academic surgeons, with and without formal laparoscopic fellowship training. The demographic profile of respondents was consistent nationally. A substantial proportion of general surgeons (> 80%) prefer the open primary entry technique, use the Hasson trocar and cannula and favour the periumbilical port site, irrespective of patient weight or history of peritoneal adhesions. One-third of surgeons surveyed use Veress needle insufflation in their surgical practices. More than 50% of respondents witnessed complications related to primary laparoscopic trocar insertion. CONCLUSION General surgeons in Canada use the open primary entry technique, with the Hasson trocar and cannula applied periumbilically to establish a pneumoperitoneum for laparoscopic surgery. This surgical approach is remarkably consistent nationally, although considerably variant across other surgical subspecialties. Peritoneal entry remains an important patient safety issue that requires ongoing evaluation and study to ensure translation into safe contemporary clinical practice.
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Mayhew PD. Complications of Minimally Invasive Surgery in Companion Animals. Vet Clin North Am Small Anim Pract 2011; 41:1007-21, vii-viii. [DOI: 10.1016/j.cvsm.2011.05.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Becker OM, Azevedo JLMC, de Azevedo OC, Hypólito OHM, Miyahira SA, Miguel GPS, Machado ACCG. Veress needle insertion into the left hypochondrium for creation of pneumoperitoneum: diagnostic value of tests to determine the position of the needle in unselected patients. Rev Col Bras Cir 2011; 38:28-34. [PMID: 21537740 DOI: 10.1590/s0100-69912011000100006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Accepted: 02/28/2010] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess the effectiveness of the Veress needle puncture in the left hypochondrium and the accuracy of the tests described for the intraperitoneal correct positioning of the tip of the Veress needle in an unselected population. METHODS Ninetyone patients consecutively scheduled for Videolaparoscopy had the abdominal wall punctured in the left hypochondrium. There were no exclusion criteria. The patients received general anesthesia and mechanical ventilation according to the protocol. After puncturing five tests were used to confirm the positioning of the needle tip within the peritoneal cavity: aspiration test--AT; resistance to infusion--Pres; recovery of the infused fluid--Prec, dripping test--DT, and test of initial intraperitoneal pressure--IIPP. The test results were compared with results from literature for groups with defined exclusion criteria. The results were used for calculating sensitivity (S) specificity (E), positive predictive value (PPV) and negative predictive value (NPV). Inferential statistical methods were used to analyze the findings. RESULTS There were 13 failures. AT had E = 100% and NPV 100%. Pres had S = 100%, E = 0; PPV = 85.71%; NPV does not apply. Prec: S = 100%, E = 53.84%, PPV = 92.85%, NPV = 100%. DT: S = 100%, E = 61.53%, PPV = 93.97% NPV 100%. In IIPP, S, E, PPV and NPV were 100%. CONCLUSION The puncture in the left hypochondrium is effective and the performed tests guide the surgeon regardless of sex, BMI, or previous laparotomy.
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Affiliation(s)
- Otávio Monteiro Becker
- Department of Surgery, Federal University of São Paulo and at the Surgical Gastroenterology Service of Hospital Municipal José de Carvalho Florence, Sao Jose dos Campos, Sao Paulo-BR
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Perko Z, Rakić M, Pogorelić Z, Družijanić N, Kraljević J. Laparoscopic transabdominal preperitoneal approach for inguinal hernia repair: a five-year experience at a single center. Surg Today 2011; 41:216-21. [PMID: 21264757 DOI: 10.1007/s00595-010-4266-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Accepted: 01/17/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE Laparoscopic hernia repair has emerged as an effective alternative method for treating inguinal hernias. It has several significant advantages over the tension-free open repair now in use. In this report we summarize our laparoscopic hernia repair results and recommendations. METHODS The transabdominal preperitoneal (TAPP) procedures for groin hernias performed between January 2003 and January 2008 at a single center were analyzed retrospectively. Individual surgeon performances were compared to determine whether the rates of complications were related to the level of surgeon experience. RESULTS A total of 312 TAPP procedures were reviewed, and 284 (91%) of the patients were followed retrospectively. There were 266 (85.25%) males and 46 (14.75%) females. The average age was 57.4 years. The mean length of hospital stay was 2.1 days. The mean duration of surgery was 35 min. Six (1.92%) intraoperative and seven (2.24%) postoperative complications were noted. Two recurrences occurred (0.70%). CONCLUSIONS Laparoscopic TAPP hernia repair has proven to be an efficient method for the treatment of groin hernias at our institution. Most patients can be treated as day-cases, namely they are hospitalized for 1 day, and they demonstrate a low recurrence rate (0.70%). Such low morbidity makes TAPP an attractive method for the routine treatment of groin hernias.
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Affiliation(s)
- Zdravko Perko
- Department of Surgery, University Hospital Split and Split University School of Medicine, Spinčićeva 1, Split, Croatia
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Dunne N, Booth MI, Dehn TCB. Establishing pneumoperitoneum: Verres or Hasson? The debate continues. Ann R Coll Surg Engl 2010; 93:22-4. [PMID: 21054924 DOI: 10.1308/003588411x12851639107557] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The technique of establishing pneumoperitoneum for laparoscopic surgery remains contentious, with various different techniques available and each having its own advocates. The Verres needle approach has attracted much criticism and is seen to entail more risk, but is this view justified in the era of evidence-based medicine? PATIENTS AND METHODS Over a 6-year period, a prospective study was undertaken of 3126 patients who underwent laparoscopic surgery performed by two upper gastrointestinal surgeons. One surgeon preferred the Verres needle and the other an open technique. A database was created of all cases and complication rates of the different techniques ascertained. RESULTS Peri-umbilical Verres needle was used in 1887 cases (60.4%) with two complications encountered, both of which were colonic injuries, with an incidence of 0.1%. Open port insertion was used in 1200 cases (38.4%) with one complication, a small bowel perforation, to give an incidence of 0.08%. The Verres needle was used in alternative positions in 22 cases (0.75%) and, when used in the left upper quadrant (19 cases), there was one complication, a left hepatic lobe puncture, with an incidence of 5.26%. Our overall incidence of intra-abdominal injury was 0.13%, all in patients who had undergone previous abdominal surgery, and in the subgroup of patients with previous surgery the rate was 0.78%. There was no mortality. CONCLUSIONS Practice varies as to the method chosen to induce pneumoperitoneum, but our results show there is no significant difference between the technique chosen and incidence of complications, and this is supported in the literature.
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Affiliation(s)
- N Dunne
- Department of General Surgery, Royal Berkshire Hospital, Reading, UK.
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Postlaparoscopic iatrogenic pseudoaneurysms of the arteries of the peritoneal and retroperitoneal space: case report and review of the literature. Surg Laparosc Endosc Percutan Tech 2010; 19:90-7. [PMID: 19390271 DOI: 10.1097/sle.0b013e31819ca96b] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS 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. MATERIALS AND METHODS 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. RESULTS AND CONCLUSIONS 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.
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Sandadi S, Johannigman JA, Wong VL, Blebea J, Altose MD, Hurd WW. Recognition and management of major vessel injury during laparoscopy. J Minim Invasive Gynecol 2010; 17:692-702. [PMID: 20656569 DOI: 10.1016/j.jmig.2010.06.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Revised: 06/02/2010] [Accepted: 06/09/2010] [Indexed: 01/05/2023]
Abstract
Laparoscopy is one of the most commonly performed procedures in the United States. Injury to a major retroperitoneal vessel occurs in 0.3% to 1.0% of procedures, most commonly during laparoscopic entry while placing the Veress needle or primary trocar. Fatal outcome can be related to massive gas embolism or exsanguination. Recommended treatment for gas embolism can range from supportive measures to external chest compression and insertion of a central line to withdraw gas from the right side of the heart. Recommended treatment of major vessel injury with massive hemorrhage consists of rapid laparotomy and control of hemorrhage using direct pressure until a surgeon experienced in vascular procedures arrives. When a major vessel injury occurs in a surgical facility distant from a medical center and without an available surgeon with vascular experience, based on the trauma literature, we recommend temporary control of blood loss using abdominal packing and closure (i.e., "damage control surgery") and judicious resuscitation (i.e., "damage control resuscitation") before transportation to a medical center.
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Affiliation(s)
- Samith Sandadi
- Department of Obstetrics and Gynecology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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Azevedo JLMC, Azevedo OC, Sorbello AA, Becker OM, Hypolito O, Freire D, Miyahira S, Guedes A, Azevedo GC. Intraperitoneal pressure and volume of gas injected as effective parameters of the correct position of the Veress needle during creation of pneumoperitoneum. J Laparoendosc Adv Surg Tech A 2010; 19:731-4. [PMID: 19792865 DOI: 10.1089/lap.2009.0080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim of this work was to establish reliable parameters of the correct position of the Veress needle in the peritoneal cavity during creation of pneumoperitoneum. METHODS The Veress needle was inserted into the peritoneal cavity of 100 selected patients, and a carbon-dioxide flow rate of 1.2 L/min and a maximum pressure of 12 mm Hg were established. Intraperitoneal pressure (IP) and the volume of gas injected (VG) were recorded at the beginning of insufflation and at every 20 seconds. Correlations were established for pressure and volume in function of time. Values of IP and VG were predicted at 1, 2, 3, and 4 minutes of insufflation, by applying the following formulas: IP = 2.3083 + 0.0266 x time +8.3 x 10(-5) x time(2) - 2.44 x 10(-7) x time(3); and VG = 0.813 + 0.0157 x time. RESULTS A strong correlation was observed between IP and preestablished time points during creation of the pneumoperitoneum, as well as between VG and preestablished time points during creation of the pneumoperitoneum, with a coefficient of determination of 0.8011 for IP and of 0.9604 for VG. The predicted values were as follows: 1 minute = 4.15; 2 minutes = 6.27; 3 minutes = 8.36; and 4 minutes = 10.10 for IP (mm Hg); and 1 minute = 1.12; 2 minutes = 2.07; 3 minutes = 3.01; and 4 minutes = 3.95 for VG (L). CONCLUSIONS Values of IP and VG at given time points during insufflation for creation of the pneumoperitoneum, using the Veress needle, can be effective parameters to determine whether the needle is correctly positioned in the peritoneal cavity.
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Affiliation(s)
- João L M C Azevedo
- Department of Surgery, Federal University of São Paulo, São Paulo, Brazil.
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Harper JD, Breda A, Leppert JT, Veale JL, Gritsch HA, Schulam PG. Experience with 750 consecutive laparoscopic donor nephrectomies--is it time to use a standardized classification of complications? J Urol 2010; 183:1941-6. [PMID: 20303114 DOI: 10.1016/j.juro.2010.01.021] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2009] [Indexed: 01/02/2023]
Abstract
PURPOSE Laparoscopic living donor nephrectomy offers patients the benefits of decreased morbidity and improved cosmesis, while maintaining equivalent graft outcomes and complication rates similar to those of open donor surgery. With expressed concern for donor safety, using a standardized complication scale would allow combining data in a donor registry so potential donors could be adequately followed and counseled. We present the largest series to our knowledge of laparoscopic living donor nephrectomy by a single surgeon. MATERIALS AND METHODS The institution's initial 750 laparoscopic living donor nephrectomies were included in the study, and a retrospective and prospective chart and database analysis was performed. RESULTS Mean donor age was 40.5 years and average body mass index was 25.7 kg/m(2). There were 175 patients (23%) with 2 or more renal arteries while 161 (21.5%) had early arterial bifurcations. There were 3 open conversions (0.4%) and the overall complication rate was 5.46%. Median hospital stay was 1 day and the readmission rate was 1.2%. There were 5 reoperations (0.67%), none of which was for the control of bleeding. No patients required a blood transfusion and there were no mortalities. Using a modified Clavien classification of complications for living donor nephrectomy 65.8% were grade 1, 31.7% grade 2 (12.2% grade 2a, 14.6% grade 2b, 4.9% grade 2c) and 2.4% grade 3. There were no grade 4 complications. CONCLUSIONS With appropriate patient selection and operative experience, laparoscopic living donor nephrectomy is a safe procedure associated with low morbidity. The use of a standardized complication system specific for this procedure is encouraged and could aid in counseling potential donors in the future.
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Affiliation(s)
- J D Harper
- Department of Urology, UCLA Medical Center, Los Angeles, California 90095, USA
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Hypólito OHM, Azevedo JLMC, de Lima Alvarenga Caldeira FMS, de Azevedo OC, Miyahira SA, Miguel GPS, Becker OM, Machado ACCG, Filho GPN, Azevedo GC. Creation of pneumoperitoneum: noninvasive monitoring of clinical effects of elevated intraperitoneal pressure for the insertion of the first trocar. Surg Endosc 2009; 24:1663-9. [DOI: 10.1007/s00464-009-0827-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2009] [Accepted: 11/15/2009] [Indexed: 11/28/2022]
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Primary midline peritoneal access with optical trocar is safe and effective in morbidly obese patients. Surg Obes Relat Dis 2009; 5:610-4. [DOI: 10.1016/j.soard.2009.05.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2008] [Revised: 05/13/2009] [Accepted: 05/13/2009] [Indexed: 11/21/2022]
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Tinelli A, Malvasi A, Hudelist G, Istre O, Keckstein J. Abdominal Access in Gynaecologic Laparoscopy: A Comparison Between Direct Optical and Open Access. J Laparoendosc Adv Surg Tech A 2009; 19:529-33. [DOI: 10.1089/lap.2008.0322] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Andrea Tinelli
- Department of Obstetrics and Gynecology, Vito Fazzi Hospital, Lecce, Italy
| | - Antonio Malvasi
- Department of Obstetrics and Gynecology, Santa Maria Hospital, Bari, Italy
| | - Gernot Hudelist
- Department of Obstetrics and Gynecology, LKH Villach, Centre for Endometriosis, Villach, Austria
| | - Olav Istre
- Department of Gynecology and Obstetrics, Ullevaal University Hospital, Kirkeveien, Oslo, Norway
| | - Joerg Keckstein
- Department of Obstetrics and Gynecology, LKH Villach, Centre for Endometriosis, Villach, Austria
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Sasmal PK, Tantia O, Jain M, Khanna S, Sen B. Primary access-related complications in laparoscopic cholecystectomy via the closed technique: experience of a single surgical team over more than 15 years. Surg Endosc 2009; 23:2407-15. [PMID: 19296168 DOI: 10.1007/s00464-009-0437-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Revised: 02/17/2009] [Accepted: 02/27/2009] [Indexed: 11/24/2022]
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC), a common laparoscopic procedure, is a relatively safe invasive procedure, but complications can occur at every step, starting from creation of the pneumoperitoneum. Several studies have investigated procedure-related complications, but the primary access- or trocar-related complications generally are underreported, and their true incidence may be higher than studies show. Major vascular or visceral injury resulting from blind access to the abdominal cavity, although rare, has been reported. Of the two methods for creating pneumoperitoneum, the open access technique is reported to have the lower incidence of these injuries. The authors report their experience with the closed method and show that if performed with proper technique, it can be as rapid and safe as other techniques. However, injuries still happen, and the search for the predisposing factors must be continued. METHODS Between January 1992 and December 2007, a retrospective study examined 15,260 cases of LC performed for symptomatic gallstone disease in the authors' institution by a single team of surgeons. The primary access-related injuries in these cases were retrospectively analyzed. RESULTS In 15,260 cases of LC, 63 cases of primary access-related complications were identified, for an overall incidence of 0.41%. Major injuries in 11 cases included major vascular and visceral injuries, and minor injuries in 52 cases included omental and subcutaneous emphysema. For the closed method, the findings showed an overall incidence of 0.14% for primary access-related vascular injuries and 0.07% for visceral injuries. CONCLUSION Primary access-related complications during LC are common and can prove to be fatal if not identified early. The incidence of these injuries with closed methods is no greater than with open methods. No evidence suggests abandonment of the closed-entry method in laparoscopy.
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Affiliation(s)
- Prakash Kumar Sasmal
- Department of Minimal Access Surgery, ILS Multispeciality Clinic, DD-6, Sector-I, Salt Lake City, Kolkata, 700 064, India
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Injuries caused by Veress needle insertion for creation of pneumoperitoneum: a systematic literature review. Surg Endosc 2009; 23:1428-32. [PMID: 19263124 DOI: 10.1007/s00464-009-0383-9] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2008] [Accepted: 01/17/2009] [Indexed: 10/21/2022]
Abstract
BACKGROUND The aim of this study was to assess the prevalence, risks, and outcomes of injuries caused by the Veress needle described in the literature. METHODS Iatrogenic injuries caused by Veress needle insertion during diagnostic or therapeutic laparoscopies in humans were researched, with no language restriction, in the Medline, Lilacs, Embase, Scielo, and Cochrane Library databases. The following words were combined: "Veress" or "insufflation needle" or "pneumoperitoneum needle," and "complications" or "injuries" or "lesions." The bibliographic references of the selected articles were also analyzed. We considered the following: (1) number of injuries described in the literature, (2) relationship between number of injuries and number of patients who underwent Veress needle insertion in the studies that reported Veress needle injury, (3) organs and structures injured (retroperitoneal vessels, digestive tract, and self-limited, minor injuries), and (4) outcome (death, conversion to laparotomy, laparoscopic repair, spontaneous resolution). RESULTS Thirty-eight selected articles included 696,502 laparoscopies, with 1,575 injuries (0.23%), 126 (8%) of which involved blood vessels or hollow viscera (0.018% of all laparoscopies). Of the 98 vascular injuries, 8 (8.1%) were injuries to major retroperitoneal vessels. There were 34 other reported retroperitoneal injuries, but the authors were not specific as to which vessel was injured. Of the 28 injuries to hollow viscera, 17 were considered major injuries, i.e., 60.7% (0.0024% of the total cases assessed). CONCLUSION The insertion of the Veress needle in the abdominal midline, at the umbilicus, poses serious risk to the life of patients. Therefore, further studies should be conducted to investigate alternative sites for Veress needle insertion.
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