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Benton-Bryant C, Pour NR, Baekelandt J, Elhindi J, Ekanyake K, Kapurubandara S. Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) in Benign Gynaecology: A Systematic Review of Adnexal, Myomectomy and Prolapse Procedures. J Minim Invasive Gynecol 2025; 32:318-351.e2. [PMID: 39647776 DOI: 10.1016/j.jmig.2024.11.004] [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: 07/18/2024] [Revised: 11/05/2024] [Accepted: 11/06/2024] [Indexed: 12/10/2024]
Abstract
OBJECTIVE Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is utilised for gynecological procedures globally, however evidence to support its application aside from hysterectomy is lacking. A systematic review to determine feasibility and safety profile of vNOTES for benign gynaecology was conducted. DATA SOURCES A literature search of MEDLINE, EMBASE, CINAHL, SCOPUS, and CENTRAL was conducted, including all types of studies reporting vNOTES for gynecological indications. After excluding cases with concurrent hysterectomy, the review focuses on procedures for benign indications and oncological procedures are reported separately. Patient characteristics and perioperative outcomes were reported, with pooled analysis for sufficiently powered categories. METHODS OF STUDY SELECTION Fifty-four articles were analyzed, including 7 comparative studies (n = 439) and 1 RCT (n = 34), reporting 2469 cases of vNOTES, including adnexal (tubal and/or ovarian) (43 articles, n = 2261), myomectomy (10 articles, n = 136) and prolapse repair (6 articles, n = 72) in predominantly premenopausal women with BMI <30 kg/m2 on pooled analysis. TABULATION, INTEGRATION AND RESULTS The overall conversion rate was low (1.38%, n = 34) with procedure specific conversion rates of 0.45 to 6.8% for adnexal procedures, 1.47% for myomectomy and none reported for prolapse repair. Overall complication rates were low (3.44%, n = 85) with no associated mortality. Five (0.20%) adhesion-related rectal injuries at colpotomy were noted, all repaired intraoperatively without long-term sequelae. CONCLUSION vNOTES appears feasible based on limited evidence, for uterine-sparing gynecological indications, despite a notable rate of rectal injury at colpotomy. There is a negligible risk of rectal injury observed at conventional laparoscopy and robotically assisted surgery, but similar rate of entry-related gastrointestinal injury. This may be due to the learning-curve or suboptimal case selection, necessitating careful training, assessment, and appropriate patient selection. Surgeons should continue registering prospective vNOTES cases via iNOTESs, to evaluate emerging perioperative trends with global uptake of this novel technique.
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Affiliation(s)
- Charlotte Benton-Bryant
- University of Sydney (Drs. Benton-Bryant and Kapurubandara), Sydney, New South Wales, Australia.
| | - Nina Reza Pour
- Sydney West Area Pelvic Surgical Unit (SWAPS) (Drs. Pour and Kapurubandara), Sydney, New South Wales, Australia; Department of Obstetrics and Gynaecology, Blacktown Hospital (Dr. Pour), Sydney, New South Wales, Australia
| | - Jan Baekelandt
- The Department of Gynaecological Oncology and Minimally Invasive Surgery, Imelda Hospital (Dr. Baekelandt), Bonheiden, Belgium
| | - James Elhindi
- Research and Education Network, Western Sydney Local Health District (Dr. Elhindi), Sydney, New South Wales, Australia; The Reproduction and Perinatal Centre, Faculty of Medicine and Health (Dr. Elhindi), University of Sydney, New South Wales, Australia
| | - Kanchana Ekanyake
- University Library, The University of Sydney (Dr. Ekanyake), Sydney, New South Wales, Australia
| | - Supuni Kapurubandara
- University of Sydney (Drs. Benton-Bryant and Kapurubandara), Sydney, New South Wales, Australia; Sydney West Area Pelvic Surgical Unit (SWAPS) (Drs. Pour and Kapurubandara), Sydney, New South Wales, Australia; Department of Obstetrics and Gynaecology, Westmead Hospital (Dr. Kapurubandara), Sydney, New South Wales, Australia
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Sinha R, Rupa B, Raina R, Bag M. Comparison of Laparoscopic and Robotic Intraoperative Adverse Events in Benign Gynecological Procedures and the Correlation of the Adverse Events With Postoperative Outcomes and Risk Analysis. Cureus 2025; 17:e80497. [PMID: 40225462 PMCID: PMC11992468 DOI: 10.7759/cureus.80497] [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: 03/12/2025] [Indexed: 04/15/2025] Open
Abstract
Introduction Intraoperative adverse events (iAEs) are a part of any gynecological surgery, including laparoscopy and robotic surgery. Robotic surgery, with advanced three-dimensional vision, is supposed to have fewer complications than laparoscopy. We aim to compare iAEs between laparoscopic (LA) and robotic (RA) procedures and correlate them with postoperative complications and risk factor analysis. Methods A prospective study was conducted in a tertiary care center between July and October 2023 with 80 cases (myomectomy, hysterectomy, and endometriosis resection). Intraoperative (as per ClassIntra classification) and postoperative (as per Clavien-Dindo classification) complications were recorded, and data was analyzed using IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States). Categorical variables were summarized as n (%), while quantitative variables were summarized by mean ±S.D. A p-value less than 0.05 was considered statistically significant. Multivariate logistic regression analysis was done for risk analysis (adjusted odds ratio with 95% confidence interval). Results Overall, we reported 3.75% (3/80) iAEs (all in LA) and 32.5% (26/80) postoperative complications. Increased postoperative complications were seen in LA 15/40 (37.5%) than in RA 11/40 (27.5%). However, the difference was statistically insignificant (p =0.12 and p =0.47). Cases with higher iAE grades consecutively experienced higher postoperative complications (p 0.0001). The independent clinical risk factors, ASA score II status (aOR: 2.335, 95%CI: 0.707-7.709), increasing uterine size (aOR: 1.076, 95%CI: 0.953-1.214), endometriosis (aOR: 2.337, 95%CI: 0.615-8.878), previous surgical history (aOR: 1.595, 95%CI: 0.544-4.677), and lower preoperative hemoglobin (aOR: 0.721, 95%CI: 0.502-1.036), affecting postoperative complications were analyzed. However, none of the factors had a statistically significant association with postoperative complications. Conclusions We observed lesser complication rates in robotic surgery than in conventional laparoscopy. We also found that those with higher iAE grades were strongly associated with higher postoperative complication grades.
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Affiliation(s)
- Rooma Sinha
- Department of Gynecology/Minimal Access Surgery, Apollo Health City, Hyderabad, IND
| | - Bana Rupa
- Department of Gynecology/Minimal Access Surgery, Apollo Health City, Hyderabad, IND
| | - Rohit Raina
- Department of Gynecology/Minimal Access Surgery, Apollo Health City, Hyderabad, IND
| | - Moumita Bag
- Department of Gynecology/Minimal Access Surgery, Apollo Health City, Hyderabad, IND
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Rocco B, Giorgia G, Simone A, Tommaso C, Mattia S, Stefano T, Ahmed E, Giorgio B, De Concilio B, Celia A, Salvatore M, Sighinolfi MC. Rectal Perforation During Pelvic Surgery. EUR UROL SUPPL 2022; 44:54-59. [PMID: 36093319 PMCID: PMC9449548 DOI: 10.1016/j.euros.2022.04.006] [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] [Accepted: 04/06/2022] [Indexed: 12/01/2022] Open
Abstract
Rectal perforations during pelvic surgery are rare but serious complications. The occurrence of rectal involvement is generally lower than that of the involvement of other portions of the bowel. The urologic field is responsible for the majority of iatrogenic rectal injuries from pelvic surgery; general and gynecologic surgeries are prone to the occurrence as well, the latter especially in the case of rectal shaving for deep infiltrating endometriosis. Attention should be posed to the prevention of rectal injuries, especially in case of challenging or salvage procedures; some tricks may be recommended to avoid thermal and mechanical damages and to realize a safe dissection. Intraoperative detection of rectal injuries is of paramount importance; once confirmed, immediate management with the closure of the defect is recommended. In general, rectal injuries diagnosed after surgery are liable to significantly worse outcomes than those detected and managed intraoperatively. Patient summary Rectal perforation is a rare but possible complication of pelvic surgeries. The more challenging the procedure (ie, surgery for locally advanced tumors or after radiation therapy), the higher the risk of rectal lesion. Intraoperative management of the injury should be attempted, with direct repair of the defect with or without fecal diversion.
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Affiliation(s)
- Bernardo Rocco
- Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy,Corresponding author. Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy. Tel. +39 335 830 6522.
| | - Gaia Giorgia
- Department of Gynecology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Assumma Simone
- Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy,Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Calcagnile Tommaso
- Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy,Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Sangalli Mattia
- Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Terzoni Stefano
- SIG Group on Continence Care, European Association of Urology Nurses, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Eissa Ahmed
- Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | | | - Antonio Celia
- San Bassiano Hospital, Bassano Del Grappa, Vicenza, Italy
| | - Micali Salvatore
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
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Comparing rates of bowel injury for laparoscopic and robotic ventral hernia repair: a retrospective analysis of the abdominal core health quality collaborative. Hernia 2022; 26:1251-1258. [DOI: 10.1007/s10029-022-02564-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/08/2022] [Indexed: 11/26/2022]
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Bowel injury in laparoscopic gynaecological surgery; 19 medicolegal cases. Eur J Obstet Gynecol Reprod Biol 2021; 270:261-264. [PMID: 34974932 DOI: 10.1016/j.ejogrb.2021.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 11/24/2021] [Accepted: 12/22/2021] [Indexed: 11/23/2022]
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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: 22] [Impact Index Per Article: 5.5] [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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Barouhas I, Mouhayar Y, Stephan JM. Intraoperative Bowel Injury During Hysterectomy. J Gynecol Surg 2021. [DOI: 10.1089/gyn.2020.0230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ivana Barouhas
- Department of Obstetrics and Gynecology, Rush University Medical Center, Chicago, Illinois, USA
| | - Youssef Mouhayar
- Department of Obstetrics and Gynecology, University of Miami/Jackson Memorial Hospital, Miami, Florida, USA
| | - Jean-Marie Stephan
- Department of Obstetrics and Gynecology, Rush University Medical Center, Chicago, Illinois, USA
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Improving vision for surgeons during laparoscopy: the Enhanced Laparoscopic Vision System (ELViS). Surg Endosc 2021; 35:2403-2415. [PMID: 33650002 DOI: 10.1007/s00464-021-08369-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 02/09/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND For many abdominal surgical interventions, laparotomy has gradually been replaced by laparoscopy, with numerous benefits for the patient in terms of post-operative recovery. However, during laparoscopy, the endoscope only provides a single viewpoint to the surgeon, leaving numerous blind spots and opening the way to peri-operative adverse events. Alternative camera systems have been proposed, but many lack the requisite resolution/robustness for use during surgery or cannot provide real-time images. Here, we present the added value of the Enhanced Laparoscopic Vision System (ELViS) which overcomes these limitations and provides a broad view of the surgical field in addition to the usual high-resolution endoscope. METHODS Experienced laparoscopy surgeons performed several typical procedure steps on a live pig model. The time-to-completion for surgical exercises performed by conventional endoscopy and ELViS-assisted surgery was measured. A debriefing interview following each operating session was conducted by an ergonomist, and a System Usability Scale (SUS) score was determined. RESULTS Proof of concept of ELVIS was achieved in an animal model with seven expert surgeons without peroperative adverse events related to the surgical device. No differences were found in time-to-completion. Mean SUS score was 74.7, classifying the usability of the ELViS as "good". During the debriefing interview, surgeons highlighted several situations where the ELViS provided a real advantage (such as during instrument insertion, exploration of the abdominal cavity or for orientation during close work) and also suggested avenues for improvement of the system. CONCLUSIONS This first test of the ELViS prototype on a live animal model demonstrated its usability and provided promising and useful feedback for further development.
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Enhanced Laparoscopic Vision Improves Detection of Intraoperative Adverse Events During Laparoscopy. Ing Rech Biomed 2020. [DOI: 10.1016/j.irbm.2020.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Abstract
OBJECTIVE To estimate the incidence and risk factors for bowel injury in women undergoing hysterectomy for benign indications. METHODS A retrospective cohort study was conducted among women undergoing hysterectomy for benign indications from 2012 to 2016 at institutes participating in the American College of Surgeons National Surgical Quality Improvement Program, including both inpatient and outpatient settings. Bowel injury was identified using Current Procedural Terminology codes as patients who underwent bowel repair at the time of hysterectomy or postoperatively within 30 days. Multivariate logistic regression models were used to control for patient clinical factors and perioperative factors. RESULTS Bowel injury occurred in 610 of 155,557 (0.39%) included women. After bivariate analysis, factors associated with bowel injury included age, race, body mass index, American Society of Anesthesiologists classification, increased operative time, surgical approach, type of hysterectomy, lysis of adhesions, and operative indication. After adjusting for potential confounders, bowel injury was found associated with older age, surgical indication of endometriosis, and abdominal surgical approach. Compared with the surgical indication of endometriosis (n=63/10,625), the surgical indications of menstrual disorder (odds ratio [OR] 0.33, 95% CI 0.23-0.47; adjusted odds ratio [aOR] 0.33, 95% CI 0.23-0.48; n=67/34,168), uterine leiomyomas (OR 0.80, 95% CI 0.61-1.05; aOR 0.44, 95% CI 0.33-0.59; n=243/51,232), and genital prolapse (OR 0.30, 95% CI 0.20-0.45; aOR 0.41, 95% CI 0.25-0.67; n=36/20,384) were each associated with lower odds of bowel injury. Compared with the vaginal approach to hysterectomy (n=27/27,434), the abdominal approach was found to have significantly increased odds of bowel injury (OR 10.80, 95% CI 7.31-15.95; aOR 10.49 95% CI 6.42-17.12; n=401/38,106); the laparoscopic approach had smaller but significantly increased odds (OR 2.06, 95% CI 1.37-3.08; aOR 2.03 95% CI 1.24-3.34; n=182/90,017) as well. CONCLUSION Increased risk of bowel injury is associated with endometriosis and the abdominal surgical approach to hysterectomy. These findings have implications for the surgical care of women with benign uterine disease.
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Schachar JS, Matthews CA. Robotic-assisted repair of pelvic organ prolapse: a scoping review of the literature. Transl Androl Urol 2020; 9:959-970. [PMID: 32420212 PMCID: PMC7215036 DOI: 10.21037/tau.2019.10.02] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/04/2019] [Indexed: 01/12/2023] Open
Abstract
The purpose of this article is to perform a scoping review of the medical literature regarding the efficacy, safety, and cost of robotic-assisted procedures for repair of pelvic organ prolapse in females. Sacrocolpopexy is the "gold standard" repair for apical prolapse for those who desire to maintain their sexual function, and minimally-invasive approaches offer similar efficacy with fewer risks than open techniques. The introduction of robotic technology has significantly impacted the field, converting what would have been a large number of open abdominal sacrocolpopexy (ASC) procedures to a minimally-invasive approach in the United States. Newer techniques such as nerve-sparing dissection at the sacral promontory, use of the iliopectineal ligaments and natural orifice vaginal sacrocolpopexy may improve patient outcomes. Prolapse recurrence is consistently noted in at least 10% of patients regardless of route of mesh placement. Ancillary factors including pre-operative prolapse stage, retention of the cervix, type of mesh implant, and genital hiatus (GH) size all adversely affect surgical efficacy, while trainees do not. Minimally-invasive apical repair procedures are suited to early recovery after surgery protocols but may not be appropriate for all patients. Studies evaluating longer-term outcomes of robotic sacrocolpopexies are needed to understand the relative risk/benefit ratio of this technique. With several emerging robotic platforms with improved features and a focus on decreasing costs, the future of robotics seems bright.
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Affiliation(s)
- Jeffrey S Schachar
- Female Pelvic Medicine and Reconstructive Surgery, Departments of Urology and Obstetrics and Gynecology, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Catherine A Matthews
- Female Pelvic Medicine and Reconstructive Surgery, Departments of Urology and Obstetrics and Gynecology, Wake Forest Baptist Health, Winston-Salem, NC, USA
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Endicott S, Lockrow E. Continuous Hydrogen Sulfide Gas Monitoring using the PortaSens II Portable Gas Leak Detector Model C16 during Laparoscopic or Robotic Surgery Cannot Be Used Intraoperatively to Detect Bowel Injury. J Minim Invasive Gynecol 2020; 28:30-33. [PMID: 32234563 DOI: 10.1016/j.jmig.2020.03.006] [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: 11/20/2019] [Revised: 03/13/2020] [Accepted: 03/17/2020] [Indexed: 10/24/2022]
Abstract
STUDY OBJECTIVE To determine the feasibility of measuring hydrogen sulfide (H2S) gas in the insufflated abdomen during laparoscopic surgery after transmural bowel injury as a marker of unrecognized bowel injuries. DESIGN This is a feasibility study performed on swine models during a robotic training course. We aimed to determine baseline H2S levels and subsequent elevations in H2S levels after enterotomy of the large and small intestines. SETTING University-based robotic training lab. PARTICIPANTS Three swine participants. INTERVENTIONS During initial insufflation of the swine abdominal cavity, baseline H2S levels were recorded over 15-second intervals for 10 minutes using the PortaSens II Portable Gas Leak Detector Model C16 (Analytical Technology, Inc., Collegeville, PA). The same values were recorded in separate studies after transmural transection of the small intestine and the large intestine using laparoscopic shears with and without monopolar electrosurgery. MEASUREMENTS AND MAIN RESULTS Baseline H2S level over the initial 10 minutes of insufflation was 0 parts per million (ppm). The device is calibrated to detect levels of H2S of 0 ppm to 200 ppm. H2S levels after small and large bowel enterotomies without monopolar electrosurgery initially showed a rise to 1 ppm to 2 ppm. However, repeat confirmatory testing failed to show any elevation in H2S levels. H2S levels after small and large bowel enterotomies with monopolar electrosurgery both showed increases to 108 ppm and 74 ppm with a duration of elevation measuring 4 minutes and 4 minutes 15 seconds, respectively. Although our study did show elevations in H2S after transection with monopolar electrosurgery, this was later determined to be the result of cross contamination with carbon monoxide, which was a confounding factor. CONCLUSION Our study demonstrated that using the methodology and detection methods described, H2S cannot be used to detect unrecognized bowel injury during laparoscopic surgery. Our results were due to cross contamination with other gases created with the use of electrosurgery, and we were unable to reproduce initial testing results, which did show slight rises in H2S levels after enterotomies without monopolar electrosurgery. Further testing of other gases produced by the gastrointestinal tract or the use of alternative detection methods may provide more clinically relevant results.
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Affiliation(s)
- Scott Endicott
- Walter Reed National Military Medical Center and Obstetrics and Gynecology (Dr. Lockrow), Uniformed Services University of the Health Sciences, Bethesda, Maryland.
| | - Ernest Lockrow
- Department of Obstetrics and Gynecology (Drs. Endicott and Lockrow), Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Abstract
Bowel and bladder injuries are relatively rare, but there can be serious complications of both open and minimally invasive gynecologic procedures. As with most surgical complications, timely recognition is key in minimizing serious patient morbidity and mortality. Diagnosis of such injuries requires careful attention to surgical entry and dissection techniques and employment of adjuvant diagnostic modalities. Repair of bowel and bladder may be performed robotically, laparoscopically, or using laparotomy. Repair of these injuries requires knowledge of anatomic layers and suture materials and testing to ensure that intact and safe repair has been achieved. The participation of consultants is encouraged depending on the primary surgeon's skill and expertise. Postoperative care after bowel or bladder injury requires surveillance for complications including repair site leak, abscess, and fistula formation.
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Prevention and management of bowel injury during gynecologic laparoscopy: an update. Curr Opin Obstet Gynecol 2019; 31:245-250. [PMID: 31045654 DOI: 10.1097/gco.0000000000000552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The current article aims to briefly review recent literature on bowel injury in gynecologic surgery with a focus on minimally invasive techniques, strategies for prevention, and management of injury. RECENT FINDINGS Recent reviews describe a low incidence of bowel injury that is likely affected by low rates of reporting and inconsistent definitions. The major risk factor for bowel injury is adhesive disease, and assessment and prevention techniques for the presence of adhesive disease are evolving. When bowel injury occurs, prompt diagnosis and intraoperative repair yields more favorable outcomes than delayed diagnosis. Repair can be performed by a gynecologic surgeon, with or without the help of a consultant depending on the extent of the injury and surgeon comfort. SUMMARY Bowel injury is a potentially catastrophic complication in gynecologic surgery, but its rarity presents a challenge in research. A high index of suspicion and meticulous surgical technique are the cornerstones of managing a bowel injury.
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Updates in Minimally Invasive Approaches to Apical Pelvic Organ Prolapse Repair. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2019. [DOI: 10.1007/s13669-019-0257-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Background Bowel injury remains a serious complication of gynecological laparoscopic surgery. We aimed to review the literature on this topic, combined with personal experiences, so as to give recommendations on how to avoid and manage this complication. Methods We performed a narrative review on bowel injury following gynecological laparoscopic surgery using PubMed covering prevention, diagnosis, and management. Search terms used were laparoscopy, gynaecology, injury, bowel, prevention, treatment. Results Important principles of prevention include proper pre-operative evaluation and increased laparoscopic surgical skills and knowledge. High clinical suspicion is crucial for early diagnosis. Diagnostic workup of suspected cases includes serial abdominal examination, measuring inflammatory markers, and performing imaging studies including abdominal ultrasound and CT scan. When bowel injury is recognized during the first laparoscopic procedure then laparoscopic primary suturing could be tried although laparotomy may be needed. When diagnosis is delayed, then laparotomy is the treatment of choice. The role of robotic surgery and three-dimensional laparoscopic gynecological surgery on bowel injury needs to be further assessed. Conclusion Early recognition of bowel injury is crucial for a favorable clinical outcome. A combined collaboration between gynecologists and general surgeons is important for timely and proper decisions to be made.
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Affiliation(s)
- Hassan M Elbiss
- Department of Obstetrics and Gynaecology, College of Medicine and Health Sciences, UAE University, 17666 Al-Ain, United Arab Emirates.
| | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University,17666 Al-Ain, United Arab Emirates.
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Walden PA, Zeybek B, Phelps JY. Understanding the Legal Essentials of a Bowel Injury Lawsuit in Minimally Invasive Gynecologic Surgery. J Minim Invasive Gynecol 2017; 25:30-37. [PMID: 28970057 DOI: 10.1016/j.jmig.2017.09.018] [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: 08/24/2017] [Revised: 09/21/2017] [Accepted: 09/24/2017] [Indexed: 12/18/2022]
Abstract
Bowel injury is a known inherent complication of minimally invasive gynecologic surgery; however, it does not automatically signify medical malpractice. Plaintiff attorneys representing patients seeking legal recourse from a bowel injury typically allege claims of intraoperative negligence, delay in diagnosis, or lack of informed consent in an effort to circumvent the assertion that it is a known inherent complication. In addition, damage awards in bowel injury lawsuits can easily exceed the amount covered by the policy limits of a medical malpractice insurance plan, leaving the gynecologist financially responsible for the difference. Therefore, it is crucial to understand when it may be appropriate to consent to a settlement offer, which can relieve the gynecologist from financial liability for amounts awarded above the medical malpractice policy limits. The purpose of this medical-legal review is to make minimally invasive gynecologic surgeons more aware of the legal strategies used by plaintiff attorneys representing patients who have incurred bowel injuries, and how to limit liability in lawsuits.
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Affiliation(s)
- Paul A Walden
- School of Medicine, The University of Texas Medical Branch at Galveston, Galveston, Texas
| | - Burak Zeybek
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, Texas
| | - John Y Phelps
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, Texas.
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Robot-assisted gynaecological cancer surgery-complications and prevention. Best Pract Res Clin Obstet Gynaecol 2017; 45:94-106. [PMID: 28528932 DOI: 10.1016/j.bpobgyn.2017.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 04/02/2017] [Accepted: 04/07/2017] [Indexed: 12/16/2022]
Abstract
Ever since the US Food and Drug Administration approval of the use of da Vinci surgical systems (Intuitive Surgical Inc., Sunnyvale, California) in gynaecology in 2005, robot-assisted surgery has been widely adopted in different countries. Some of the applications in benign and oncological gynaecology include myomectomy, sacrocolpopexy, tubal anastomosis, simple hysterectomy, radical hysterectomy, radical trachelectomy, pelvic and/or para-aortic lymphadenectomy and even debulking surgery for ovarian cancer and pelvic exenteration for recurrent cervical and vaginal cancer. Although there is robust evidence on the safety and treatment outcomes in robot-assisted surgery, complications still rarely occur. Team approach is particularly important in robotic surgery and thorough communication between the bedside assistant and the console surgeon cannot be stressed any more. Thus, complications can be due to miscommunication between the console surgeon and bedside assistant, positioning of the patients, the length of the operations, the malfunction of the instrument and the risks specific to the types of anaesthesia and surgery per se, leading to thromboembolism, haemorrhage, organ damage, and so on. The most important strategies that can prevent complications are to have thorough preoperative assessment of the patients' fitness, good communication between surgical team members, caution regarding the positioning, a good knowledge of the pelvic and abdominal anatomy, careful and meticulous manipulation of the instrument and early recognition of the complications. In this article, different types of complications and the preventive measures are described.
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