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Polat M, Incebiyik A, Tammo O. Abdominal access in laparoscopic surgery of obese patients: a novel abdominal access technique. Ann Saudi Med 2023; 43:236-242. [PMID: 37554021 DOI: 10.5144/0256-4947.2023.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND An important step in laparoscopic surgery is abdominal access. Several abdominal access techniques have been described to reduce complications. We compare our novel abdominal access technique (MESAD) with other abdominal access techniques, particularly to reduce complications in obese patients. OBJECTIVE Compare the MESAD method and other methods we use for abdominal access in gynecologic laparoscopic surgery of obese patients DESIGN: Retrospective SETTING: Gynecology department in university hospital PATIENTS AND METHODS: Patients who underwent abdominal access by the MESAD technique, the Veress needle technique, and the Hasson technique were included in our study. In addition to demographic data, minor and major complications, number of unsuccessful attempts, conversion to another technique, and abdominal access times were collected from all patient files. MAIN OUTCOME MEASURES Clinical data and complications SAMPLE SIZE: 66 patients, 26 by MESAD technique, 24 by the Veress needle technique, and 16 by the Hasson technique. RESULTS There were two major complications (one in the Veress group and one in the Hasson technique group) and 7 minor complications. No significant difference was found between the groups in terms of complications (P=.477, P=.476, respectively). The fastest technique for abdominal access was in the MESAD technique whereas the slowest was in the Hasson (P<.001). The failure of abdominal access and subsequent conversion to another technique was most common in the Veress group. However, no significant difference was found between the groups (P=.092). CONCLUSIONS The MESAD technique is an easy method to both learn and teach. We think that the low major-minor complication rates in the MESAD technique will allow surgeons to reduce their anxiety at the first entry and to perform a more comfortable operation. LIMITATIONS Retrospective CONFLICT OF INTEREST: None.
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Affiliation(s)
- Mesut Polat
- From the Department of Obstetrics and Gynecology, Zeynep Kamil Training and Research Hospital, Istanbul, Turkey
| | - Adnan Incebiyik
- From the Department of Gynecology and Obstetrics, Harran University - Osmanbey Campus, Sanliurfa, Turkey
| | - Omer Tammo
- From the Department of Gynecology and Obstetrics, Mardin Training and Research Hospital, Mardin, Turkey
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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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Lefebvre G, Devenny KA, Héroux DL, Bowman CL, Neilson HK, Mimeault R, Singh SS, Calder LA. Intraoperative injuries from abdominopelvic surgery: an analysis of national medicolegal data. Can J Surg 2021; 64:E127-E134. [PMID: 33666381 PMCID: PMC8064243 DOI: 10.1503/cjs.010219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Intraoperative injuries during abdominopelvic surgery can be associated with substantial patient harm. The objective of this study was to describe abdominopelvic intraoperative injuries and their contributing factors among medicolegal cases. Methods This study was a descriptive analysis of medicolegal matters reported to a national body, with subgroup analyses by type of surgery. We reviewed medicolegal matters involving a population-based sample of physicians who were subject to a civil legal action or complaint to a regulatory authority that was closed between 2013 and 2017 in Canada. Results Our analysis included 181 civil legal cases and 88 complaints to a regulatory authority. Among legal cases, 155 patients (85.6%) (median age 47 yr) underwent elective procedures. The most common injury site was the bowel (53 cases [29.3%]). Injuries frequently occurred during dissection (79 [43.6%]) and ligation (38 [21.0%]), were identified postoperatively (138 [76.2%]) and necessitated further surgery (139 [76.8%]). Many patients experienced severe harm (55 [30.4%]) or died (25 [13.8%]). Peer experts in nongynecologic cases were more likely than those in gynecologic cases to include criticisms of a provider in a harmful incident (79 [71.2%] v. 30 [42.9%], p < 0.01). Peer expert criticisms often related to clinical evaluation, decision-making and misidentification of anatomy. Criticisms of nontechnical skills identified documentation and communication deficiencies. Conclusion This study confirms the importance of provider and team training to improve clinical evaluation and decision-making, documentation and communication. Effective protocols may help support clinicians in providing safer surgical care.
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Affiliation(s)
- Guylaine Lefebvre
- From Practice Improvement, Canadian Medical Protective Association, Ottawa, Ont. (Lefebvre, Mimeault); Medical Care Analytics, Canadian Medical Protective Association, Ottawa, Ont. (Devenny, Héroux, Bowman, Neilson, Calder); the Department of Obstetrics and Gynecology, University of Ottawa, Shirley E. Greenberg Women's Health Centre, Ottawa, Ont. (Singh); and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Calder)
| | - Kirsten A Devenny
- From Practice Improvement, Canadian Medical Protective Association, Ottawa, Ont. (Lefebvre, Mimeault); Medical Care Analytics, Canadian Medical Protective Association, Ottawa, Ont. (Devenny, Héroux, Bowman, Neilson, Calder); the Department of Obstetrics and Gynecology, University of Ottawa, Shirley E. Greenberg Women's Health Centre, Ottawa, Ont. (Singh); and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Calder)
| | - Diane L Héroux
- From Practice Improvement, Canadian Medical Protective Association, Ottawa, Ont. (Lefebvre, Mimeault); Medical Care Analytics, Canadian Medical Protective Association, Ottawa, Ont. (Devenny, Héroux, Bowman, Neilson, Calder); the Department of Obstetrics and Gynecology, University of Ottawa, Shirley E. Greenberg Women's Health Centre, Ottawa, Ont. (Singh); and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Calder)
| | - Cara L Bowman
- From Practice Improvement, Canadian Medical Protective Association, Ottawa, Ont. (Lefebvre, Mimeault); Medical Care Analytics, Canadian Medical Protective Association, Ottawa, Ont. (Devenny, Héroux, Bowman, Neilson, Calder); the Department of Obstetrics and Gynecology, University of Ottawa, Shirley E. Greenberg Women's Health Centre, Ottawa, Ont. (Singh); and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Calder)
| | - Heather K Neilson
- From Practice Improvement, Canadian Medical Protective Association, Ottawa, Ont. (Lefebvre, Mimeault); Medical Care Analytics, Canadian Medical Protective Association, Ottawa, Ont. (Devenny, Héroux, Bowman, Neilson, Calder); the Department of Obstetrics and Gynecology, University of Ottawa, Shirley E. Greenberg Women's Health Centre, Ottawa, Ont. (Singh); and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Calder)
| | - Richard Mimeault
- From Practice Improvement, Canadian Medical Protective Association, Ottawa, Ont. (Lefebvre, Mimeault); Medical Care Analytics, Canadian Medical Protective Association, Ottawa, Ont. (Devenny, Héroux, Bowman, Neilson, Calder); the Department of Obstetrics and Gynecology, University of Ottawa, Shirley E. Greenberg Women's Health Centre, Ottawa, Ont. (Singh); and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Calder)
| | - Sukhbir S Singh
- From Practice Improvement, Canadian Medical Protective Association, Ottawa, Ont. (Lefebvre, Mimeault); Medical Care Analytics, Canadian Medical Protective Association, Ottawa, Ont. (Devenny, Héroux, Bowman, Neilson, Calder); the Department of Obstetrics and Gynecology, University of Ottawa, Shirley E. Greenberg Women's Health Centre, Ottawa, Ont. (Singh); and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Calder)
| | - Lisa A Calder
- From Practice Improvement, Canadian Medical Protective Association, Ottawa, Ont. (Lefebvre, Mimeault); Medical Care Analytics, Canadian Medical Protective Association, Ottawa, Ont. (Devenny, Héroux, Bowman, Neilson, Calder); the Department of Obstetrics and Gynecology, University of Ottawa, Shirley E. Greenberg Women's Health Centre, Ottawa, Ont. (Singh); and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Calder)
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