Post-operative complications following minimal access surgery

Principles and strategies for dealing with complications in laparoscopy

PURPOSE OF REVIEW

To help surgeons and to make patients become fully aware of the risks of laparoscopic surgery. As complications are an inevitable reality of surgery, we need to be aware of the types of complications in a systematic way, train to respond in an appropriate way, and learn to communicate in a transparent and honest way to deal with complications in laparoscopic surgery.

RECENT FINDINGS

This article aims to classify complications associated with laparoscopy according to the different phases in surgery and to promote a comprehensive strategy for dealing with them.

SUMMARY

To promote a culture of risk management which delivers the benefits and minimizes the risks associated with laparoscopic surgery.

Dealing with complications in laparoscopy

With increasing adoption of laparoscopic surgery in gynaecology, there has been a corresponding rise in the types and rates of complications reported. This article sets out to classify complications associated with laparoscopy according to the phases of the surgery; assess the incidence, the mechanisms, the presentations; and recommend methods for preventing and dealing with complications in laparoscopic surgery. Its aim is to promote a culture of risk management based on the development of strategies to improve patient safety and outcome.

Anesthesia for operative endoscopy

Developments in both instruments and techniques have led to an increasing popularity of endoscopic surgery during the last two decades. Even though there are numerous advantages to using endoscopic surgery, life threatening surgical and anesthetic complications still exist. Precautions must be taken to cope with the potential complications. Anesthetic technique must provide optimal surgical conditions and lead to early recovery of the patient. Monitorization must allow safety of the patient during these potentially hazardous procedures. Both the anesthesiologist and the surgeon must be thoroughly aware of the potential complications of the procedure. This review discusses the physiological alterations occurring during operative endoscopy, the principles of anesthetic management and complications related both to surgery and to anesthesia techniques.

Complications and litigation in gynecologic endoscopy

Most medical malpractice lawsuits that involve gynecologic endoscopy and laparoscopy result from either improper prevention, inadequate recognition, or delayed intervention. Continuing recognition of this will prevent many and mitigate most such cases. We can learn much from the events and rapid progress of the past decade. Although most laparoscopic improvements have been technical and instrument driven, a basic understanding of anatomy, physiology, and diagnostics remains essential to high-quality patient care and risk reduction.