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Complications in laparoscopic surgery
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Complications in laparoscopic surgery

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Dr John AC Thanakumar …

Dr John AC Thanakumar
Senior Consultant
Minimal Access, Bariatric and Gastrointestinal Surgery
Global Hospital
Chennai
www.lapsurgeon.org

Published in: Education

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    • 1. Complications in Minimal Access SurgeryDr John AC ThanakumarMS, MNAMS, FRCS, FRCS, FIAGES, Dip MISSenior Consultant in Minimal Access, Bariatric and GI SurgeryGlobal Hospital, Chennai.
    • 2. Complications of Laparoscopy Those of any surgical operation and anesthesia Those only confined to laparoscopic surgery Only the latter are discussed in this presentation
    • 3. Limitations in Laparoscopy Only a 2-dimensional view Restricted vision Limited tactile feedback Increasing emphasis on technology Learning curve
    • 4. Advantages of Laparoscopy Magnified views Exceptional resolution and views 30 and 45 degree telescopes Flexible devices Laparoscopic ultrasounds
    • 5. Complications of Needle and Trochar Vascular Injury Visceral Injury • Stomach • Colon • Bladder
    • 6. •Vascular Injury• Visceral Injury Stomach Colon Bladder Complications of Needle and Trochar  Life threatening large retroperitoneal vessel  77604 lap choles, 36 -0.05%-Aorta,IVC, Iliac injury  Mortality in these pts 8.8%  In collected 16 major vascular injuries, mortality was 13% Deziel DJ, Millikan KW, Economou SG, Doolas A, Ko ST, Airan MC: Complications of laparoscopic cholecystectomy: A national survey of 4@292 hospitals and an analysis of 77,604 cases. Am j Surg 165:9-14, 1993. 25. Baadsgaard SE, Bille S, Egeblad K: Major vascular injury during gynecologic laparoscopy: Report of a case and review of published cases. Acta Obstet Gynecol Scand 68:283-285, 1989.
    • 7. •Vascular Injury• Visceral Injury: Stomach Avoid Colon Complications of Needle and trochar Bladder  Aspirate needle, look for bright blood  Convert early if injury is suspected  Hemostatic instability- Conversion is a must
    • 8. •Vascular Injury• Visceral Injury: Stomach Colon Complications of Needle and trochar Bladder  Significant injury in 0.01-0.04%  Undetected, sepsis,peritonitis, fistula, abscess  75,000 laparoscopic cholecystectomies, 4.6 percent of patients with gastrointestinal injuries died Deziel DJ, Millikan KW, Economou SG, Doolas A, Ko ST, Airan MC: Complications of laparoscopic cholecystectomy: A national survey of 4@292 hospitals and an analysis of 77,604 cases. Am j Surg 165:9-14, 1993.
    • 9. •Vascular Injury• Visceral Injury: Stomach Avoid Colon Complications of Needle and trochar Bladder  Proper technique  NG tube  Controlled inflation  Resonance of the abdomen  Watch IAP
    • 10. •Vascular Injury• Visceral Injury: Stomach Colon Thermal Injury Bladder  Thermal injuries with Cautery/laser- severe-resect  Injury with needle, trochar, instruments- observe, suture or resect  Repair open or laparoscope- Experience
    • 11. •Vascular Injury• Visceral Injury: Stomach Colon Complications of Needle and trochar Bladder  Prevent by catheterization  Needle injury- Catheter  Trochar injury- Suture the defect
    • 12. Complications of Pneumoperitoneumo Acidosiso Arrhythmiaso Extraperitoneal insufflationo Pneumothoraxo Gas embolism
    • 13. •Acidosis•Arrhythmias Complications of Pneumoperitoneum•Extraperitoneal Insufflation•Pneumothorax•Gas embolism  CO2 leads acidosis-arrhythmia  Mechanical effects of IAP = >Cardiac output
    • 14. •Acidosis•Arrhythmias•Extraperitoneal insufflation•Pneumothorax Complications of Pneumoperitoneum•Gas embolism  Increased ventilatory pressures and arterial desaturation  Chest tube
    • 15. •Acidosis•Arrhythmias•Extraperitoneal insufflation•Pneumothorax Complications of Pneumoperitoneum•Gas embolism  Incidence is 0.002-0.0016%  Etiology is vein injury with increased IAP  Wheel like murmur,wide QRS  Head end down left side down,aspirate via central catheter and ext massage
    • 16. Wound Hernia Infection Tumor Recurrence
    • 17. Wound•Hernia•Infection•Tumor Recurrence Wound o Hernia o Infection o Tumor Recurrence
    • 18. Wound•Hernia•Infection• Tumor Recurrence Hernia  Incidence 0.1-0.3%  Higher the trochar, higher the hernia  Infection  Prevent- Suture facial 10 mm defect
    • 19. Wound•Hernia•Infection Infection•Tumor Recurrence  Incidence of diagnostic <0.1%  Lap Cholecystectomy 1%  Prevent by retrieval bag
    • 20. Wound•Hernia•Infection• Tumor Recurrence Tumor Recurrence  Retrieval bags  Low threshold for enlarging incision
    • 21. Lap Cholecystectomy Complications Incidence of bile duct injuries 0.25-6% Less after 13 operations/100in institutions Mortality of LC is 0.1% Mortality due to co morbids/ injuries
    • 22. Prevent CBD injury Hug the GB at dissection Window between GB and bed of GB Demo the cystic duct to GB junction Clear Vision of Calot Use heat wisely
    • 23. Conversion in LC Incidence is 3.6-6.9% Indications- Bleed, Unclear anatomy,CBD injury, acute GB, pancreatitis Selection decreases incidence to 2%
    • 24. Lap Antireflux Surgery Complications Incidence is 4-16 Perforation of esophagus, stomach,spleen, pneumo Dysphagia 22-57% . Needs dilatation 4-32% Prevent by loose, short, floppy wrap
    • 25. Lap Hernia Complications Incidence is 6-31% after TAPP Bladder, Inf epigatric bleed, Cord injury 1-2.9% hernia recurrence Mesh Infection-1 in 535 TAPPS Retension of urine in 3-7%
    • 26. Lap Appendectomy Complications Lap shows no advantage over open In open wd infection= Intra abscess in Lap
    • 27. Future Virtual training Robotics Special instruments for haptics Laparoscopy will improve
    • 28. Any Queries?
    • 29. Contact For more details:drjact@gmail.comMobile: 09443709158For more information- Google my name - www.youTube.com Search Dr John Thanakumar for videos Slides at www.authorstream.com www.lapsurgeon.org http://www.youtube.com/watch?v=UDDIH6udfYQ