Complicações em Vídeo-Laparoscopia

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Dr. Anibal Wood Branco …

Dr. Anibal Wood Branco
19th Video Urology World Congress
Florianópolis - Sc

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  • 1. Complicações em Vídeo-Laparoscopia Dr. Anibal Wood Branco 19th Video Urology World Congress Florianópolis - Sc
  • 2.
    • Curva de Aprendizado
    • Complications of laparoscopic nephrectomy in 185 patients: a multi-institutional review
    • Gill IS , Kavoussi LR , Clayman RV , Ehrlich R , Evans R , Fuchs G , Gersham A , Hulbert JC , McDougall EM , Rosenthal T
    • J Urol 1995 ; 154:479-83. 16%
    • 12%-Benigna 24%-Maligna 71% 20casos iniciais
    • Dificuldade Técnica do Procedimento
    • Meta-analysis of the complications of laparoscopic renal surgery: comparison of procedures and techniques.
    • Parrek G, Hedican S P, Bruskewitz R C, Nakada SY
    • J Urol 2006; 175:1208-13 .
    • Complicações Maiores 9,5% Complicações Menores 1,9% LPN 21%
  • 3.
    • Nefrectomia Convencional
    • X
    • Nefrectomia Laparoscópica
    • Laparoscopic radical nephrectomy : comparison of clinical
    • Stage T1 and T2 renal tumors . Urology. 2006 Dec;68(6):1183-7.
    • Gong EM, Lyon MB, Orvieto MA, Lucioni A, Gerber GS, Shalhav AL.
    • Laparoscopic versus open nephrectomy in 210 consecutive patients: outcomes, cost, and changes in practice patterns.
    • Surg Endosc 2003; 17:1889-95.
    • Heniford BT , Matthews BD , Smith TI , Lincourt AE , Hayes DH , Eskind LB , Irby PB , Teigland CM
  • 4.
    • Trans-peritonial x Extra-peritonial
    • Prospective randomized comparison of transperitoneal versus retroperitoneal laparoscopic radical nephrectomy.
    • Desai MM , Strzempkowski B , Matin SF , Steinberg AP , Ng C , Meraney AM , Kaouk JH , Gill IS
    • J Urol 2005; 173:38-41 .
    • Íleo prolongado similar entre as duas técnicas
    • Prospective, randomized controlled study: transperitoneal laparoscopic versus retroperitoneoscopic radical nephrectomy.
    • Nambirajan T , Jeschke S , Al-Zahrani H , Vrabec G , Leeb K , Janetschek G
    • Urology 2004; 64:919-24.
    • < t. cir. Retroperitonioscópica
  • 5.
    • Laparoscópica Pura X Hand-Assisted
    • Wound complications after hand assisted laparoscopic surgery.
    • Montgomery JS , Johnston WK , Wolf JS
    • J Urol 2005; 174:2226-30.
    • A comparison of hand-assisted and pure laparoscopic techniques in live donor nephrectomy.
    • Branco A.W. ,Branco Filho A.J., Stunitz , Kondo W., George M.A.
    • Clinics 2008;63(6)
    • Meta-analysis of the complications of laparoscopic renal surgery: comparison of procedures and techniques.
    • Pareek G , Hedican SP , Gee J R , Bruskewitz RC , Nakada SY
    • J Urol 2006; 175:1208-13.
  • 6.
    • Complicações Relacionadas ao Acesso
    • 0,5%
    • Optical access trocar injuries in urological laparoscopic surgery
    • J Urol 2003; 170:61-3
    • Thomas MA , Rha KH , Ong AM , Pinto PA , Montgomery RA , Kavoussi LR , Jarrett TW
    • - Punção Aberta no Início da Curva de Aprendizado
    • - Decúbito Lateral
    • - Hipocondrio Esquerdo
  • 7.  
  • 8.
    • Perfuração Intestinal <0,5%
    • Lesões de Órgãos Sólidos <0,5%
  • 9. Complicações Intra-Operatórias
    • Hemorragia 1,4% - 4%
    • Laparoscopic linear cutting stapler failure
    • Urology Volume 60, Issue 3 , September 2002, Pages 415-419
    • Donna Y. Denga, Maxwell V. Menga, , Hiep T. Nguyena, Gary C. Bellmanb and Marshall L. Stoller
    • Complicações Vasc. Menores
    • Complicaçóes Vasc. Maiores
  • 10.
    • The use of polymer (Hem-o-lok) clips for management of the renal hilum during laparoscopic nephrectomy
    • Eur Urol 2006; 49:816-9
    • Baumert H , Ballaro A , Arroyo C , Kaisary AV , Mulders PF , Knipscheer BC
    • 130 casos. ... recommend its use during laparoscopic nephrectomy and live donor nephrectomy.
    • Fatal and nonfatal hemorrhagic complications of living kidney donation.
    • Ann Surg 2006; 243:126-30
    • Friedman AL , Peters TG , Jones KW , Boulware LE , Ratner LE
  • 11. COMPLICAÇÕES PÓS-OPERATÓRIAS
    • Íleo 1,5%
    • Obstrução Intestinal < 0,5%
    • Hérnia < 0,5%
  • 12.
    • Laparoscopic extraperitoneal radical prostatectomy in complex surgical cases. Rodriguez AR, Kapoor R, Pow-Sang JM J Urol May 2007 (Vol. 177, Issue 5, Pages 1765-70)
    • - high body mass index, previous pelvic surgery or large prostate
    • - Não houve diferença nas taxas de complicações
    • - Próstatas >60g. Apresentaram maiores sangramento sem interferir na taxa de transfusão
  • 13.
    • Complications of endoscopic extraperitoneal radical prostatectomy (EERPE): prevention and management. Stolzenburg JU, Rabenalt R, Do M, Lee B, Truss MC, McNeill A, Burchardt M, Jonas U, Liatsikos EN World J Urol Dec 2006 (Vol. 24, Issue 6, Pages 668-75
    • The incidence of most complications directly correlates with the surgeons experience, and the various complications are related to technical errors rather than to the technique itself .
  • 14. Transperitoneal or extraperitoneal approach for laparoscopic radical prostatectomy: a false debate over a real challenge Cathelineau X , Cahill D , Widmer H , Rozet F , Baumert H , Vallancien G J Urol 2004; 171:714-6 . The 2 procedures are equivalent in terms of operative, postoperative and pathological data. Each surgeon has to choose considering personal experience, training and standardization.
    • A Direct Comparison of Robotic Assisted Versus Pure Laparoscopic Radical Prostatectomy: A Single Institution Experience ,
    • François Rozet, Jamison Jaffe, Guillaume Braud, Justin Harmon, Xavier Cathelineau, Eric Barret, Guy Vallancien J Urol 2007; 178 Issue 2: 478-482) We demonstrated that the laparoscopic radical prostatectomy is equivalent to the robotic assisted laparoscopic prostatectomy in the hands of skilled laparoscopic urological surgeons at our institution with respect to operative time, operative blood loss, hospital stay, length of bladder catheterization ,complications and positive margin rate.
    • 4 conv. R.A. 0 conv. P.L.
  • 15. Infecção por Micobactéria
    • Resistência ao Glutaraldeído
    • Formação de Biofilme
    • Limpeza inadequada de Instrumental Cirúrgico(Materiais Descartáveis)