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Complications in laparoscopic surgery

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

Published in: Education

Complications in laparoscopic surgery

  1. 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. 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. 3. Limitations in Laparoscopy Only a 2-dimensional view Restricted vision Limited tactile feedback Increasing emphasis on technology Learning curve
  4. 4. Advantages of Laparoscopy Magnified views Exceptional resolution and views 30 and 45 degree telescopes Flexible devices Laparoscopic ultrasounds
  5. 5. Complications of Needle and Trochar Vascular Injury Visceral Injury • Stomach • Colon • Bladder
  6. 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. 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. 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. 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. 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. 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. 12. Complications of Pneumoperitoneumo Acidosiso Arrhythmiaso Extraperitoneal insufflationo Pneumothoraxo Gas embolism
  13. 13. •Acidosis•Arrhythmias Complications of Pneumoperitoneum•Extraperitoneal Insufflation•Pneumothorax•Gas embolism  CO2 leads acidosis-arrhythmia  Mechanical effects of IAP = >Cardiac output
  14. 14. •Acidosis•Arrhythmias•Extraperitoneal insufflation•Pneumothorax Complications of Pneumoperitoneum•Gas embolism  Increased ventilatory pressures and arterial desaturation  Chest tube
  15. 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. 16. Wound Hernia Infection Tumor Recurrence
  17. 17. Wound•Hernia•Infection•Tumor Recurrence Wound o Hernia o Infection o Tumor Recurrence
  18. 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. 19. Wound•Hernia•Infection Infection•Tumor Recurrence  Incidence of diagnostic <0.1%  Lap Cholecystectomy 1%  Prevent by retrieval bag
  20. 20. Wound•Hernia•Infection• Tumor Recurrence Tumor Recurrence  Retrieval bags  Low threshold for enlarging incision
  21. 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. 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. 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. 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. 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. 26. Lap Appendectomy Complications Lap shows no advantage over open In open wd infection= Intra abscess in Lap
  27. 27. Future Virtual training Robotics Special instruments for haptics Laparoscopy will improve
  28. 28. Any Queries?
  29. 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

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