Uploaded byTariq Mohammed
Complication of laparoscopy
Laparoscopy surgery, while minimally invasive, carries risks of complications. Common complications include bowel injury, bleeding, and hernia formation. Bowel injuries can occur from trocars, instruments, or electrocautery and may be difficult to detect, sometimes not appearing for days. Vessel injuries to major blood vessels in the abdomen are also risks. Preventive measures include proper patient positioning, careful trocar placement, and avoiding deep dissection. Neurologic injuries from positioning are rare but possible. The urinary tract is also at risk of injury from instruments. As laparoscopy is used for more complex cases, complication rates can be expected to rise but proper training and awareness of risks can help minimize complications.
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Complication of laparoscopy
- 1. COMPLICATION OF LAPAROSCOPY Khalid Sait Professor Directorof Gynecological Oncology Unit
- 2. Laparoscopy surgery • Often consideredas minimally invasive surgery but risk is not……. • Complications 8.9% laparoscopy vs. 15.2% laparotomy (meta-analysis)
- 3. Laparoscopy surgery • Generally safebut does have mortality (0.03%-0.49%) • Generally more complex surgery/ earlier on a learning curve will lead to more complications
- 4. Laparoscopy surgery • Are currentlybeing increasingly used for wider and wider application • Complication rate can be expected to rise
- 5. • Know how equipmentwork before use it !
- 7. • “ If youhave not had a complication during surgery , you are not doing enough surgery”
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- 10. Bowel injury • INCIDENCE:0.1-0.5% • The incidence varies according to the type of surgery, surgical history, the skill and experience of the surgeon • High risk factors include previous abdominal and pelvic surgery, history of peritonitis, endometriosis or bowel surgery, and major surgical procedure
- 11. TYPES OF BOWELINJURIES • BY VERRES NEEDLE • BY TROCAR • BY GRASPERS AND SCISSORS • BY ELECTROCOAGULATIOIN (50%)
- 12. Bowel injury byVERRES needle • Recognition by: • – Leakage of bowel content through the Veress • – Aspiration of gastric or feculent material • – Initial intra-abdominal pressure of > 8 mmHg • – Absent second pop sound on inserting the Veress needle • – Restricted mobility of the needle after insertion
- 13. Bowel injury byVERRES needle • In the majority of the cases conservative (observation and antibiotics) • If lacerations resulted or the intestinal wall is devitalized repair should be made
- 14. BOWEL INJURY BYTHE TROCAR
- 15. BOWEL INJURY BYTHE INSTRUMENT
- 16. Bowel injury causedby electro- coagulation • 1. Delayed tissue necrosis after thermal injury is difficult to diagnose. • 2. It is responsible for the delay in diagnosis of bowel injury (3-4 days after the procedure) • 3. Peritonitis and high mortality (20%) due to late diagnosis
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- 20. Capacitive coupling • Riskfactors: • Longer instruments
- 21. Other electrosurgical complications • Alternatesite burns at the dispersive site • Partial detachment • Manufacturing/quality defect • Placement over moist skin, bony prominence • Caution with pacemakers • Monopolar currents may override/ reset pacemakers
- 22. GI Injury • Biggestproblem is delay in diagnosis • 34-62% of injuries noted at time of surgery • Average time to small bowel perf 3.3 days • Average time with large bowel perf 2-10 days
- 23. Prevention of bowelinjury • Entry technique ( open is safe ) • Proper grounding of the patient • Do not activate the monopolar energy unless in contact with the tissue to be desiccated • Do not use blunt dissection extensively • Be careful with sharp excision in endometriosis if the planes are not identified
- 24. Trocar Site Hernias • Hernias are well reported • Ports greater than 10 mm • 21 per 100000 cases • 17.9% despite fascial closure • 86.3% with trocars greater than 10 mm • Close port sites
- 25. Hernia Prevention “J”needle
- 26. Vascular Injuries • Traumato a large vessel • Risk of major vessel injury 1/1000
- 27. • Umbilicus to aorticbifurcation changes with BMI & positioning • 0.4cm – normal • 2.9cm – BMI >30
- 28. IVC injury byVERRES needle
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- 30. Measures to avoiddeep vessel injury • Avoid Trendlenburg position • The angle of insertion should be 45% at the umbilicus in thin patient and more vertical in obese patients • Use disposable trocars or sharp instruments to avoid use of unnecessary force during primary entry
- 31. ABDOMINAL WALL VESSELINJURY How to avoid? • 1. Always stay lateral to the rectus muscle • 2. Avoid the inguinal region • 3. Trans-illumination of the anterior abdominal wall to avoid vessels. • 4. Always insert perpendicular to the skin. • 5. Use the conical tipped 5 mm trocar
- 32. Injury to inferiorepigastric vein
- 33. Injury to inferiorepigastric vessels
- 34. Neurologic Injury • Peripheral Neurologic Injury • inappropriate positioning of the patient • pressure exerted by surgeon/ assistants • rarely happens from surgical dissection (exception is obturator and genitofemoral nerve injury with increasing retroperitoneal dissections)
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- 36. Urinary Tract Injuries • Bladderand ureters susceptible • 0.2/1000 • Use foley or empty bladder
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- 38. Urinary Tract Injury • Bladderinjury noted at 1.1 days • Ureteric injury at 29.4 days • Be aware of low urine output • Ascites / peritonitis • Investigate with IVP cysto and retrograde
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- 40. Diaphragm injury byinstrument
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- 42. Port site mets • Well recognised • Increased with CO2 pneumoperitoneum • Increased intra abdominal pressures • Excessive manipulation • Failure to use bags • May occur in similar rates to open cases?
- 43. Other Complications • Anaesthetic • IncreasedCO2 • Problems with ventilation pressures • Arrhythmias • Pain • Subcutaneous emphysema/ pneumomediastinum • Wound infection
- 44. Conclusion • Laparoscopic surgery doeshave considerable advantages • Need to be aware of all potential complications and have methods available to fix!