This document provides information about the Department of Urology at Govt Royapettah Hospital and Kilpauk Medical College in Chennai, India. It lists the professors and assistant professors in the department and provides an introduction to laparoscopy. The rest of the document discusses the history of laparoscopy, choices of insufflation gas, physiological effects of pneumoperitoneum, and potential complications of laparoscopy procedures. It provides details on cardiovascular, respiratory, renal, and other organ system effects of increased abdominal pressure during laparoscopy. The document also outlines potential complications from veress needle placement, trocar insertion, insufflation, and electrosurgery and their management.
HoLEP: the gold standard for the surgical management of BPH in the 21st CenturyDr. Manjul Maurya
HoLEP is at least as effective as other surgical therapies, including TURP, OP and other laser modalities, with fewer complications, shorter hospital stays, and decreased catheter time. These benefits make HoLEP the procedure of choice for men seeking surgical relief for BPH related LUTS and the gold standard for the 21st Century.
HoLEP: the gold standard for the surgical management of BPH in the 21st CenturyDr. Manjul Maurya
HoLEP is at least as effective as other surgical therapies, including TURP, OP and other laser modalities, with fewer complications, shorter hospital stays, and decreased catheter time. These benefits make HoLEP the procedure of choice for men seeking surgical relief for BPH related LUTS and the gold standard for the 21st Century.
Surgical procedures have been improved to reduce trauma to the pt, morbidity, mortality and hospital stay with consequent reduction in health care cost.
Many painful operations that once required prolonged hospitalizations are now being performed on an out Pt or short stay basis.
the implications for anesthesiologist are to use the technique that not only allows for optimal surgical conditions, but intraoperative Pt comfort and safety, and a rapid anesthetic recovery
The development of better equipment and facilities, along with increased knowledge and understanding of anatomy and pathology have allowed the development of endoscopy for diagnostic and operative procedure. Starting from 1970 used various pathologic gynecological conditions have been diagnosed and treated with laparoscope.
Perioperative management of patients on corticosteroidsTerry Shaneyfelt
In these annotated PowerPoints I discuss the evaluation and perioperative management of patient taking or who have taken steroids. I discuss how to determine if the adrenal axis is suppressed and how to provide supplemental glucocorticoids if needed. Remember to download these slides to see the annotations for each slide.
Anaesthesia to patiens with liver disease or a liver transplantscanFOAM
A presentation by Anna Januszkiewicz at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Delivered in collaboration between scanFOAM, SSAI & SFAI.
Laparoscopic Urologic surgery, is a part of the curriculum of Minimal Access Surgery, and requires lot of skills and patience. All new surgeons carrying out Basic Laparoscopic surgery should aim at also doing Lap. Urological surgeries, which has a steep learning curve, but with with excellent outcomes.
Dr Ho Siew Hong shared his experience on how to perform the ideal puncture for PCNL in a lecture to Asian urologists during the Advanced Urology Course 2008 in Singapore
The tumescent liposuction procedure involves the use of lidocaine (a local anesthetic), epinephrine (a hormone and a neurotransmitter that shrinks blood vessels and minimizes bleeding), and a saline solution that is injected into the treatment area. The fluid causes the fat and skin to swell up, making it easier to suction out excess fatty cells.
Anaesthetic implication of laparoscopic surgery will help medical students as well as doctors performing safe anaesthesia practice in laparosc opic surgery.
Surgical procedures have been improved to reduce trauma to the pt, morbidity, mortality and hospital stay with consequent reduction in health care cost.
Many painful operations that once required prolonged hospitalizations are now being performed on an out Pt or short stay basis.
the implications for anesthesiologist are to use the technique that not only allows for optimal surgical conditions, but intraoperative Pt comfort and safety, and a rapid anesthetic recovery
The development of better equipment and facilities, along with increased knowledge and understanding of anatomy and pathology have allowed the development of endoscopy for diagnostic and operative procedure. Starting from 1970 used various pathologic gynecological conditions have been diagnosed and treated with laparoscope.
Perioperative management of patients on corticosteroidsTerry Shaneyfelt
In these annotated PowerPoints I discuss the evaluation and perioperative management of patient taking or who have taken steroids. I discuss how to determine if the adrenal axis is suppressed and how to provide supplemental glucocorticoids if needed. Remember to download these slides to see the annotations for each slide.
Anaesthesia to patiens with liver disease or a liver transplantscanFOAM
A presentation by Anna Januszkiewicz at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Delivered in collaboration between scanFOAM, SSAI & SFAI.
Laparoscopic Urologic surgery, is a part of the curriculum of Minimal Access Surgery, and requires lot of skills and patience. All new surgeons carrying out Basic Laparoscopic surgery should aim at also doing Lap. Urological surgeries, which has a steep learning curve, but with with excellent outcomes.
Dr Ho Siew Hong shared his experience on how to perform the ideal puncture for PCNL in a lecture to Asian urologists during the Advanced Urology Course 2008 in Singapore
The tumescent liposuction procedure involves the use of lidocaine (a local anesthetic), epinephrine (a hormone and a neurotransmitter that shrinks blood vessels and minimizes bleeding), and a saline solution that is injected into the treatment area. The fluid causes the fat and skin to swell up, making it easier to suction out excess fatty cells.
Anaesthetic implication of laparoscopic surgery will help medical students as well as doctors performing safe anaesthesia practice in laparosc opic surgery.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
2. Moderators:
Professors:
Prof. Dr. G. Sivasankar, M.S., M.Ch.,
Prof. Dr. A. Senthilvel, M.S., M.Ch.,
Asst Professors:
Dr. J. Sivabalan, M.S., M.Ch.,
Dr. R. Bhargavi, M.S., M.Ch.,
Dr. S. Raju, M.S., M.Ch.,
Dr. K. Muthurathinam, M.S., M.Ch.,
Dr. D. Tamilselvan, M.S., M.Ch.,
Dr. K. Senthilkumar, M.S., M.Ch.
Dept of Urology, GRH and KMC, Chennai. 2
3. INTRODUCTION
TILL 1990-LAPROSCOPY, A DIAGNOSTIC TOOL
1990-LAP CHOLECYSTECTOMY
1991-LAP NEPHRECTOMY
3
Dept of Urology, GRH and KMC, Chennai.
4. HISTORY
• 1902-KELLING COINED "KOELIOSCOPIE“
• USED FILTERED AIR FOR
PNEUMOPERITONEUM IN DOG
• USED NITZE CYSTOSCOPE
• 1910-JACOBEUS OF STOCKHOLM-FIRST
ENDOSCOPIC ABDOMINAL INSPECTION IN
HUMAN-USED AIR
4
Dept of Urology, GRH and KMC, Chennai.
5. HISTORY
1920-ORNDOFF –RADIOLOGIST USED OXYGEN AS
INSUFFLANT-USED VALVED CANULA
1924-ZOLLIKOFER OF SWITZERLAND-CO₂ MORE
PRACTICAL CHOICE
5
Dept of Urology, GRH and KMC, Chennai.
6. CHOICE OF INSUFFLANT
CO₂ - most commonly used
Colourless ,non combustible,inexpensive
Quickly absorbed
High diffusion coefficient
Hypercarbia ,hypercapnia ,arrythmias
Stored in viscera,bone,muscle
6
Dept of Urology, GRH and KMC, Chennai.
7. CHOICE OF INSUFFLANT
Nitrous oxide
Less irritating, fewer acid base disturbances
&arrythmias
Supports combustion
Helium –inert, non combustible
Useful in COPD & poor hypercarbia tolerance
Decrease in tumor cell growth &
inflammatory reaction
7
Dept of Urology, GRH and KMC, Chennai.
8. CHOICE OF INSUFFLANT
Helium –high risk of gas embolism
Don’t use in extraperitoneal innsufflation-↑risk
of pneumothorax
Room air,oxygen-air embolism,combustion, intra
abdominal explosion
8
Dept of Urology, GRH and KMC, Chennai.
9. PHYSIOLOGICAL EFFECTS OF
PNEUMOPERITONEUM
Cardiovascular effects depends upon
Intra abdominal pressure
Patient position
co₂ absorption
Intravascular volume status
Pre existing cardiopulmonary status
Current medications
9
Dept of Urology, GRH and KMC, Chennai.
10. CARDIO VASCULAR EFFECTS
At low atrial pressure[normal or hypovolemic
state]→for pneumoperitoneum upto 20mmHg
→venous return is reduced
At high atrial pressure[hypervolemic state]→ IVC
resists↑IAP→venous return is actually enhanced
Net effect-↑TPR depressing cardiac function-more
pronounced in hypovolemic individuals
10
Dept of Urology, GRH and KMC, Chennai.
11. CARDIOVASCLAR EFFECTS
Cardiac index↓ by 50% of pre operative value within
5 minutes of insufflation,stabilises after 10 minutes
as systemic vascular resistance drops
EUROPEAN ASSOCIATION FOR ENDOSCOPIC
SURGERY PRACTICE GUIDELINES –
At IAP up to 15mmHg,↓venous return & cardiac output
is minimal without consequence in healthy individuals
11
Dept of Urology, GRH and KMC, Chennai.
12. CARDIOVASCULAR EFFECTS
Tachycardia,ventricular extrasystole-due to
hypercapnia
Brady arrythmia-due to peritoneal irritation and
vagal stimulation
Significance-clinical warning for
pneumothorax,hypoxia,gas embolism
Unreliability of CVP
12
Dept of Urology, GRH and KMC, Chennai.
14. RESPIRATORY EFFECTS
↑IAP→limits diaphragmatic movement →FRC↓,
pulmonary dead space unaffected→average peak
airway pressure needed to keep up constant tidal
volume increases parallel to ↑IAP
Non pressure related respiratory effects
Head down position ↓vital capacity
Pulmonary edema in ↑left atrial pressure
14
Dept of Urology, GRH and KMC, Chennai.
16. RENAL EFFECTS
Thorington&Schmidt found in dogs that
IAP>15mmHg - oliguria
IAP>30mmHg - anuria
Causes-↑renal vein pressure
Direct renal compression [Harman & co]
?ADH, ?AVP - unclear
16
Dept of Urology, GRH and KMC, Chennai.
17. RENAL EFFECTS
Renal vein& IVC pressure correlates with IAP
Renal artery pressure relatively unaffected by IAP
changes
With ↑IAP,increase in renal vascular resistance far
exceeded systemic vascular resistance
Direct effects on kidney plays major role
17
Dept of Urology, GRH and KMC, Chennai.
18. RENAL EFFECTS
In 1994 CHIU et al found that
Renal cortical blood flow↓ with↑IAP
Renal medullary blood flow↑upto 20mmHg &↓
>20mmHg
Low dose dopamine[2μg/kg] can prevent dip in urine
output [PEREZ et al,2002 ]
Summary-At IAP 10-15mmHg urine output ↓
significantly & associated with↓ RBF
18
Dept of Urology, GRH and KMC, Chennai.
19. INTRACRANIAL PRESSURE
Monroe –kellie doctrine hypothesis
Vascular,CSF,osseous,parenchymal
Este-Mcdonald colleagues
↑IAP→↓venous outflow from spinal cord via
lumbar & pelvic plexuses → ↑intracranial
pressure
19
Dept of Urology, GRH and KMC, Chennai.
20. INTRACRANIAL PRESSURE
Rosenthal & colleagues postulated that ,↑ICP is by
two phase mechanism
Early passive venous effect
Late active arterial effect
Acute elevation of ICP elicits CUSHING REFLEX
Todate ,no neurological sequelae in normal patients
20
Dept of Urology, GRH and KMC, Chennai.
22. VISCERAL EFFECTS
Decreased blood flow noted in mesentry,
liver,pancreas,stomach,spleen, small& large intestine
Increased blood flow in adrenals
No ↑ incidence of GE reflux/regurgitation
22
Dept of Urology, GRH and KMC, Chennai.
23. ACID BASE METABOLIC
EFFECTS
Co₂ absorbed from peritoneal membrane in TPL
&preperitoneal adipose& connective tissue in RPL
scopy
Co₂ absorption is more, during initial 30-60 minutes
of the procedure
Hypercarbia & respiratory acidosis is more common
ABG must in-lap >1 hour,COPD,RF,CCF.
23
Dept of Urology, GRH and KMC, Chennai.
24. ACID BASE METABOLIC
EFFECTS
Ideally End tidal co₂ & o₂ should be monitored using
a capnometer.
With ↑ in end tidal co₂, adjust the respiratory rate &
tidal volume.
24
Dept of Urology, GRH and KMC, Chennai.
25. HEMODYNAMIC EFFECTS IN RELATION
TO PATIENT POSITION
parameter Head up Head down
Heart Rate
MAP
SVR
CO
ICP
25
Dept of Urology, GRH and KMC, Chennai.
26. HARMONAL & METABOLIC
EFFECTS
Increase in βendorphin,cortisol,prolactin,
epinephrine,nor epinephrine,dopamine.
Reduced tissue loss of amino nitrogen in LAP
responsible for rapid convalescense
Lap procedures generally result in less
immunosuppression
26
Dept of Urology, GRH and KMC, Chennai.
27. COMPLICATIONS WITH VERESS
NEEDLE PLACEMENT
Pre peritoneal placement
Steep pressure rise
Unequal abdominal distension
Check –signs of proper entry
Negative aspiration
Easy irrigation of saline
Negative aspiration of saline
Positive drop test, normal advancement test
27
Dept of Urology, GRH and KMC, Chennai.
28. VASCULAR INJURIES
First sign-blood appearing at hub of the needle
Prevention-direct needle towards hollow of pelvis
Blunt subcutaneous fat separation, grasp & stabilise
anterior fascia before puncture
Non umbilical site of entry
Use of blunt trochars
28
Dept of Urology, GRH and KMC, Chennai.
29. VISCERAL INJURIES
Initial sign-aspiration of blood, urine, bowel
contents/high pressure on insufflations
Management-reintroduce at different site
Bleeding from liver/spleen need argon beam
coagulator or apply surgical hemostat[fibrin
glue]
Bowel/bladder entry needs only needle
withdrawal
29
Dept of Urology, GRH and KMC, Chennai.
30. VISCERAL INJURIES
Prevention-NG tube
Foley catheter
Stabilize abdominal wall fascia
Check proper signs of peritoneal entry
30
Dept of Urology, GRH and KMC, Chennai.
31. COMPLICATIONS OF
INSUFFLATION
Bowel insufflations
Gas embolism-mc cause is puncture of blood
vessel/organ
first sign-acute cardiovascular collapse
Dysrhythmias, tachycardia, cyanosis,
pulmonary edema
Millwheel precordial murmur
31
Dept of Urology, GRH and KMC, Chennai.
32. COMPLICATIONS OF
INSUFFLATION
Management of gas embolism
Cessation of insufflations
Desufflate peritoneal cavity
Turn pt in left lateral decubitus position
Hyperventilate with 100% oxygen
Advance central line into Rt heart & aspirate gas
32
Dept of Urology, GRH and KMC, Chennai.
33. COMPLICATION OF
INSUFFLATION
Barotrauma-prolonged elevated pressure [>15mm hg]
Cause-malfunction of insufflator
Insufficient pressure monitoring
PEEP ventilation –rupture of pulmonary bulla
Initial sign- hypotension-↓ venous return from IVC
compression
33
Dept of Urology, GRH and KMC, Chennai.
34. BAROTRAUMA
Management- desufflate the abdomen
Replace malfunctioning insufflator
Reinitiate pneumoperitoneum
Subcutaneous emphysema-cause
Improper veress needle placement
Leakage of co₂ around ports
Problem resolves in 2 to 3 post op days
34
Dept of Urology, GRH and KMC, Chennai.
35. PNEUMOPERICARDIUM
Cause-gas leak along major blood vessels,through
congenital defects
Incidence-0.8%
Diagnosis rarely made during procedure, usually
made in recovery room with CXR
Treatment-interrupt procedure
Desufflate abdomen
pericardiocentesis
35
Dept of Urology, GRH and KMC, Chennai.
37. Complications of blind
placement of first trochar
Injury to GI organs-small/large intestine injury
Injury to intra abdominal vessels-0.11%-2%
More common in retroperitoneoscopy
Aorta & common iliac vessels-mc
In intestinal adhesions- mesentric vessel of
fixed loop, may be injured
First sign-hypotension, tachycardia
Treatment-emergency laporotomy
37
Dept of Urology, GRH and KMC, Chennai.
38. COMPLICATIONS
Prevention-special care in children
Look for CT scan if available
IAP may be temporarilyraisedto25mmHG
Avoid trochar through scar
treatment-vascular repair
38
Dept of Urology, GRH and KMC, Chennai.
39. INJURY TO URINARY TRACT
Mc with trochar passage
Incidence-0.02% to8.3%
Mc-bladder injury
Sign-pnematuria, macroscopic haematuria
Confirm-intra vesical installation of indigo carmine
Treatment-lap/open surgical repair[don’t allow to
heal on their own]
39
Dept of Urology, GRH and KMC, Chennai.
40. COMPLICATIONS OF SECONDARY
TROCHAR PLACEMENT
Bleeding at cannula site
Position related problems,
crossing swords & striking
handles
40
Dept of Urology, GRH and KMC, Chennai.
41. COMPLICATIONS OF GA
Cardiac arrythmias & cardiac arrest
MC - sinus tachycardia, bradyarrythmias
Causes- CO₂ insufflation, ↑ vagal tone
Changes in BP
Aspiration of gastric contents
Hypothermia [0.3⁰c for each 50L of co₂ insufflated]
↑bleeding tendency, ↑adrenergic response,
prolonged recoverytime, ↑early post op MI.
41
Dept of Urology, GRH and KMC, Chennai.
42. Complications of lap surgery
Bowel injury-Electro surgical etiology
Inappropriate direct activation
Coupling to another instrument
Capacitative coupling
Insulation failure
42
Dept of Urology, GRH and KMC, Chennai.
43. Bowel injury-management
Intra op – looks as white spots in serosa
Full extent of bowel necrosis-takes 18 days
Intraperitoneal free air unreliable
Early or late
Monopolar thermal injury/bipolar thermal injury
Preventive measures
43
Dept of Urology, GRH and KMC, Chennai.
44. BLADDER INJURY
Predisposing factors-prior pelvic/bladder surgery,
prior RT, endometriosis, bladder diverticula,
amyloidosis
Management- intra op or post op diagnosis
In post op- extraperitoneal or intraperitoneal
44
Dept of Urology, GRH and KMC, Chennai.
45. URETERAL INJURY
As a result of monopolar cautery around ureter
Common in lap hysterectomy-1%,lap endometrial
ablation,pelvic lymphadenectomy,lap radical
prostatectomy
Management-intra op or post op.
45
Dept of Urology, GRH and KMC, Chennai.
46. NERVE INJURIES
Invariably due to patient positioning
Brachial plexus appears to be at high risk
Schiatic nerve –stretching along superior leg when pt
in lateral decubitus position
Femoral nerve-lateral rotation& abduction of hip
46
Dept of Urology, GRH and KMC, Chennai.
47. EARLY POST OP
COMPLICATIONS
Acute hydrocele
Scrotal&abdominal ecchymosis
Pain
Incisional hernia->10mm port –in adults
Wound infection
DVT
rhabdomyolysis
47
Dept of Urology, GRH and KMC, Chennai.
48. DEEP VEIN THROMBOSIS
Immediate heparin anticoagulation
Pneumatic sequential compression devices
Unfractionated heparin 5000 units ,2 hours pre op
and 12th hourly post op
48
Dept of Urology, GRH and KMC, Chennai.
49. RHABDOMYOLYSIS
Mc after RPL procedures
Incidence -1%
Mc in male –LAP renal procedures>5hrs
Severe pain in downside hip area, brown urine,
CPK>5000units/dl
Hydration & alkalinisation, extended physiotheraphy.
Avoid kidney rest, hypotension ,gel/fluid pad.
49
Dept of Urology, GRH and KMC, Chennai.
50. LATE POST OP COMPLICATIONS
Lymphocele – mc after pelvic procedures, take
weeks to develop, present as mass/pressure effect –
CT- Percutaneous drainage/lap marsupialization.
Chylous ascites- mc after left sided retroperitoneal
surgeries,-abdominal distension-low fat medium
chain triglyceride diet-observe. CT scan reveal
ascites, tap & analyse.
Treatment- somatostatin, suturig of leaky lymphatic
channel.
50
Dept of Urology, GRH and KMC, Chennai.
51. PNEUMORETROPERITONEUM
Higher chance of subcutaneous emphysema,
pnemothorax and pneumomediastinum[7%],
vascular injuries
Less chance of intraperitoneal visceral injury, port
site hernia.
51
Dept of Urology, GRH and KMC, Chennai.