The laparoscopic approach has intrinsic potential complications due to the type of access trocars and pneumoperitoneum. Trocar placement is performed through several muscular planes when the lateral approach is used, and subsequent pneumoperitoneum may dissect these anatomic planes. Despite careful suture of portholes, we observed a postoperative decrease of hematocrit and blood accumulation in the abdominal wall in 3 patients.
All of them had a low platelet count and a slow elevation of platelet count. Laparoscopic splenectomy is feasible, and the incidence of severe complications is reduced. We thank M. Puig, MD, and J. Gich, MD, for their help with the statistical analysis. All Rights Reserved. Table 1. View Large Download. Laparoscopic splenectomy: outcome and efficacy in consecutive cases. Ann Surg. Semin Laparosc Surg. Surg Laparosc Endosc. Surg Endosc.
What types of claims are associated with laparoscopic surgery?
Surgical Diseases of the Spleen. Can J Surg. Eur J Surg. Curr Probl Surg. J Am Coll Surg. J Surg Res.
- The Alexandrian Riots of 38 C.E. and the Persecution of the Jews. A Historical Reconstruction (Supplements to the Journal for the Study of Judaism).
- A Guide to Prevention and Management;
- What is a nephrectomy?.
Patients and methods. Sign in to access your subscriptions Sign in to your personal account. Create a free personal account to download free article PDFs, sign up for alerts, and more. Purchase access Subscribe to the journal. Sign in to download free article PDFs Sign in to access your subscriptions Sign in to your personal account. Get free access to newly published articles Create a personal account or sign in to: Register for email alerts with links to free full-text articles Access PDFs of free articles Manage your interests Save searches and receive search alerts.
Get free access to newly published articles. Create a personal account to register for email alerts with links to free full-text articles. Sign in to save your search Sign in to your personal account. Create a free personal account to access your subscriptions, sign up for alerts, and more. Purchase access Subscribe now. Purchase access Subscribe to JN Learning for one year. Sign in to customize your interests Sign in to your personal account. Create a free personal account to download free article PDFs, sign up for alerts, customize your interests, and more.
Recommended for you
Even obstructive pulmonary diseases can interfere with gaseous exchange, resulting in an accentuation of hypercarbia state. History of cardiac diseases: As hypercarbia and pneumoperitoneum-induced peritoneal stretching stimulates sympathetic nervous system, even mild chronic hypertension can precipitate relative hypovolemia and hypotension. Thus proper history of hypertension and cardiac illness should be evaluated thoroughly.
Patients with previous abdominal surgery, obesity and pregnancy should be planned for laparoscopic surgery after careful preoperative evaluation. All the above conditions are not absolute contraindication for surgery. In case of patient with previous abdominal surgery, the only contraindication is a documented evidence of frozen abdomen. Initial port placement should be well away from all abdominal scars. The right or left upper quadrant in the midclavicular line is the safe starting point.
Pregnancyis also not an absolute contraindication for laparoscopic surgery. The port should be placed at a site such that it avoids injury to the gravid uterus. There is increase risk of development of fetal acidosis. This problem should be managed by maintaining et-CO 2 between 25 and 33 by changing minute ventilation. The arterial blood gas monitoring should be considered as a special tool in these patients.
Obesity, when BMI is over 30, may be associated with co-morbidities such as cardio-pulmonary or metabolic disorders. Extra long instruments may be needed in these patients, as they have very thick subcutaneous layer of fat. Proper visualization of intra-abdominal contents needs proper elevation of the anterior abdominal wall. This may result in increased pneumoperitoneum pressure up to 15—20 mmHg, so complete muscle relaxation should be provided during surgery. This high intra-abdominal pressure can result in hypercarbia, so these patients should be under strict monitoring of et-CO 2 Any rise in et-CO 2 should be managed by desufflation of abdomen and by putting the patient in reverse Trendelenburg position.
Obesity is an independent risk factor for perioperative DVT formation, and therefore it is prudent to use compression pneumatic device along with subcutaneous heparin in these patients, unless contraindicated.https://rrafnuzzleme.ml
[Full text] Patient positioning during minimally invasive surgery: what is current | RSRR
Laparoscopic surgery, a modern surgical technique, has gained popularity over conventional abdominal surgery. There are a number of advantages of laparoscopic surgery as compared to an open procedure. These include reduced pain due to smaller incisions and minimal blood loss and shorter recovery time. The key element in laparoscopic surgery is the creation of pneumoperitoneum, which is generally made by CO 2. The major problems during laparoscopic surgery are related to CO 2 -induced pneumoperitoneum, which can affect the cardiopulmonary function, systemic carbon dioxide absorption, extraperitoneal gas insufflation, venous gas embolism, unintentional injuries to intra-abdominal structures and patient positioning.
Additional problems may occur in the obese, the pregnant ladies and in those who have had previous surgery. These problems can be averted if certain precautions have been kept in mind. These are:. All the cardiopulmonary-compromised patients should be assessed preoperatively by a physician or a cardiologist.
Complications in Laparoscopic Surgery
They are not contraindications for laparoscopic surgery. High-risk consent with intensive monitoring is mandatory to prevent mishaps. Informed consent for risk of anaesthesia in cardiopulmonary-compromised patients, additional port placement in case of previously operated patient, risk of abortion or preterm delivery in case of pregnant women should be explained.
Lower pressure pneumoperitoneum 10—12 mmHg with proper hydration of patient can prevent the consequences of preload and afterload on cardiac function. Using helium or nitrous oxide gas for the creation of pneumoperitoneum, if available in cardiopulmonary-compromised patients.
Measuring the et-CO 2 and arterial blood gas analysis, especially in cardiopulmonary-compromised patients and pregnant women to avoid fetal acidosis. Extra long trocar and instruments may be needed in obese patients.
Related Complications in Laparoscopic Surgery: A Guide to Prevention and Management
Copyright 2019 - All Right Reserved