Complications of Urologic Laparoscopic Surgery

202 Pages·2005·1.171 MB·English

by  Sanjay Ramakumar, Thomas W. Jarrett

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RECOGNITION, MANAGEMENT
AND PREVENTION
EDITED BY
SANJAY RAMAKUMAR
University of Arizona Health Sciences Center
Tucson, Arizona, U.S.A.
THOMAS JARRETT
Johns Hopkins Medical Institutions
Baltimore, Maryland, U.S.A.
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DK2405_Discl.fm Page 1 Monday, April 25, 2005 7:45 AM
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Preface
Laparoscopy has made a significant impact on the surgical
management of disease. Advances in technology such as the
CCD camera, improved optics, computerized systems, and
smaller instrumentation have expanded applications from
diagnostic procedures to advanced ablative and reconstruc-
tive surgery. Urologists were well positioned for this revolu-
tion because of the endoscopic skills already acquired with
transurethral surgery. Surgeons now have an increasing
awareness of the impact an operation has on a patient and
that minimizing morbidity and decreasing convalescence are
essential to patient care. All the surgical principles such as
cancer control, hemostasis, and asepsis are maintained with
the patient returning to normal life significantly faster and
with less suffering.
Minimally invasive surgery, however, has some draw-
backs, which may be responsible for its slow acceptance in
all disciplines. Training in these techniques is difficult and
only recently have training programs incorporated laparo-
scopic surgery as a key training component. Surgeons who
completed training before the laparoscopic era may find it
iii
iv Preface
difficult to spend the time and effort required for safe laparo-
scopic surgery. Also, longer operating times associated with
laparoscopic surgery can be a disincentive to this approach.
Despite this, the surgical community continues to pursue
advanced laparoscopic skills for the benefit of their patients.
An integral component of laparoscopic training is a keen
understanding of the potential pitfalls that may arise.
Although the magnification provided with laparoscopy pro-
vides better visualization, complications are still difficult to
recognize owing to the sometimes unfamiliar anatomy,
decreased tactile feedback, 3-D vision and ability to only
visualize small portions of the surgical field at a given time.
Furthermore, the distance between operator and surgical
field prevents a surgeon from ‘‘placing one’s hands in the
wound and saving the day.’’
The laparoscopist must develop a ‘‘sixth sense’’ and
anticipate problems. This concept is not different from open
surgery, but the clinical clues during the operation are differ-
ent and need to be understood. When a complication does
occur, open conversion is not always necessary and laparo-
scopictechniquestocorrectaproblemexist.Laparoscopicpro-
cedures have also seen a unique set of complications, perhaps
areflectionofthelearningcurveoradifferentapproachtothe
operative site. Understanding these principles is the key to
successful prevention strategies and good outcomes.
Ratherthansubdividingthistextbyprocedure,wechose
tofocusonbroadcategoriesofcomplicationsseenwithlaparo-
scopic urologic surgery, their recognition, management, and
prevention. Finally, this manual can provide the reader an
easyreferencethancanbeincorporatedintoany laparoscopic
training program as well as a step-by-step guide to recogniz-
ing and managing difficult situations for surgeons already
performing minimally invasive surgery.
Sanjay Ramakumar
Thomas Jarrett
Contents
Preface . . . . iii
Contributors . . . . ix
1. Anesthetic Considerations/Complications . . . . 1
David C. Cuellar and Timothy D. Averch
Key Points . . . . 6
References . . . . 6
2. Complications of Laparoscopic Access . . . . . . 13
Matthew T. Gettman
Introduction . . . . 13
Prevention Strategies . . . . 15
Intraoperative Complications . . . . 23
Postoperative Complications . . . . 24
Conclusion . . . . 25
References . . . . 26
3. Major Vascular Injuries of Urologic Laparoscopic
Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Paul Yurkanin, Eugene Park, and Sanjay Ramakumar
Introduction . . . . 33
Review of the Literature . . . . 34
Keys to Diagnosis . . . . 35
Management Strategies . . . . 36
v
vi Contents
Prevention Techniques . . . . 39
Key Points . . . . 39
References . . . . 40
4. Stapler Malfunction and Management . . . . . . 43
David Y. Chan
Introduction . . . . 43
Scope of the Problem . . . . 44
Prevention . . . . 45
Conclusions . . . . 46
Key Points . . . . 47
References . . . . 47
5. Bowel Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Timothy M. Philips and Jay T. Bishoff
Introduction . . . . 49
Review of the Literature . . . . 50
Keys to Diagnosis . . . . 51
Management Strategies . . . . 57
Prevention Techniques . . . . 57
Key Points . . . . 61
References . . . . 62
6. Gallbladder, Pancreas and Splenic
Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
JonVarkarakis,ThomasJarrett,andSanjayRamakumar
Gallbladder Injuries . . . . 67
Pancreatic Injuries . . . . 68
Key Points . . . . 70
References . . . . 70
7. Liver Injury During Urologic
Laparoscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Kenneth Ogan and Jeffrey A. Cadeddu
Introduction . . . . 73
Abdominal Access and Liver Retraction
Injuries . . . . 74
Keys to Diagnosis . . . . 76
Management Strategies . . . . 76
Prevention Techniques . . . . 79
Contents vii
Key Points . . . . 79
References . . . . 80
8. Pleural Injury During Laparoscopic Renal
Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Joseph J. Del Pizzo
Introduction . . . . 83
Intraoperative Recognition . . . . 84
Management . . . . 86
Discussion . . . . 88
Key Points . . . . 91
References . . . . 91
9. Urinary Leak Complications
of Laparoscopy . . . . . . . . . . . . . . . . . . . . . . . . . . 93
George K. Chow
Introduction . . . . 93
Ureteral Injuries . . . . 94
Bladder Injuries . . . . 97
Renal Pelvic/Collecting System Injuries . . . . 98
Urethral Injuries . . . . 98
Conclusion . . . . 99
Key Points . . . . 100
References . . . . 100
10. Complications of Organ Extraction . . . . . . . . . 103
Oscar Fugita
Introduction . . . . 103
Intact Extraction vs. Morcellation . . . . 104
Complications During Live Donor
Nephrectomy . . . . 105
Complications During Radical Nephrectomy . . . . 107
Port Site Seeding . . . . 108
Key Points . . . . 109
References . . . . 110
11. Hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
Peter Colegrove and Sanjay Ramakumar
Incidence . . . . 115
Urologic Literature . . . . 118
Recognition . . . . 119