How to Recognize, Prevent and Address Complications of Laparoscopic Gynecologic Surgery (original) (raw)
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Dealing with complications in laparoscopy
Best Practice & Research in Clinical Obstetrics & Gynaecology, 2009
With increasing adoption of laparoscopic surgery in gynaecology, there has been a corresponding rise in the types and rates of complications reported. This article sets out to classify complications associated with laparoscopy according to the phases of the surgery; assess the incidence, the mechanisms, the presentations; and recommend methods for preventing and dealing with complications in laparoscopic surgery. Its aim is to promote a culture of risk management based on the development of strategies to improve patient safety and outcome.
Complications of gynecological laparoscopy: experience of a single center
Clinical and experimental obstetrics & gynecology, 2014
The purpose of this study was to describe the prevalence and type of laparoscopic complications seen in a teaching hospital. Four hundred and forty-one diagnostic and operative laparoscopic procedures were performed by the same senior resident/resident surgical team. Direct entry technique was used for all procedures. The procedures included 74 (16.8%) diagnostic and 367 (83.2%) operative laparoscopies. The overall complication rate was 7.7% (34 cases). Conversion to laparotomy occurred in 16 cases (3.6%). The complication rate was found to be slightly higher than the rates quoted in the literature. This rate of 7.7% is still an acceptable one.
Complications of gynaecologic laparoscopy: an audit
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2018
Background: Minimal access surgery as a modality of treatment for various gynecologic conditions is rapidly gaining grounds in the recent years1. Approximately 30 years after its introduction; the use of laparoscopy in gynecology has evolved from diagnostic purposes into a more coordinated system for the repair or removal of diseased abdominal and pelvic organs. The rapid increase in the number of procedures being performed, the introduction of new equipment, and variability in the training of surgeons all contribute to the complication rate. The objective is to review complications associated with laparoscopic gynecological surgeries and identify associated risk factors.Methods: Hospital based descriptive observational study performed between January 2013 to December 2017 which included all gynecologic laparoscopies performed in present institute. Variables were recorded for patient characteristics, indication for surgery, length of hospital stay (in days), major and minor complica...
Perioperative morbidity of gynecological laparoscopy. A prospective monocenter observational study
Acta Obstetricia Et Gynecologica Scandinavica, 2000
To study the morbidity rate of gynecological laparoscopy and to the most influential variables. Methods. We conducted a prospective observational study from January 1st 1992 to December 31st 1998 in a single tertiary care center. It concerned patients who underwent gynecological laparoscopic surgery performed by seniors and residents. We have prospectively recorded patients characteristics, indications for laparoscopy, leading diagnosis, main operative procedures, post-operative course, surgical and anesthetic incidents and accidents. Complications were defined as any event that would modify the usual course of laparoscopy or of the postoperative period. Results. One thousand and thirty-three laparoscopies were included. 80.1% of the procedures were major or advanced laparoscopies. The overall complication rate was 3%, with a laparotomy rate of 1.2%. About half of those complications (54.8%) occurred during the installation of laparoscopy. Veress needle and first trocar insertion accounted for 23.5% of those accidents (0.3% of the procedures) and suprapubic trocar insertion for 76.5%. Hemorrhages constituted almost all of the complications occurring during the operative stage (80%). The risk increased with the level of surgery and decreased with surgeon's experience. Prior abdominal surgery had no significant effect on the overall morbidity rate. Post-operative and anesthetic complications were rare. The overall complication rate as well as the laparotomy rate were stable all along the course of the study. Conclusions. Complication rate of gynecological laparoscopy is not negligible. Efforts should be made to lower the complications induced by the installation of laparoscopy, especially for secondary trocars.
Perioperative morbidity of gynecological laparoscopy
Acta Obstetricia et Gynecologica Scandinavica, 2000
Background. To study the morbidity rate of gynecological laparoscopy and to the most influential variables. Methods. We conducted a prospective observational study from January 1st 1992 to December 31st 1998 in a single tertiary care center. It concerned patients who underwent gynecological laparoscopic surgery performed by seniors and residents. We have prospectively recorded patients characteristics, indications for laparoscopy, leading diagnosis, main operative procedures, post-operative course, surgical and anesthetic incidents and accidents. Complications were defined as any event that would modify the usual course of laparoscopy or of the postoperative period. Results. One thousand and thirty-three laparoscopies were included. 80.1% of the procedures were major or advanced laparoscopies. The overall complication rate was 3%, with a laparotomy rate of 1.2%. About half of those complications (54.8%) occurred during the installation of laparoscopy. Veress needle and first trocar insertion accounted for 23.5% of those accidents (0.3% of the procedures) and suprapubic trocar insertion for 76.5%. Hemorrhages constituted almost all of the complications occurring during the operative stage (80%). The risk increased with the level of surgery and decreased with surgeon's experience. Prior abdominal surgery had no significant effect on the overall morbidity rate. Post-operative and anesthetic complications were rare. The overall complication rate as well as the laparotomy rate were stable all along the course of the study. Conclusions. Complication rate of gynecological laparoscopy is not negligible. Efforts should be made to lower the complications induced by the installation of laparoscopy, especially for secondary trocars.
Human Reproduction, 1998
A multicentre study was carried out in seven top French centres for laparoscopic gynaecological surgery. This series covers a period of 9 years, in which 29 966 diagnostic and operative laparoscopic operations were performed. The risk of complications has been assessed according to the complexity of the laparoscopic procedure in question. The means of diagnosis and treatment of the complications have been analysed, together with the importance of the surgeon's degree of experience. The mortality rate was 3.33 per 100 000 laparoscopies. The overall complication rate was 4.64 per 1000 laparoscopies (n ⍧ 139). The rate of complications requiring laparotomy was 3.20 per 1000 (n ⍧ 96). The complication rate was significantly correlated with the complexity of the laparoscopic procedure (P ⍧ 0.0001). One in three complications (34.1%; n ⍧ 43) occurred while setting up for laparoscopy, and one in four (28.6%) were not diagnosed during the operation. As new indications for laparoscopic surgery in gynaecology have appeared, there has been a parallel and statistically significant increase in the rate of urological complications (P ⍧ 0.001). Increased experience by the surgeons has had three consequences: a statistically significant drop in the number of bowel injuries (P ⍧ 0.0003), a drop in the rate of complications requiring laparotomy for those laparoscopic surgical procedures that are well defined (P ⍧ 0.01), and a change in the way complications are treated, with a significant increase in the proportion of incidents treated by laparoscopy (P ⍧ 0.0001).
Principles and strategies for dealing with complications in laparoscopy
Current Opinion in Obstetrics & Gynecology, 2010
Purpose of review To help surgeons and to make patients become fully aware of the risks of laparoscopic surgery. As complications are an inevitable reality of surgery, we need to be aware of the types of complications in a systematic way, train to respond in an appropriate way, and learn to communicate in a transparent and honest way to deal with complications in laparoscopic surgery. Recent findings This article aims to classify complications associated with laparoscopy according to the different phases in surgery and to promote a comprehensive strategy for dealing with them. Summary To promote a culture of risk management which delivers the benefits and minimizes the risks associated with laparoscopic surgery.
Major Complications of Laparoscopy: A Follow-Up Finnish Study
Obstetrical & Gynecological Survey, 1999
Methods: This was a nationwide record-linkage study from January 1995 through December 1996 including all Finnish hospitals performing gynecologic laparoscopies. Data files of the National Patient Insurance Association and the Finnish Hospital Discharge Register were used. Data were compared with previous results from 1990 to 1994.
Introduction of a safety checklist for gynecological laparoscopy
2020
This study focuses on the importance of a safety checklist for gynecological laparoscopic surgeries. There is no dedicated safety check list for gynecological laparoscopy although several general safety checklists are used in practice. (e.g. WHO safety check list). The aim was to introduce a safety check list dedicated to gynecological laparoscopy. This check list is based on our experience in performing gynecological laparoscopy in a tertiary care centre with a high workload. This check list is introduced after studying the complications occurring in areas covered by the check list. Present data from 776 cases performed over 4 years at professorial unit in obstetrics and gynecology, university of Sri Jayewardenepura, Colombo South teaching hospital, Kalubowila, Sri Lanka. Mean surgical time and complications associated with patient positioning were assessed. Complications associated with the areas assessed were found to be low. However, it is belief that these can be further reduc...