Complications of Urologic Laparoscopic Surgery PDF

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 reconstructive surgery. Urologists were well positioned for this revolution 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 drawbacks, which may be responsible for its slow acceptance in all disciplines. Training in these techniques is difficult and only recently have training programs incorporated laparoscopic surgery as a key training component. Surgeons who completed training before the laparoscopic era may find it difficult to spend the time and effort required for safe laparoscopic 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 provides 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 different and need to be understood. When a complication does occur, open conversion is not always necessary and laparoscopic techniques to correct a problem exist. Laparoscopic procedures have also seen a unique set of complications, perhaps a reflection of the learning curve or a different approach to the operative site. Understanding these principles is the key to successful prevention strategies and good outcomes.

Rather than subdividing this text by procedure, we chose to focus on broad categories of complications seen with laparoscopic urologic surgery, their recognition, management, and prevention. Finally, this manual can provide the reader an easy reference than can be incorporated into any laparoscopic training program as well as a step-by-step guide to recognizing and managing difficult situations for surgeons already performing minimally invasive surgery.