Ten Key Points to Remember in Prevention and Management of Laparoscopic and Endoscopic Surgical Complications
1. All abdominal or pelvic procedures carry an inherent risk of bowel injury irrespective of the use of an open or MIS format.
2. Unsuspected and untreated injuries can result in major morbidity or mortality.
3. The key to management of these potentially life threatening problems must be centered on prevention and the prompt recognition and early treatment of injuries should they occur.
4. Thorough understanding of the anatomy, the use of sound surgical principles and careful technique will prevent many problems.
5. MIS procedures require well-thought-out positioning of patient an trocars, careful use of traction and countertraction, clear visualization of instruments and surrounding structures, and careful use of electrosurgical and other devices.
6. Injury management may include suturing, resection, stapling, exteriorization, and conversion to an open procedure.
7. Conversion to an open procedure is always an option.
8. Pneumatic sleeves may be helpful in some circumstances to prevent and to treat bowel injuries.
9. Careful planning, meticulous technique, and attention to detail will prevent or minimize the incidence of bowel-related complications of MIS procedures.
10. A high index of suspicion is prudent for patients with fever, peritonitis, decreasing hematocrit, ileus, or "failure to thrive."
--Raymond J. Lanzafame, MD, MBA
From postgraduate course on Prevention and Management of Laparoscopic and Endoscopic Surgical Complications, Endo Expo 2002, New Orleans
"The use of the robot has the potential to convert surgical procedures that we presently perform by laparotomy to laparoscopy.
The use of present prototypes in surgical procedures that are already performed by laparoscopy may not be cost-effective.
The rapid evolution of robotics assures that they will play a role in the future."
--Tommaso Falcone, MD
Endo Expo 2002, New Orleans
"Endoscopic access provides an important advantage, leading frequently to the simplification of procedures, as is the case for operative hysteroscopy.
Medical practices have undergone rapid progress and many changes."
--Victor Gomel, MD
Honorary Chair, Endo Expo 2002
"Laparoscopic and endoscopic surgery is possible to teach and to learn in Latin America because laparoscopic techniques are systematic and reproducible, easy to teach, and easy to learn.
All the surgeons' experiences should be registered for data analysis and posterior publication in journals.
Quality control for our endoscopic work should be done to get the best results."
--Christian Miranda, MD
Honorary Chair, Endo Expo 2002
Avoiding Legal (Malpractice) Problems
1. Knowledge is power. Find out why complaints, lawsuits "really" begin. What triggers the complaint?
2. When all is not going well- according to expectations, give the problem more time, expend more effort, and make yourself more visible. Be concerned; show the concern.
3. Tell the truth, quickly, early.
4. Get experienced advice, not necessarily from someone who is cynical or glib.
5. We study much about what and how to do. Learn also what not to do, why not, and the traps of the activity.
6. Improve and sharpen well-tried and effective skills before rushing to new misadventures.
7. Know more than your opponent.
8. Work harder at preventing a problem for yourself than at getting into trouble.
9. The shortest distance between two points is not always a straight line.
--Harry Rein, JD, MD
"Robotics will inevitably find their way into mainstream medicine over the next decade, however, all procedures will not benefit from the technology.
The role of robotics will have to be defined by those that show a clear benefit to both patient and surgeon.
The challenge ahead will be training new and existing surgeons the new techniques."
--Thomas Jarrett, MD
"Laparoscopic ablative surgery for renal carcinomas has become well accepted and is now considered the standard of care for patients with organ-confined disease.
Laparoscopic reconstructive urology is playing an ever increasing role in minimally invasive surgical therapies for patients with urologic disease. However, these procedures are technically very challenging.
Robotic assisted surgery is a major factor in facilitating the laparoscopic reconstructive urologic procedures and will play an increasingly prominent role in the advancement of this aspect of laparoscopic urology.
The training and maintenance of laparoscopic urology skills has been a limiting factor in the widespread application of this minimally invasive surgery for urologic patients. New concepts in training and skills assessment are required for dissemination of laparoscopic urology to community urologists. These training concepts are presently in the formative stages of development."
--Elspeth M. McDougall, MD
www.Laparoscopy.org The Laparoscopic Surgery Information Source
