Smart Surgeons Learn From Their Mistakes, Brilliant Surgeons Learn From Other Surgeons'Mistakes: Prevention and Management of Laparoscopic and Endoscopic Surgical Complications
“All abdominal or pelvic procedures carry an inherent risk of bowel injury,” said Raymond J. Lanzafame, MD, MBA, FACS, in his discussion
“Understanding Energy Sources, Mechanisms of Injury, & Their Management.” Bowel injuries during surgery can be caused during trocar insertion; acts of aggression, such as rough handling of tissue, poor technique, adhesiolysis, and instrument insertion or removal; mechanical causes, such as traction injuries, instrument malfunction, or instrument misuse; and thermal causes, such as light sources, monopolar cautery, bipolar cautery, and lasers. Bowel injuries are generally preventable with careful technique. Most can be repaired with laparoscopic techniques, pneumatic sleeves may be helpful sometimes in some cases, and most importantly, conversion to an open procedure is always an option. To prevent or minimize bowel-related complications during MIS, it is necessary to carefully plan the operation and use meticulous technique and attention to detail. If your patient experiences fever, peritonitis, decreasing hematocrit, ileus, or failure to thrive, this may be a sign of a bowel injury. A skilled surgeon can safely perform laparoscopic bowel surgery, but he or she must have a complete understanding of the instruments being used because electrosurgical devices and lasers can cause severe injuries if not used properly.
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