Howard N. Winfield, MD, discussed surgeons’ mistakes from the genitourinary (GU) perspective in his presentation “Prevention & Management of Urological Laparoscopic Complications.” The rate of complications increases
with the complexity of the procedure, according to Winfield. Before 1990, the rate of complications during diagnostic laparoscopy was 0.84 per 1000 cases. But from 1990 to the present, complications with laparoscopic and robotic urologic surgery are 1% to 5% for easy procedures, 3% to 10% for moderate procedures, and 7% to 25% for difficult procedures. The 4 most common GU complications are vascular injuries, postoperative bleeding requiring transfusion, ileus, and wound infection. The complications that are unique to GU and GYN are positioning issues; ureteral, bowel, and vascular injuries due to clipping or stapling errors; exiting the abdomen; and abdominal wall trocar-site hernias. The rate of complications decreases as surgeons’ experience increases. The laparoscopic learning curve for pelvic lymph node dissection is 10-20 cases; for simple nephrectomy, it is >20 cases; for radical nephrectomy, it is 30-50 cases, for radical prostatectomy is it >70 cases, and for robotic prostatectomy, it is 25-30 cases. To decrease the learning curve, education needs to improve by the use of telementoring and teleconferencing; virtual reality training programs with surgical simulators; graduated laparoscopic skills training using video trainers, animal laboratories, cadavers, and proctoring; frequent surgery; and using hand-assist techniques. Complications can be prevented by increased training and proctoring, careful patient selection and preparation, preoperative planning between the OR and staff; establishing a laparoscopic team; meticulous attention to detail; and honesty, humility, and humbleness.
www.Laparoscopy.org The Laparoscopic Surgery Information Source