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Complications ??
• tachycardia, hypotension.
Management Intestinal Injury
• Faecal contamination at the tip of the Veres
needle or trocar, or subtle signs such as
bowel-wall haematoma , bowel surface for
possible injury.
• Should be repaired immediately.
• Laparoscopically or by exteriorising the injured
loop through a mini-laparotomy
• Two-layered closure using 4/0 Vicryl or PDS
Urinary Tract Injury
• Occuring 0.05 - 8.3%.
• Common site: bladder (0,05 - 8%),
ureter (0.5 - 3%)
• Bladder: dome (common),
posterior base
• Ureter: near the infundibulopelvic
ligament
• Diagnosis: direct vision of injury.
• Late: vesicovaginal fistula, loin
pain, loss of renal function,
peritonitis.
• IVP, CT-Scan with contrast,
cystoscopy
Urinary Tract Injury
Therapy:
• Early recognition
• Bladder injury: repair with 2 layers of
absorbable suture. Catheter placement for 7 -
10 days
• Ureter injury: consult to urology, repair by
laparotomy or laparoscopy (if far from
bladder, injury < 1.5 cm)
Urinary Tract Injury
Prevention:
• Empty the bladder prior to trocar insertion
• Direct vision of insertion of secondary
trocar
• Identifying the ureter prior ligating the
tissue adjacent to the ureter
• Cystoscopy to assess for sutures in bladder,
kinking of ureter, and efflux from ureter
Laparoscopy Tips….
• Always watch the TIP of your scissors
• Always watch TISSUE EFFECT with grasping
• Beware of CROSSING instrument Shafts
• COMMUNICATE with and watch your assistant
• LOOK twice BURN once
• If you don’t KNOWwhat it is DON’T burn it !!
• IDENTIFY ANATOMY !
• IF DISORIENTED ZOOM OUT !!
Conclusion
• “ Knowledge is Power “
• Know your ANATOMY
• Know your TOOLS
• Know your PROCEDURE
• Know how to AVOID complications
Patient selection
Planning , anticipation and preparation
Entry
• Know how to RECOGNIZE complications
• Intra-op
• Post-op
• Know how to MANAGE complications
• Know your LIMITATIONS
• Major complications during laparoscopy are rare but can be
catastrophic.
• Surgical training, patient selection, understanding of anatomy
and energy sources, planning of surgery.
• Complications can be encountered preoperatively,
intraoperative, postoperative
TERIMA KASIH