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Optical Access Trocar Injuries in Urological Laparoscopic Surgery

2003; Lippincott Williams & Wilkins; Volume: 170; Issue: 1 Linguagem: Inglês

10.1097/01.ju.0000067622.28886.75

1527-3792

Mathew Thomas, Koon Ho Rha, Albert M. Ong, Peter A. Pinto, Robert A. Montgomery, Louis R. Kavoussi, Thomas W. Jarrett,

Surgical Simulation and Training

No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Jul 2003Optical Access Trocar Injuries in Urological Laparoscopic Surgery MATHEW A. THOMAS, KOON H. RHA, ALBERT M. ONG, PETER A. PINTO, ROBERT A. MONTGOMERY, LOUIS R. KAVOUSSI, and THOMAS W. JARRETT MATHEW A. THOMASMATHEW A. THOMAS , KOON H. RHAKOON H. RHA , ALBERT M. ONGALBERT M. ONG , PETER A. PINTOPETER A. PINTO , ROBERT A. MONTGOMERYROBERT A. MONTGOMERY , LOUIS R. KAVOUSSILOUIS R. KAVOUSSI , and THOMAS W. JARRETTTHOMAS W. JARRETT View All Author Informationhttps://doi.org/10.1097/01.ju.0000067622.28886.75AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Inadvertent injuries during trocar and Veress needle placement are a rare but potentially serious complication of laparoscopic surgery. An access alternative is an optical trocar under direct vision. Limited data are available regarding the safety of this technique. We reviewed complications related to optical access trocars during standard transperitoneal urological laparoscopic procedures performed at a single institution. Materials and Methods: From 1995 to 2001 the optical access trocar was used as the initial trocar in 1,283 urological laparoscopic procedures. The procedures included simple and radical nephrectomy in 309 cases, donor nephrectomy in 386, partial nephrectomy in 79, pyeloplasty in 173 and various other procedures in 336. Intra-abdominal complications caused by optical access trocar were assessed. Results: The optical trocar was inserted at the umbilicus in 88 patients (7.4%), in the right upper quadrant in 445 (34.7%) and in the left upper quadrant in 750 (58.5%). There were 4 injuries (0.31%) associated with the optical access trocar. Complications occurred on the left side in 3 cases and on the right side in 1, including 1 injury to bowel, 1 mesenteric injury resulting in a retroperitoneal hematoma and 2 injuries to epigastric vessels. Three cases were recognized and repaired immediately but in a case of epigastric vessel injury the expanding abdominal wall hematoma required postoperative repair. Conclusions: Optical access trocars provide a safe and rapid technique for initial trocar placement. Results of this large series support the finding that few trocar related complications are associated with the optical access trocar. References 1 : Open versus closed establishment of pneumoperitoneum in laparoscopic surgery. Br J Surg1997; 84: 599. Google Scholar 2 : Needle and trocar injury during laparoscopic surgery in Japan. Surg Endosc1997; 11: 1198. Google Scholar 3 : A modified instrument and method for laparoscopy. Am J Obstet Gynecol1971; 110: 886. Google Scholar 4 : Use of the Hasson cannula producing major vascular injury at laparoscopy. Surg Endosc1999; 13: 1238. Google Scholar 5 : Safe creation of pneumoperitoneum using an optical trocar. Surg Endosc1999; 13: 306. Google Scholar 6 : Use of the optical access trocar for safe and rapid entry in various laparoscopic procedures. Surg Endosc2001; 15: 570. Google Scholar 7 : Trocar injuries in laparoscopic surgery. J Am Coll Surg2001; 192: 677. Google Scholar 8 : Survey of laparoscopic entry injuries provoking litigation. J Am Assoc Gynecol Laparosc2001; 8: 341. Google Scholar 9 : Major and minor injuries during the creation of pneumoperitoneum. A multicenter study on 12,919 cases. Surg Endosc2001; 15: 566. Google Scholar 10 : Trocar and Veress needle injuries during laparoscopy. Surg Endosc2001; 15: 275. Google Scholar 11 : The safety of laparoscopy performed by direct trocar insertion and carbon dioxide insufflation under vision. Aust N Z J Obstet Gynaecol1997; 37: 216. Google Scholar 12 : Bowel injury in open technique laparoscopic cannula placement. Urology1994; 43: 559. Google Scholar 13 : Serious trocar accidents in laparoscopic surgery: a French survey of 103,852 operations. Surg Laparosc Endosc1996; 6: 367. Google Scholar From the James Buchanan Brady Urological Institute and Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland© 2003 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 170Issue 1July 2003Page: 61-63 Advertisement Copyright & Permissions© 2003 by American Urological Association, Inc.Keywordssurgical instrumentskidneyintraoperative complicationslaparoscopyMetricsAuthor Information MATHEW A. THOMAS More articles by this author KOON H. RHA More articles by this author ALBERT M. ONG More articles by this author PETER A. PINTO More articles by this author ROBERT A. MONTGOMERY More articles by this author LOUIS R. KAVOUSSI Financial interest and/or other relationship with In Touch Health, INOSE Guide and Transurgical. More articles by this author THOMAS W. JARRETT Financial interest and/or other relationship with Merck and Valley Laboratories. More articles by this author Expand All Advertisement PDF DownloadLoading ...