Special Considerations Previous Procedures

Care must be taken when approaching patients who have undergone prior abdominal surgeries. These patients may have postsurgical adhesions, which increase the risk of bowel injury during Veress needle insertion, trocar placement, and dissection. In addition, the fibrosis secondary to prior surgery can make dissection more challenging. Veress needle placement should be as far from the previous incision site as possible.

In a series of 700 laparoscopic urologic procedures from a single center, comparison between patients with previous abdominal surgery (48%) and those with none (52%) revealed higher complication rates (9.4% vs. 4.8%) and higher open conversion rates (7.5% vs. 1.2%) in the previously operated patients. However, the differences were not statistically significant. The patients with prior surgery also had higher transfusion rates and slightly longer hospital stays, most likely due to higher medical comorbidity in this group (8).

Seifman et al. reported on 190 patients, of whom 40% had undergone previous abdominal surgery. The authors found that the group with prior abdominal surgery was associated with longer hospital stay (3.8 days vs. 2.6 days) and higher complication rates (16% vs. 5%). Specifically they reported that an upper midline and ipsilateral upper-quadrant scar were associated with a higher incidence of access complication (12% vs. 0%) (9).

In patients with a history of prior open abdominal surgery, an open Hassn trocar placement or a retroperitoneal approach should be considered (10).

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