Surgeon Experience

Studies have shown that the incidence of complications and the conversion rate decrease significantly after the surgeon has performed more than 40 to 50 laparoscopic procedures (4,44). Complications, as previously noted, are also related to the difficulty of the laparoscopic procedure. Laparoscopic training is now a part of all urological residency programs, and extensive training is now offered in more than 20 fellowships in the United States. Assisting in laparoscopic procedures and then independently performing procedures under the supervision of an experienced surgeon can be accomplished via a formal mentoring system. This should minimize major complications including bowel complications.

SUMMARY

■ Laparoscopic bowel injury, if not promptly recognized and treated, can result in devastating

consequences.

■ The postoperative presenting symptoms and signs are not typical of bowel perforation following

open surgery.

■ Close postoperative clinical monitoring and serial imaging with computed tomography of the

abdomen and pelvis are valuable.

■ A low threshold for surgical exploration could be lifesaving.

Rectal injury can occur when the Denonvilliers' fascia is not properly incised at the base of the prostate during the retrovesical dissection or more often during the apical dissection.

■ A thorough knowledge of the anatomy, surgeon's experience, and constant awareness of the potential problems associated with energy-based instrumentation are crucial in preventing majority of the gastrointestinal complications of urologic laparoscopy.

■ Detailed preoperative discussion with the patient about all possible complications including bowel injury is mandatory.

■ Proper patient selection, surgeon's experience, meticulous attention to detail, and knowledge of potential complications that are associated with each procedure are the most important factors in minimizing complications.

0 0

Post a comment