August 2007 · Vol. 19, No. 08Averting complications of laparoscopy: Pearls from 5 patients
Ureter, bladder, small bowel, colon, vascular system—all are at risk of damage during operative laparoscopy
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Fast Track
As many as 50% of unilateral ureteral injuries are asymptomatic
Intraoperative findings that suggest bladder injury include air in the urinary catheter, hematuria, and trocar-site drainage of urine
Trocar injury to the bladder dome requires one- or two-layer closure followed by 5 to 7 days of urinary drainage
Abrasions and lacerations can occur when traction is exerted on the bowel using serrated graspers
When bowel injury escapes detection until after the initial surgery, resection of all necrotic tissue is mandatory
Preoperative bowel prep is indicated in patients undergoing extensive pelvic surgery and in those whose history suggests endometriosis or significant pelvic adhesions
Lack of control or a wrong angle at insertion of the Veress needle and trocars is a major cause of large-vessel injury
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Farr
Nezhat,
MDDr. Nezhat is Professor of Obstetrics and Gynecology and Director of Gynecologic Minimally Invasive and Robotic Surgery in the Division of Gynecologic Oncology, Mount Sinai Medical Center, New York City. Ceana
Nezhat,
MDDr. Nezhat is Director of the Nezhat Medical Center and the Center for Special Minimally Invasive Surgery and Reproductive Medicine in Atlanta. He also is Adjunct Clinical Associate Professor of Obstetrics and Gynecology at Stanford University School of Medicine in Stanford, Calif. Camran
Nezhat,
MDDr. Nezhat is Fellowship Director at the Center for Special Minimally Invasive and Robotic Surgery, and Clinical Professor of Obstetrics and Gynecology, University of California San Francisco, and Clinical Professor of Surgery at Stanford University School of Medicine in Stanford, Calif.
Q. What is the only surgical procedure that is completely safe?
A. The surgical procedure that is not performed.
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