Errors and dangers in laparoscopic surgery
Background. About 46.5 million of surgical procedures and 5 million of gastrointestinal endoscopies are performed annually in the United States alone. Each procedure involves contact of the medical equipment with sterile tissues of the patient, so transmission of infection is the main risk of such procedures.
Objective. To describe the main errors and dangers in laparoscopic surgery.
Materials and methods. Analysis of literature data and own research on this topic.
Results and discussion. Endoscopic examinations in gastroenterology can transmit more than 300 types of infections, 70 % of which are salmonella and Pseudomonas aeruginosa. During bronchoscopy 90 types of infections are transferred. Different hospital facilities undergo different decontamination procedures. Objects that penetrate the skin or mucous membranes, or into sterile tissues or the circulatory system, require sterilization. Endoscopes are subject to pre-cleaning, leak testing, manual cleaning, rinsing and disinfection. Ideally, laparoscopes and arthroscopes should be sterilized between procedures in different patients. Such devices are difficult to clean and disinfect due to their complex structure. In the absence of adequate disinfection, infection of the patients occurs in cases where the number and virulence of the introduced bacteria or fungi is sufficient to overcome their own immune defenses. Prevention of infectious complications includes preoperative antiseptic treatment of the operating field and appropriate antibiotic prophylaxis (ABP). Abdominal drainage should be performed only when blood or bile accumulates in the operating field. Regular use of drainage in uncomplicated laparoscopic cholecystectomy (CE) increases the likelihood of infection. Examination of 65 laparoscopic operations for postoperative ventral hernias revealed that the reinforcement of preoperative ABP by the means of 7-day course of fluoroquinolones or cephalosporins significantly reduced the volume and rate of seroma formation. The strategy for the prevention of postoperative complications includes delicate tissue handling, thorough sterilization of instruments, abdominal lavage with Dekasan (“Yuria-Pharm”), the use of broad-spectrum antibiotics, the use of plastic containers for removed organs and pathological formations, etc. In laparoscopic surgery, more than half of intestinal and vascular injuries are the access complication (pneumoperitoneum, the introduction of the first trocar). A significant proportion of such injuries is not diagnosed during injury. Thermal injuries are also possible during laparoscopic interventions. To prevent them, it is advisable to check the instruments for damage, use plastic trocars, use bipolar coagulation methods, use safe methods of dissection and coagulation (ultrasound scissors, vessel sealing technology).
The frequency of damage to the bile ducts during laparoscopic CE is 0.26-0.30 %. The author’s study evaluated the effectiveness of laparoscopic subtotal CE in performing technically complex CE. Dekasan was used as an antiseptic for external and intraabdominal lavage during the interventions. Properties of Dekasan are the following: bactericidal, fungicidal, virocidal, sporocidal effects; lack of resorptive action; enhancing of the antibiotics’ effect; reducing the adhesion of microorganisms. In the first period (2005-2008) complex CE (1.5 %) was switched to the open operations. The frequency of postoperative complications was 28 %. In the second period, subtotal CE were used. The average operation time was 95 minutes; the average blood loss was 80 ml. Postoperative complications occurred in 14.6 % of patients. Mortality in the first period was 0.1 %, in the second – 0 %.
Conclusions. 1. Endoscopes should be thoroughly disinfected to minimize the risk of infections transmission. 2. Prevention of infectious complications also includes preoperative antiseptic treatment of the operating field and appropriate ABP. 3. In laparoscopic surgery, more than half of intestinal and vascular injuries are the complications of access. 4. Performing laparoscopic subtotal CE is an alternative to conversion in cases where it is impossible to laparoscopically identify anatomical structures.
This work is licensed under a Creative Commons Attribution 4.0 International License.