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Laparoscopy and Robotic Surgery in Urology

• Laparoscopy in Urology
• Laparoscopy in Urology: surgical technique
• Laparoscopy in Urology: complications

Complications of Laparoscopy and Robotic Surgery

Comparison between laparoscopy and open surgery:

Laparoscopic surgery compared to open surgery has a similar spectrum of side effects. Laparoscopy however reduces complications due to the surgical approach (surgical site infections, pain or abdominal hernia). In addition, laparoscopy minimizes bleeding complications, mostly due to the elevated abdominal pressure during the procedure which minimizes venous bleeding and leeds to an improved visualization of the surgical field. Overall, the recovery is faster after laparoscopic surgery compared to open surgery.

Complications of the laparoscopic approach:

A variety of complications (bowel injury, vascular injury) may be triggered by the establishment of pneumoperitoneum with the help of the Veress needle. The reasons are incorrect positions of veress cannula, adherent bowel loops to the abdominal wall and injury due to the blind insertion of the first trocar. A safe open surgical technique for the establishment of the pneumoperitoneum and insertion of the first trokar is highly recommended (please see section surgical technique of laparoscopy).

Complications caused by the pneumoperitoneum:

The increased intra-abdominal pressure (12–15 mmHg) leads to the following pathophysiological changes which may trigger a decompensation if comorbidity is present:

Decreased venous back flow:

Loss in blood pressure, heart failure, venous thrombosis.

Increased airway pressures:

Pneumothorax, pneumomediastinum.

Hypercapnia:

The penetration of CO₂ in tissue layers leads to emphysema and hypercapnia. This is usually compensated by an increase in the respiratory minute volume.

Complications of electrocautery:

Complications of electrocautery may arrise due to accidental coagulation of vital structures or due to technical defects (mainly due to monopolar electrocautery). Monopolar electrocautery harbours the risk of accidential coagulation due to faulty insulation of instrument shafts and unexpected electrical currents between instrument and vital structures (e.g., ureter oder bowel). Symptoms due to unnoticed thermal injury typically arrise after 5–7 days. Bipolar coagulation offers a safe alternative to monopolar electrocautery and should be preferably used.

References

  Deutsche Version: Komplikationen in der Laparoskopie