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Chapter-07 Avoiding and managing complications of laparoscopic surgery

BOOK TITLE: Minimally Invasive Gynecologic Surgery: Evidence-Based Laparoscopic, Hysteroscopic and Robotic Procedures

Author
1. Zupi Errico
2. Centini Gabriele
3. Moros Jesús Castellano
ISBN
9781909836099
DOI
10.5005/jp/books/12892_8
Edition
1/e
Publishing Year
2016
Pages
8
Author Affiliations
1. Viale Parioli 12 Rome, Italy, Tor Vergata, University of Rome-Italy, University of Rome Tor Vergata, Rome, Italy
2. University of Siena, Siena, Italy
3. Medifem, Zulia, Venezuela; IRCAD, Strasbourg, France
Chapter keywords
laparoscopic complication, endometriosis, extraperitoneal insufflations, aortic bifurcation, appropriate instruments, ultrasound, urinary tract injuries, cesarean section, thermal injury, cystoscopy, hysterectomy, vesicovaginal fistula, gynecological surgery, pneumoperitoneum, bladder dysfunction

Abstract

This chapter discusses avoiding and managing complications of laparoscopic surgery, where laparoscopy brought numerous advantages to gynecological surgery, such as smaller incisions, less postoperative pain, and shorter hospitalizations. To avoid injuries to the midline vessels, it is important to neither place the patient in the Trendelenburg position nor place the legs in a lithotomy position before the insertion of the first trocar. The entry device must be inserted straight into the pelvis, where the space is wider. The Veress needle must be grasped at mid-shaft, as one would a pencil, in order to reduce the length of the active part and avoid a sudden and too deep penetration into the abdominal cavity. The coupling effect is more dangerous in laparoscopy than in laparotomy because of the restricted field of vision. The anatomical proximity of the ureteral tract to the uterus and ovaries creates a risk for injury in any gynecological procedure.

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