Pre and PosPre and PosConsiderations in

Pediatric Lapar

I l FI l FIsrael FraIsrael FraAssociate ProfesAssociate Profes

P U AP U A

Section of PedSection of Ped

New York MedNew York Med

ValhallValhall

st Operativest Operative n the care of theroscopy Patient

MDMDanco, MDanco, MDssor of Urologyssor of Urologygygy

diatric Urologydiatric Urology

dical Collegedical College

a, NYa, NY

Preoperative CPreoperative CPreoperative CPreoperative C

“Preoperative pa“Preoperative papatient selection patient selection ppas the actual lapas the actual lapprocedure”procedure”procedureprocedure

Gomella and Winfield PreoPreparation in LaparoscopKozminski and Winfield 19PUA Kozminski and Winfield 19

ConsiderationsConsiderationsConsiderationsConsiderations

atient care and atient care and are as important are as important pparoscopic aroscopic

operative Laparoscopic pic Urologic Surgery ed. Gomella 994994

ContraindicationsContraindicationsContraindicationsContraindications

Massive HemopeMassive HemopeCoagulopathy thCoagulopathy thCoagulopathy thCoagulopathy thcontrollablecontrollableDiff b l diDiff b l diDiffuse bowel disDiffuse bowel disto obstruction or to obstruction or

PUA

s to Laparoscopys to Laparoscopys to Laparoscopys to Laparoscopy

eritoneumeritoneumat is notat is notat is not at is not

t ti ith dt ti ith dstention either due stention either due ileusileus

Special consideraSpecial considerataken for thetaken for the

Patients with venPatients with venshuntsshuntsPrior history of NPrior history of NP i l t iP i l t iPrior laparotomiePrior laparotomieobstructionobstruction

PUA Diaphragmatic hDiaphragmatic h

ations should be ations should be Following: Following:

ntriculoperitoneal ntriculoperitoneal

NEC or peritonitisNEC or peritonitisf b lf b les for bowel es for bowel

erniasernias

Special consideraSpecial considerataken for thetaken for the

Massive AscitesMassive AscitesPrune Belly SyndPrune Belly SyndPrune Belly SyndPrune Belly SyndCardiac or respirCardiac or respirth t i i CO2th t i i CO2that impair CO2 that impair CO2 OrganomegalyOrganomegaly

PUAg g yg g y

Morbid obesityMorbid obesity

ations should be ations should be Following: Following:

dromedromedromedromeratory problems ratory problems

hhexchangeexchange

PreoperativPreoperativPreoperativPreoperativRoutine labs andRoutine labs andRoutine labs andRoutine labs andConfirm the presConfirm the pres

th dith dior the appendix or the appendix prior abdominal prior abdominal

PUA

ve Studiesve Studiesve Studiesve Studiesd PT PTTd PT PTTd PT PTTd PT PTTsence or absence sence or absence i ti t h h di ti t h h din patients who had in patients who had surgerysurgery

PreoperativPreoperativPreoperativPreoperativ

Evaluate the palpEvaluate the palpprior to laparoscoprior to laparoscop pp pIn patients with sIn patients with schecking if therechecking if therechecking if there checking if there adhesions with Uadhesions with U

PUA

ve Studiesve Studiesve Studiesve Studies

pable testis size pable testis size opy in NPTopy in NPTpypyshunts consider shunts consider

are pockets orare pockets orare pockets or are pockets or US or CTUS or CT

Post OperaPost OperaPost OperaPost Opera

PainPainHydrationHydrationHydrationHydrationFeedingFeedingDrains and tubesDrains and tubesFeversFeversPUA FeversFeversLumps and BumLumps and BumBleedingBleeding

ative Careative Careative Careative Care

ss

psps

Pain ManPain ManPain ManPain Man

Narcotics Narcotics ToradolToradolToradolToradolAcetaminophenAcetaminophenPCAPCA

PUA

nagementnagementnagementnagement

ShouldeShouldeShouldeShoulde

Keep patients flaKeep patients flaMinimizes post opshoulder pain

This is generallyThis is generallyThis is generally This is generally patients with sucpatients with suc

PUA

er Painer Painer Painer Pain

at for several hoursat for several hoursop complaints of p p

not a problem innot a problem innot a problem in not a problem in ction drainsction drains

Post OperativPost OperativPost OperativPost Operativ

Studies indicate Studies indicate hydrated patient hydrated patient y py ppost operatively.post operatively.Patients should bPatients should bPatients should bPatients should bpreoperatively if preoperatively if

PUA

ve Vomitingve Vomitingve Vomitingve Vomiting

that a well that a well has less vomiting has less vomiting gg

be hydratedbe hydratedbe hydrated be hydrated possible.possible.

To Hydrate or NTo Hydrate or NTo Hydrate or NTo Hydrate or N

ReimplantsReimplantsPyeloplastiesPyeloplastiesPyeloplastiesPyeloplastiesUDTUDTVaricocelesVaricocelesMajor reconstrucMajor reconstrucPUA Major reconstrucMajor reconstruc

Not to Hydrate?Not to Hydrate?Not to Hydrate?Not to Hydrate?

ctive surgeriesctive surgeriesctive surgeriesctive surgeries

Post operatiPost operatiPost operatiPost operati

Clears initiallyClears initiallyRegular dietRegular dietRegular diet Regular diet Mitrofanoffs and Mitrofanoffs and

Clears for 24 hou

PUA

ive Feedingive Feedingive Feedingive Feeding

cecostomiescecostomiesurs

DraDraDraDra

Remove drains aRemove drains adrainage is minimdrainage is minimggStress the systemStress the systemdrainsdrainsdrainsdrains

PUA

ainsainsainsains

as soon as the as soon as the malmalm before pulling m before pulling

StenStenStenSten

Most DJ stents reMost DJ stents reweeksweeksObtain US pre reObtain US pre rebaselinebaselinebaselinebaselineUS post removalUS post removal

PUA

ntsntsntsnts

emain in place 4emain in place 4--6 6

emoval as a emoval as a

l 4l 4--6 wks later6 wks later

Increased UrinIncreased UrinIncreased UrinIncreased Urin

Check location oCheck location oSuction drainageSuction drainageSuction drainageSuction drainageanastomosisanastomosisCl d f lCl d f lClogged foley caClogged foley caToo much fluidsToo much fluids

PUAPost obstructive Post obstructive

nary drainagenary drainagenary drainagenary drainage

of DJ stentof DJ stente againste againste against e against

th tth tatheteratheter

diuresisdiuresis

Abdominal distAbdominal distAbdominal distAbdominal dist

Bowel obstructioBowel obstructioUrinary ascitesUrinary ascitesUrinary ascitesUrinary ascitesUrinomaUrinomaBleedingBleedingSubcutaneous emSubcutaneous emPUA Subcutaneous emSubcutaneous em

tention or masstention or masstention or masstention or mass

onon

mphysemamphysemamphysemamphysema

Lumps anLumps anLumps anLumps an

Hernia at trocar sHernia at trocar sEvisceration of oEvisceration of oEvisceration of oEvisceration of oHematomasHematomasPneumoscrotum Pneumoscrotum

PUA

nd bumpsnd bumpsnd bumpsnd bumps

sitesiteomentumomentumomentumomentum

and pneumolabiaand pneumolabia

PostoperatiPostoperatiPostoperatiPostoperati

Pne mothoraPne mothoraPneumothoraxPneumothoraxPneumoniaPneumoniaAtelectasisAtelectasisAtelectasisAtelectasis

PositioningPainPainUrinary ascites

InfectionInfectionPUA

InfectionInfectionBowel injuryBowel injuryInfected urinoma oInfected urinoma oInfected urinoma oInfected urinoma o

ive Feversive Feversive Feversive Fevers

or hematomaor hematomaor hematomaor hematoma

Post operativPost operativPost operativPost operativ

Trocar siteTrocar siteEpigastric aEpigastric aEpigastric aEpigastric aRaw dissecRaw dissecUnsecured Unsecured Renal tissuRenal tissuPUA Renal tissuRenal tissu

ve bleedingve bleedingve bleedingve bleeding

artery injuriesartery injuriesartery injuriesartery injuriesction bedsction bedsvesselsvesselseeee

Diminished UDiminished UDiminished UDiminished U

N l h i lN l h i lNormal physiologNormal physiologDehydrationDehydrationyyObstructionObstructionMalpositioning ofMalpositioning ofMalpositioning ofMalpositioning ofBladder perforatiBladder perforati

PUA Disruption of anaDisruption of anaAcute Renal failuAcute Renal failuAcute Renal failuAcute Renal failu

Urinary OutputUrinary OutputUrinary OutputUrinary Output

iigic response gic response

f stentsf stentsf stentsf stentsionionastomosisastomosisureureureure

RespiratoryRespiratoryRespiratoryRespiratory

PneumothoraxPneumothoraxChylothoraxChylothoraxChylothoraxChylothoraxHemothoraxHemothoraxPulmonary emboPulmonary emboPneumoniaPneumoniaPUA PneumoniaPneumonia

y Problemsy Problemsy Problemsy Problems

olusolus

NeurologicNeurologicNeurologicNeurologic

Nerve injuriesNerve injuriesObturator nerveGenitofemoral nervFemoral nervePhrenic nerveHypogastric plexus

PUAyp g p

StrokesStrokesBrachial Nerve PalBrachial Nerve PalBrachial Nerve PalBrachial Nerve Pal

c Problemsc Problemsc Problemsc Problems

ve

s

sysysysy

ConcluConcluConcluConclu

Good preoperativeGood preoperativesome cases assessome cases assesyour procedure muyour procedure mushould eliminate sushould eliminate suThe problems encoThe problems encooperatively after laoperatively after la

PUA are really not muchare really not muchencountered after oencountered after o

usionsusionsusionsusions

e planning and in e planning and in sment may make sment may make

uch easier and it uch easier and it urprisesurprisesountered post ountered post paroscopic surgery paroscopic surgery h different than those h different than those open surgeryopen surgery

AdditionalAdditionalAdditionalAdditional

H d i d R i tH d i d R i tHemodynamic and RespiratorHemodynamic and RespiratorRetroperitoneal Laparoscopic Retroperitoneal Laparoscopic LorenzoLorenzo AJ, KarsliAJ, Karsli C, HalachmC, HalachmBissonnetteBissonnette B FarhatB Farhat WAWABissonnetteBissonnette B, FarhatB, Farhat WAWAThe Journal of UrologyThe Journal of UrologyApril 2006 (Vol. 175, Issue 4, April 2006 (Vol. 175, Issue 4, Optical Access Trocar Injuries inOptical Access Trocar Injuries inOptical Access Trocar Injuries in Optical Access Trocar Injuries in THOMASTHOMAS MA, RHAMA, RHA KH, ONGKH, ONG AMAMKAVOUSSIKAVOUSSI LR, JARRETTLR, JARRETT TWTWThe Journal of UrologyThe Journal of Urology

PUA July 2003 (Vol. 170, Issue 1, PagJuly 2003 (Vol. 170, Issue 1, Pag

l readingsl readingsl readingsl readings

Eff t f P di t i U l i lEff t f P di t i U l i lry Effects of Pediatric Urological ry Effects of Pediatric Urological Surgery: A Prospective Study Surgery: A Prospective Study

mimi S, DolciS, Dolci M, LuginbuehlM, Luginbuehl I, I,

Pages 1461Pages 1461--1465)1465)Urological Laparoscopic SurgeryUrological Laparoscopic SurgeryUrological Laparoscopic Surgery Urological Laparoscopic Surgery

M, PINTOM, PINTO PA, MONTGOMERYPA, MONTGOMERY RA, RA,

ges 61ges 61--63)63)

Nerve injury after laparoscopic varicCrocker J, Reinberg Y. Department oMinnesota, USA. J Urol. 2004 Aug;17PURPOSE: Laparoscopic varicocelectomychildren. Occasional reports of nerve injurychildren. Occasional reports of nerve injury published. There is anatomical variation in tvariable branching patterns of the nerves inpatients, focusing on the incidence of sensolaparoscopic varicocelectomy. MATERIALSlaparoscopic varicocelectomy. MATERIALSpatients who underwent laparoscopic varicoand DV) from 1997 to 2002 were retrospectpostoperative sensory complications were oRESULTS: A total of 58 patients underwent SU S tota o 58 pat e ts u de e tanalysis and 51 with a total of 62 varicoceleexperienced transient numbness of the ipsian average of 8.0 months (range 6 to 9). Sypostoperatively (range 0 to 10 days). In affe

PUAp p y ( g y )consistent with injury to the genitofemoral nvaricocelectomy is a minimally invasive proCautery or harmonic dissection of the peritotraction on the tissues surrounding the cordgsurgeons should be aware of the possibility

cocelectomy. Chrouser K, Vandersteen D, of Urology, Mayo Clinic, Rochester, 72(2):691-3; discussion 693. is a minimally invasive option for varicoceles in after inguinal laparoscopic procedures have beenafter inguinal laparoscopic procedures have been

the sensory innervation of the anterior thigh and nvolved. We report a retrospective analysis of our ory changes on the ipsilateral anterior thigh after

S AND METHODS: The medical records of allS AND METHODS: The medical records of all ocelectomy at 1 institution performed by 2 of us (YR tively reviewed. Demographics, outcomes and any obtained by chart review and telephone interview. laparoscopic varicocelectomy during this 5-year apa oscop c a coce ecto y du g t s 5 yea

es were available for review. Three patients (4.8%) lateral anterior thigh, which resolved or improved in ymptoms were not always noticed immediately ected patients the sensory distribution was usually p y ynerve. CONCLUSIONS: Laparoscopic cedure that still has the potential for complications. oneum overlying the spermatic cord and excessive d should be avoided intraoperatively. Patients and p yy of nerve injury and the resultant sensory deficit.

Pneumothorax in pediatric patients experience with 4 patients. WatermaH ilt BD Di i i f U l UHamilton BD, Division of Urology, ULake City, Utah, USA. J Urol. 2004 MPURPOSE: Pneumothorax is a rare but knsurgery and has been described occasionaduring such procedures are discussed as isinvestigate the occurrence of pneumothoraxchildren. MATERIALS AND METHODS: Pnprocedures in 4 pediatric patients (3 femaleyears (mean 5.4 years). Laparoscopic surgpartial nephrectomy, left upper pole partial ndysplastic kidney and bilateral Cohen reimpmaximum insufflation pressure of 15 mm Hgtotal of 285 laparoscopic urologic procedurePneumothorax was suspected due to decreincreased respiratory effort and decreased confirmed with chest x-rays. Operative time

PUA Duration of surgery before pneumothorax dmedian 168). Conservative management ofchest tube was used in 1. In all cases the eUrologists performing laparoscopy in childredeveloping during the procedure. Evaluatiofor pneumothorax in these patients. Close o

after urological laparoscopic surgery: an BJ, Robinson BC, Snow BW, Cartwright PC, U i it f Ut h S h l f M di i S ltUniversity of Utah School of Medicine, Salt Mar;171(3):1256-8; discussion 1258-9. nown complication of adult urological laparoscopic lly in children as well. The etiologies for pneumothorax

s the management of pneumothorax in this setting. We x during laparoscopic pediatric urological procedures in eumothorax developed during urological laparoscopic

es, 1 male). Patient age ranged from 8 months to 11 ical procedures performed included right upper pole nephroureterectomy, removal of left multicystic plantation of ureters. Procedures were performed with a g. During the same time period as these four cases, a es were performed at our institution. RESULTS: eased oxygen saturations, subcutaneous emphysema, chest lung sounds unilaterally. Pneumothorax was

e ranged from 171 to 249 minutes (mean 199.5). developed ranged from 75 to 239 minutes (mean 176, f pneumothorax was used in 3 patients and a pigtail stimated blood loss was minimal. CONCLUSIONS: en should be aware of the possibility of a pneumothorax n for decrease in O2 saturation should include a search observation generally suffices for management.

Thoracic complications during urologicalSteinberg AP Ng CS Desai MM Kaouk JHSteinberg AP, Ng CS, Desai MM, Kaouk JHInvasive Surgery, Glickman Urological InsOhio 44195, USA. J Urol. 2004 Apr;171(4)PURPOSE: We documented thoracic related comMATERIALS AND METHODS: A total of 1129 patieMATERIALS AND METHODS: A total of 1129 patie5-year period. Operative reports and postoperativeidentify patients with thoracic related medical and sleast 1 chest x-ray in the immediate or early postopwas no clinical indication to perform chest x-ray. RE

l t l l M di l lwere completely normal. Medical pulmonary compincidentally detected gas collections in the chest wrespectively. Medical complications in 12.6% of caseffusion in 4.8% and pulmonary embolus in 0.3%. Sin 4 patients (0.35%), hemothorax in 1 (0.08%) andp ( ), ( )collections were radiographically noted in 34 of thepneumomediastinum in 19 (3.1%), pneumothorax iof 40 (90%) thoracic surgical complications (3) andoccurred during retroperitoneal laparoscopy. Re-intpulmonary embolus requiring vena caval filter placPUA pulmonary embolus requiring vena caval filter plac(0.17%) and hemothorax requiring emergency opeconversion to complete the initial proposed operatimanagement of incidental CO2 pneumothorax, pneinitially in the clinically stable patient. Inadvertent dlaparoscopically without open conversion. Althoughthreatening, requiring prompt identification and ma

l laparoscopy. Abreu SC, Sharp DS, Ramani AP, H Gill IS Section of Laparoscopic and MinimallyH, Gill IS. Section of Laparoscopic and Minimally stitute, Cleveland Clinic Foundation, Cleveland, :1451-5. plications during urological laparoscopic surgery.

ents underwent major urological laparoscopic procedures in aents underwent major urological laparoscopic procedures in a e radiographic reports were retrospectively reviewed to surgical sequelae. Of the patients 619 (55%) underwent at perative period. In the remaining 510 patients (45%) there ESULTS: Of 619 patients undergoing chest x-ray 438 (71%) li ti i l th i li ti d b li i llications, surgical thoracic complications and subclinical,

were identified in 12.6%, 0.5% and 5.5% of patients, ses included pulmonary infiltrate/atelectasis in 9.7%, pleural Surgical complications included symptomatic pneumothorax d chylothorax in 1 (0.08%). Subclinical abnormal thoracic gas y ( ) ge 619 patients (5.5%) on chest x-ray, including in 10 (1.6%) and pneumopericardium in 5 (0.8%). Overall 36 d subclinical, incidentally detected gas collections (33) tervention was necessary in 6 patients (0.5%), namely ement in 3 (0 3%) pneumothorax requiring a chest tube in 2ement in 3 (0.3%), pneumothorax requiring a chest tube in 2

en thoracotomy in 1 (0.08%). No patient underwent open on. CONCLUSIONS: Due to its high solubility the expectant eumopericardium and pneumomediastinum is recommended

diaphragmatic entry can be satisfactorily repaired h it is rare, surgical thoracic complications are potentially life nagement.

Transperitoneal laparoscopy into the operative time, length of stay and comJr. Department of Urology, University USA J Urol. 2003 Jan;169(1):36-40. C1):548; author reply 548-9..PURPOSE: We evaluated the effect of prPURPOSE: We evaluated the effect of proutcomes in patients undergoing a renal/atransperitoneal approach. MATERIALS ANprocedures via a transperitoneal approachto obtain operative and perioperative datap p ppreviously undergone abdominal surgery. operation had a longer mean hospital staymedian operative room time (median 220 major complication rates were greater in pj p g pp = 0.009 and 16% versus 5%, p = 0.022,were not altered (4% versus 2% and 33%midline scar/ipsilateral upper quadrant scacomplication rate (12% versus 0%, p = 0.0

PUAp ( , p

(21% versus 13%, p = 0.502). Multiple logabdominal surgery was the only factor assCONCLUSIONS: Previous open abdominmajor complications, which most likely resj p , ythe scar impacted the access complicatioopen surgical procedures should be countransperitoneal route is elected. Alternativ

previously operated abdomen: effect on mplications. Seifman BD, Dunn RL, Wolf JS of Michigan Health System, Ann Arbor, MI,

Comment in: J Urol. 2003 Aug;170(2 Pt

revious abdominal surgery on perioperative revious abdominal surgery on perioperative adrenal laparoscopic procedure via a ND METHODS: Renal/adrenal laparoscopic h were assessed. Medical records were reviewed a. RESULTS: Of the 190 patients 76 (40%) had p ( %)

Patients with versus without an earlier abdominal y (3.8 versus 2.6 days, p = 0.002) but not longer versus 210 minutes, p >0.05). Operative and

patients with previous operations (16% versus 4%, p p p ( ,, respectively). Access and total complication rates

% versus 24%, respectively, p >0.1). An upper ar was associated with a greater access 029) but not a higher operative complication rate ) g p pgistic regression confirmed that previous sociated with operative complications.

nal operation increased the risk of operative and sulted in increased length of stay. The location of g yn rate. Patients who have undergone previous seled on the greater risk of complications if the

vely a retroperitoneal approach may be used.

Complications of laparoscopic prourological laparoscopy. Cadeddu JA, Bishoff JT, Hamilton B, SchulamS, Averch TD. Department of UroloMedical Center, Dallas 75390-9110,PURPOSE: To increase the safety and effPURPOSE: To increase the safety and effprograms have been developed to increasevaluated the impact of dedicated laparosafter trainees entered clinical practice. MA13 centers where laparoscopy was perfor13 centers where laparoscopy was perfortraining in urological laparoscopy before claparoscopic procedures performed after complications. Procedures were classifiedtraining each surgeon participated in a metraining each surgeon participated in a melaparoscopic cases were performed with t11.9%. The rate was unchanged when thecompared with all subsequent cases (12%The re-intervention rate was 1 1% The co

PUAThe re intervention rate was 1.1%. The coand early complication rates attributable tocases were identical. The most common cleakage/urinoma in 9, transfusion in 7 andsurgeons who completed at least 12 montsurgeons who completed at least 12 montinitial versus subsequent surgical experienof the learning curve for laparoscopy.

ocedures after concentrated training in JA, Wolfe JS Jr, Nakada S, Chen R, Shalhav m PG, Dunn M, Hoenig D, Fabrizio M, Hedican ogy, University of Texas Southwestern , USA. J Urol. 2001 Dec;166(6):2109-11. ficiency of laparoscopic surgery clinical trainingficiency of laparoscopic surgery clinical training se the skill and efficiency of urological trainees. We scopy training on the rate and type of complications ATERIALS AND METHODS: Data were obtained from med by a single surgeon with at least 12 months ofmed by a single surgeon with at least 12 months of

clinical practice. Data included training experience, commencing clinical practice and associated

d as easy, moderate and difficult. RESULTS: During ean of 71 cases In clinical practice a total of 738ean of 71 cases. In clinical practice a total of 738 the group reporting an overall complication rate of e initial 20, 30 and 40 cases per surgeon were %, 11.9% and 12% versus 11.8 to 12%, respectively). omplication rate increased with case difficulty Overallomplication rate increased with case difficulty. Overall o laparoscopic technique in the initial 20, 30 and 40 complications were neuropathy in 13 patients, urine d ileus in 5. CONCLUSIONS: The complication rate of ths of laparoscopy training did not differ according toths of laparoscopy training did not differ according to nce. Intensive training seems to decrease the impact

Complications of pediatric urologEsposito C, Lima M, Mattioli G, MMontinaro L Riccipetitoni G GarMontinaro L, Riccipetitoni G, GarM, Settimi A, Amici G, Jasonni V,Surgery, Magna Graecia UniversA 169(4) 1490 2 di i 14Apr;169(4):1490-2; discussion 14PURPOSE: We evaluate the results and procedures in children. MATERIALS ANDprocedures were performed at 8 Italian cdata of urological procedures for a total oto 14 years old. The indications for surge159, ambiguous genitalia in 37, total nepadrenalectomy in 3 and other diagnostic retroperitoneoscopic approach in 72 case(89.7%). Patient records were analyzed toccurred during the laparoscopic proceduRESULTS: We recorded 19 complication

PUA conversion to open surgery and 13 did noof 4 years all children were alive and hadcomplications. CONCLUSIONS: Our studsurgery has an acceptable rate of compliuse of open laparoscopy in pediatric patieMost complications can be avoided with scompliance with the indications for surge

gical laparoscopy: mistakes and risks. Mastroianni L, Centonze A, Monguzzi GL, r i A Sa anelli A Damiano R Messinarzi A, Savanelli A, Damiano R, Messina , Palmer LS. Division of Pediatric sity, Catanzaro, Italy. J Urol. 2003 492492. complications of laparoscopic urological

D METHODS: In a 3-year period 4,350 laparoscopic centers of pediatric surgery. We analyzed only the of 701 laparoscopic operations on patients 1 month ery were cryptorchidism in 414 cases, varicoceles in hrectomy in 34, partial nephrectomy in 4, procedures in 50. We adopted a es (10.3%) and a laparoscopic approach in 629 to search for any complication that may have ure and assess how they were managed.

ns (2.7%) in our series, of which 6 required ot. There was no mortality. At a maximum follow-up

d no problems related to the laparoscopic dy shows that pediatric laparoscopic urological ications with no mortality. We believe that routine ents is a key factor to help avoid complications. surgeon and team experience, together with proper

ery.

A nation's experience of bleediSchafer M Lauper M KrahenbuSchafer M, Lauper M, KrahenbuLaparoscopic and ThoracoscopSurg. 2000 Jul;180(1):73-7. BACKGROUND: Bleeding complications g punderreported. The aim of the current studcomplications and major vascular injuries PATIENTS AND METHODS: The Swiss ASurgery (SALTS) prospectively collected tg y ( ) ystandard laparoscopic procedures (1995 tinterest in intraoperative and postoperativinjuries. RESULTS: In all, 331 patients (2.Whereas 44 patients suffered from an extinternal in the remaining 287. Thirty-three transfusion with a mean blood loss of 1,63of external and 91% of internal bleeds. Thbleeding complications. External bleeding

PUA developed internal bleeding. External bleewhereas 50% of internal bleeds required foccurred in 12 patients (incidence 0.08%)CONCLUSIONS: Bleeding complications Meticulous dissection technique, immediamandatory for their management.

ng complications during laparoscopy. uhl L Swiss Association foruhl L. Swiss Association for pic Surgery, Zurich, Switzerland. Am J

during laparoscopic surgery are rare but probably g p p g y p ydy was to elucidate the clinical relevance of bleeding during standard laparoscopic procedures.

Association of Laparoscopic and Thoracoscopic the data on 14,243 patients undergoing different g gto 1997). These data were analyzed with special

ve bleeding complications and major vascular 3%) had intraoperative bleeding complications.

ternal bleed of the abdominal wall, the bleeding was patients with internal bleeding required blood

30 mL. Surgical hemostasis was necessary in 68% here were 250 patients (1.8%) with postoperative g occurred in 143 patients, and 107 patients eding was mainly treated conservatively (92%), further surgical intervention. Major vascular injuries ) with open treatment being necessary in all cases. are, in fact, common during laparoscopic surgery.

ate recognition, and adequate surgical treatment are

Complications of urological laparoexperience. Thomas R, Steele R, ApUniversity Medical Center, New OrAug;156(2 Pt 1):469-71. PURPOSE. Urological laparoscopy has unique set of complications Our retrospeunique set of complications. Our retrospeof maintaining a low number of complicatstandardized approach plus clinicians witAND METHODS. We evaluated 282 conslaparoscopic procedures at our institutionlaparoscopic procedures at our institutionpelvic lymph node dissection, and 41 (15The common factor in all of these laparosthus standardization for the entire series (4.2%) 5 were noted intraoperatively and(4.2%) 5 were noted intraoperatively andpatients (1.8%) required open surgical invascular (1), ureteral (1) and bladder (1) technical difficulties in 7 patients (2.8%) ain 1. Delayed complications included uret

PUAin 1. Delayed complications included uret2, exacerbation of bowel diverticulitis reqendotracheal intubation for hypercapnia iCONCLUSIONS. Along with appropriate benefit of significant laparoscopic experiebenefit of significant laparoscopic experieoveremphasized. The success of this com(2%) and minor (2.5%) complications exp

oscopy: a standardized 1 institution Ahuja S. Department of Urology, Tulane j p gyrleans, Louisiana 70112, USA. J Urol. 1996

a significant and steep learning curve plus its own ective study documents the success at 1 institutionective study documents the success at 1 institution tions during urological laparoscopy using a th significant laparoscopic experience. MATERIALS secutive adults who underwent urological n. Of the procedures 241 (85%) were performed forn. Of the procedures 241 (85%) were performed for 5%) for renal and other miscellaneous conditions. scopic procedures was a single team approach, of procedures. RESULTS. Of 12 complications

d 7 were discovered in the postoperative period. Fived 7 were discovered in the postoperative period. Five tervention, including 3 intraoperative repairs of injuries. Procedures were aborted because of and because of hemorrhage during adrenalectomy teral injury in 1 patient, seroma at the trocar site interal injury in 1 patient, seroma at the trocar site in

quiring surgical intervention in 1, prolonged in 1 and transient brachial nerve palsy in 2. patient selection and adequate instrumentation, the

ence and standardization cannot beence and standardization cannot be mbined approach is reflected in the low rate of major perienced at 1 institution.

C li ti i di t i lComplications in pediatric uroloPeters CA. Department of SurgeSchool, Boston, Massachusetts,PURPOSES: To assess the level of activityPURPOSES: To assess the level of activity relationship to complications a survey of thePediatrics, Section on Urology was conductquestionnaire was mailed to 251 pediatric uRESULTS: Of the respondents 75% reporteRESULTS: Of the respondents 75% reporte(average 54 cases). Patient age ranged frolaparoscopy was 19 of 401 total cases yearrepresented by the reported experience. Co(average complication rate 6 06% per pract(average complication rate 6.06% per practsubcutaneous emphysema the complicationrepair occurred in 0.39% of cases, includingpredictor of complication rate was laparoscopneumoperitoneum was also important in th

PUApneumoperitoneum was also important in th2.6% significant complication rate in contrasCONCLUSIONS: Laparoscopy is widely pragood safety record. Complications occur anfor supervised experience with emphasis onfor supervised experience with emphasis on

i l l lt fgical laparoscopy: results of a survey. ry, Children's Hospital, Harvard Medical , USA. J Urol. 1996 Mar;155(3):1070-3. in pediatric urological laparoscopy and itsin pediatric urological laparoscopy and its

e membership of the American Academy of ted. MATERIALS AND METHODS: An anonymous

urologists and 153 responses were recorded. ed performing diagnostic and operative laparoscopyed performing diagnostic and operative laparoscopy m newborn to 20 years. Average case load for rly. More than 5,400 laparoscopic cases are omplications were reported in 5.38% of cases titioner) Excluding preperitoneal insufflation ortitioner). Excluding preperitoneal insufflation or n rate was 1.18%. Complications requiring surgical g bowel, bladder and great vessel injury. The clearest opic experience. The technique used to obtain hat Veress needle technique was associated with ahat Veress needle technique was associated with a st to 1.2% for open technique (p < 0.006). acticed in the pediatric urological community with a nd important means of minimizing them are to provide n the details of safe techniquen the details of safe technique.