MIS Complications: Managing the Emergency Consultation

MIS Complications: Managing the Emergency Consultation MIS Complications: Managing the Emergency Consultation MIS Complications: Managing the Emergency Consultation George S. Ferzli MD, FACS Professor of Surgery SUNY HSC, Brooklyn, NY George S. Ferzli MD, FACS Professor of Surgery SUNY HSC, Brooklyn, NY George S. Ferzli MD, FACS Professor of Surgery SUNY HSC, Brooklyn, NY

Is there a laparoscopic surgeon in the house? A 12 year old boy has inserted an eyebrow pencil into his penis. CT scan shows the pencil is now lodged in his bladder- - he’s waiting in the emergency room...

When is there an urgent need for a laparoscopic surgeon? ,[object Object],[object Object],[object Object],[object Object],[object Object]

I. Before an operation begins: ,[object Object],[object Object]

I. Before an operation begins: ,[object Object]

I. Before an operation begins: ,[object Object],[object Object],[object Object]

II. Upon entry into the abdomen- Untoward events ,[object Object],[object Object],[object Object],[object Object],[object Object]

Injury to abdominal wall blood vessels- Prevention ,[object Object],[object Object],Saber et al. Safety zones for anterior abdominal wall entry during laparoscopy. Ann Surg 2004; 239:182

Injury to abdominal wall blood vessels- Management ,[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Harkki-Sirren P et al. Major Complications of laparoscopy: Follow-up Finnish study. Obst Gyned 1999; 94:95 Deziel DJ et cl. Complications of laproscopic cholecystectomy. Am J Surg 1993; 165:9 Saville L et al. Laparoscopy and major retroperitoneal vascular injuries. Surg Endosc 1995; 9:1096 Chapron et al. Major vascular injuries during gynecologic laparoscopy. JACS 1997

Vascular injury- Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],Curet M. Surg Clinic NA; 80:1093

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Schrenk P et al. Mechanism, management and prevention of laparoscopic bowel injuries. Gastroin Endosc 1996; 43:572 Bishoff J et al. Laparoscopic bowel injury: Incidence and clinical presentation. J Urol 1999; 161:887

Bowel injury- Management ,[object Object],[object Object],[object Object],[object Object]

Bladder injury ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Nehzat C et al. Laparoscopic management of intentional and unintentional cystostomy. Jnl Urol 1996; 156:1400 Armenakas N et al. Iatrogenic bladder perforations. JACS 2004; 198:78

Bladder injury- Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Harkki-Sirren P et al. Major Complications of Laparoscopy: Follow-up Finnish Study. Obst Gyned 1999; 94:95 Chan et al. Am J Obstet Gynecol; 188:1273

Ureteral injury- Prevention ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Seidman D et al. In Laparoscopic Surgery. McGraw-Hill 2003

Ureteral injury- Diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Ureteral injury- Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],Pecoraro AP et al. The routine use of diagnostic laparoscopy in the intensive care unit. Surg Endosc. 2001 Jul;15(7):638-41. Epub 2001 May 14. Gagne DJ et al. Bedside diagnostic minilaparoscopy in the intensive care patient. Surgery. 2002 May; 131(5):491-6.

Consultation with an advanced laparoscopist plays a critical role when… ,[object Object],[object Object],[object Object],[object Object],[object Object]

So what happened to the eyebrow pencil? … a laparoscopic surgeon saved the day! 1 2 3 4

Liability and the laparoscopic consultation ,[object Object],[object Object],[object Object]

MIS Complications: Managing the Emergency Consultation

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