Abdominal Access Complications During Surgical Laparoscopy

Abstract

Abdominal access and creation of pneumoperitoneum carry a definite risk of visceral injury. Pneumoperitoneum is created most commonly for the ' • performance of transabdominal laparoscopic surgery. Visceral injury in its broadest sense, during abdominal access and creation of pneumoperitoneum is divisible into injuries of blood vessels, gastro-intestinal organs, and the genito-urinary system. Although these catastrophic injuries• are rare, they represent a major reason for mortality from laparoscopic procedures, and a e; significant source of the morbidity associated with any laparoscopic

procedure.

There are four basic techniques used to create pneumoperitoneum; blind. Veress needle insertion followed by blind trocar insertion, blind direct trocar insertion, open visualized trocar insertion without prior pneumoperitoneum (Hasson technique), and optical trocar insertion with or without prior pneumoperitoneum. Thirty one patiems (6.7%) with abdominal access complications during

surgicallaparoscopy, three patients (0.6%)with major vascular, nine patients (1.9) with minor vascular injuries, six patients (1.3%) with bowel injuries, one case (0.2%) with bladder injuries, and twelve patients (2.6%) with abdominal wall complications.