Trocar-associated complications of laparoscopic surgery Journal Article

  


Author: Curtin, J. P.
Article Title: Trocar-associated complications of laparoscopic surgery
Abstract: A 59-year-old woman with a history of Hodgkin's lymphoma presented for evaluation of an asymptomatic solid right ovarian mass. The mass had been discovered on a routine abdominal-pelvic computed tomographic (CT) scan and measured 4.7 cm in maximum diameter. A transvaginal ultrasound confirmed the presence of the mass; the left ovary was normal and there were no ascites. A serum CA-125 was minimally elevated at 45 U/mL. The patient underwent a laparoscopic bilateral salpingo-oophorectomy. The pneumoperitoneum was established via a periumbilical incision using the open technique. A 10-mm trocar sheath was placed in the midline, and a 12-mm trocar sheath was placed in the left lateral abdominal wall to accommodate an endoscopic stapling device. After a thorough examination of the peritoneal cavity, the presence of the ovarian neoplasm was confirmed. To isolate the infundibular pelvic ligament and the ovarian vessels, the retroperitoneal pelvic space was developed bilaterally. When the location of the ureter could be shown, a window was created in the peritoneum to skeletonize the ovarian vessels, and then the vascular pedicle was clamped, stapled, and divided with the endoscopic stapler. The utero-ovarian pedicle was also clamped, stapled, and cut in a similar fashion. The specimens were removed via an extended midline incision, and the frozen-section diagnosis was consistent with a benign fibroadenoma. The patient was discharged on the first postoperative day on a regular diet. The patient was readmitted 6 days later with complaints of nausea, vomiting, and abdominal distension. Abdominal fiat and upright radiographs showed dilated loops of small bowel with air-fluid levels. An abdominal CT scan with oral contrast showed a high-grade obstruction with a loop of small bowel herniating through the anterior abdominal wall. The patient underwent an exploratory laparotomy via the 12-mm left lateral abdominal wall trocar site. Findings at laparotomy included an intact fascial layer, with a loop of small bowel herniated into the preperitoneal space via the defect in the anterior peritoneum from the 12-mm trocar insertion. The loop of bowel was released and was without evidence of compromise. The peritoneal defect was closed, and the patient recovered and was released in 3 days on a regular diet. She has had no further bowel complaints during 3 years of follow-up.
Keywords: adult; case report; laparoscopic surgery; postoperative complication; medical instrumentation; gynecologic surgery; surgical instrument; human; female; article
Journal Title: Clinical Consultations in Obstetrics and Gynecology
Volume: 8
Issue: 2
ISSN: 1043-0660
Publisher: W.B. Saunders Co.  
Date Published: 1996-06-01
Start Page: 113
End Page: 117
Language: English
PROVIDER: scopus
DOI/URL:

https://www.scopus.com/inward/record.uri?eid=2-s2.0-0029902674&partnerID=40&md5=8650196cf71a00131f48a96e5444adaf
Notes: Article -- Export Date: 22 November 2017 -- Source: Scopus