Complications and conversions of pediatric videosurgery: The Italian multicentric experience on 1689 procedures

Abstract

We believe that the routine use of open laparoscopy in pediatric patients is a key factor to avoiding complications related to the Veress needle and blind introduction of the first trocar. Moreover, the surgeon's laparoscopic experience, the correct indications for laparoscopic surgery, and the verification of the laparoscopic equipment before surgery are also important rules to follow to reduce the incidence of complications. In the beginning, it is preferable to have the assistance of an expert laparoscopic surgeon to decrease the complications related to the learning curve period.

Minimally invasive surgery for ovarian cysts in children

“…Despite several potential advantages of the laparoscopic approach, certain limitations of this approach include the need for specialized equipment [29], associated higher cost, and longer operating time [30]. Furthermore, large cysts may limit the working space and hinder the insertion of the trocar.…”

Complications of Laparoscopic Minimally Invasive Surgery

“…[11][12][13] Hemorrhage from lesions of the abdominal wall vessels generally ceases spontaneously; a ligation may be necessary only if the epigastric vessels are involved. 7 Lesions of the intra-abdominal organs generally have no serious consequences if they are promptly identified and treated, whereas lesions of the intra-or retroperitoneal vessels generally require immediate conversion. 14,15 At present, complications related to the Veress needle are rare thanks to the routine use in most centers of open laparoscopy to introduce the first trocar.…”

“…24,25 The anesthesiologist should be asked to maintain relaxation of the abdominal wall; this allows a lower pneumoperitoneum pressure, so that fewer complications related to insufflation develop. 7 Most complications can be reduced by aptness of the surgeon and the team, together with a proper indi-ESPOSITO AND MONTUPET …”

“…An interesting article about the multicenter experience of the Italian Society of Videosurgery in Infancy (SIVI) reported that in a series of 1689 MIS procedures in children, the complication rate was 4.6%, and that in 72.2% of these cases, the complications could be managed laparoscopically, whereas in 27.8%, conversion to open surgery was necessary. 7 Frequently, the complications of laparoscopic MIS procedures are attributed to the so-called learning curve. We believe that this idea is not entirely correct.…”

“…5 After clip positioning, it is important to avoid coagulation near the clips because this maneuver can cause secondary displacement. 7 The main consideration in removing freed organs is the size of the structure. It is sometimes necessary to enlarge a trocar opening or create a minilaparotomy to enable organ extraction.…”