Please wait loading VIdeo Lecture of Prof. R.K. Mishra about Safe Laparoscopic Mistakes and Errors in Minimal Access Surgery
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Minimal access surgery is becoming extraordinarily popular largely in reaction to market forces. The only most significant predictor of adverse events in minimal access procedures is the connection with the provider using the specific operation.
Surgeons must acquire the necessary technical skills and expertise before performing new procedures on patients. Hospitals and payers should help make sure that providers possess the requisite experience before allowing procedures to be performed in their facilities or spending money on them, since patients alone will generally be unable to determine surgeon competency.
A number of governing bodies and surgical societies have published guidelines that outline standards for practicing postgraduate surgeons for skill acquisition in minimal access surgery, but these recommendations are based more about good sense and clinical experience than rigorous evidence. It is not known how influential the following tips have been in the granting of privileges.
Continued scientific studies are needed to determine the threshold for safe performance of the along with other procedures, the very best training methods to ensure competence, and techniques to minimize patient harm while proceduralists gain the experience they should be competent and to train others.
The enthusiasm for laparoscopic surgery has been tempered somewhat with the recent reports of unique complications associated with this minimal access surgical approach. Complications of laparoscopic surgery can be grouped into the following three categories:
1. complications of access
2. Physiologic complications of the pneumoperitoneum; and
3. Complications of the operative procedure.
As in all aspects of medicine, laparoscopic surgery requires experience on the part of the surgeon in order to afford patients the best possible outcome without any mistake and error. The laparoscopic internal anatomy visible through a high definition laparoscope differs in perspective from that presented in the open case. The surgeon who perform minimal access surgery, they have to acquire basic techniques such as suturing have to be relearned, and there is a decrease in tactile sense as an instrument is interposed between fingertip and tissue. In Minimal Access Surgery every surgeons and gynecologist have defined a learning curve for different laparoscopic procedures after which the rate of complications plateau and mistake can be minimized and most series note a decrease in the time necessary to complete a procedure from the first cases to the last. To perform laparoscopic surgery adequate instruction and super-vision would seem prudent as a surgeon ascends the learning curve. Ultimately, complications can be minimized but never avoided. Expeditious diagnosis and appropriate management of complications are requisite of all surgeons and gynecologists who want to perform safe laparoscopic surgery.
