Safety in laparoscopy.
A survey of accidents during laporoscopy and the best way to avoid or correct them is presented. Accidents during the creation of the pneumoperitoneum include vascular and visceral lesions by the needle and false routes of the gas. Accidents at the introduction of the big trocar are 1) bowel lesion, 2) wounding of the vena cava or aorta, and 3) wounding of the bladder. Cardiorespiratory accidents have occurred at all stages of the operation, with over pressure of the pneumoperitoneum considered the major factor. Insufflation and chromoperturbation can occur during auxillary maneuvers. Safety with electrosurgery is discussed and precautions listed. Some of the secondary complications that have been reported include severe intraperitoneal hemorrhage, small hematomas, transient paralysis of the brachial plexus, intestinal or omental adhesion, and salpingitis. 3 general safety precautions are noted: 1) aspiration of the pneumoperitoneum needle to prevent reaspiration, 2) insertion of a normal needle, and 3) repeated control of intraperitoneal pressure. Trainees in laparoscopy should be made aware of potential problems so that this sterilization procedure will be much safer than laparotomy.