Avoiding laparoscopic complications.

Two years after laparoscopic cholecystectomy was introduced, and new horizons in laparoscopic surgery were being developed, a noted academic surgeon told me that although he had initially doubted the viability of laparoscopic 'cholecystectomy, he had become an avid supporter. He cautioned, however, that many surgeons would perform the operation with minimal training and marginal laparoscopic skills and that the injury rate would be devastating. Unfortunately, that prophecy has come to pass. In this dissertation, I would like to discuss some of those complications and how to avoid them. I choose not to dwell on minor or peripheral complications such as wound infection, pneumonia, deep venous thrombosis, urinary tract infection and the like, but rather, concentrate on complications related directly to laparoscopy and Iaparoscopic surgery. Laparoscopic complications are either a direct result of poor laparoscopic technique or related to anatomic misidentification. Technical complications include major vascular or intestinal injury or insufflation injury. Anatomic injuries usually involve the bile ducts, ureter or sensory nerves due to poor dissection and identification.