How to avoid injury to bowel during laparoscopy
Be reluctant to perform laparoscopy in a patient known to have significant adhesions. Also, be aware of risk of injury at trocar entry and mindful of how you use energy devices.
IN THIS ARTICLE
Upon direct contact with the intestine, energy devices cut into the tissue in a manner similar to mechanical scissors or a knife but produce a larger wound. The reason? The transfer of heat to areas adjacent to the primary wound produces additional necrosis. Heat conduction, capacitive coupling, high-frequency leaks, and front scatter coagulate the intestinal wall with subsequent tissue devitalization and necrosis, the extent of which depends on the power density at contact and the duration of energy applied.
It is impossible to predict the depth or area of devitalization in energy-inflicted injury by visualization of the event.
In the Baggish review of 130 intestinal injuries, the number of injuries sustained during the operative procedure was 19 involving the small intestine and 29 involving the large bowel.12 Of this subset, 44% (21 cases) were secondary to the use of energy devices, with monopolar electrosurgical instruments alone accounting for 9 (43%) of the injuries.
Even best-laid plans can go awry
Despite our best intentions and precautions, accidents do sometimes happen, and bowel injury is no exception.In Part 2 of this article, I detail steps you can take to detect injuries in as timely a manner as possible.
