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Titre du document / Document title

Trocar injuries in laparoscopic surgery

Auteur(s) / Author(s)

BHOYRUL Sunil (1) ; VIERRA Mark A. (1) ; NEZHAT Camran R. (1 2) ; KRUMMEL Thomas M. (1) ; WAY Lawrence W. (3) ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

(1) Department of Surgery, Stanford University School of Medicine, Palo Alto, CA, ETATS-UNIS
(2) Department of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, CA, ETATS-UNIS
(3) Department of Surgery, University of California San Francisco School of Medicine, San Francisco, CA, ETATS-UNIS

Résumé / Abstract

BACKGROUND: Disposable trocars with safety shields are widely used for laparoscopic access. The aim of this study was to analyze risk factors associated with injuries resulting from their use as reported to the Food and Drug Administration. STUDY DESIGN: Manufacturers are required to report medical device-related incidents to the Food and Drug Administration. We analyzed the 629 trocar injuries reported from 1993 through 1996. RESULTS: There were three types of injury: 408 injuries of major blood vessels, 182 other visceral injuries (mainly bowel injuries), and 30 abdominal wall hematomas. Of the 32 deaths, 26 (81%) resulted from vascular injuries and 6 (19%) resulted from bowel injuries. Eighty-seven percent of deaths from vascular injuries involved the use of disposable trocars with safety shields and 9% involved disposable trocars with a direct-viewing feature. The aorta (23%) and inferior vena cava (15%) were the vessels most commonly traumatized in the fatal vascular injuries. Ninety-one percent of bowel injuries involved trocars with safety shields and 7% involved direct-view trocars. The diagnosis of an enterotomy was delayed in 10% of cases, and the mortality rate in this group was 21%. In 41 cases (10%) the surgeon initially thought the trocar had malfunctioned, but in only 1 instance was malfunction subsequently found when the device was examined. The likelihood of injury was not related to any specific procedure or manufacturer. CONCLUSIONS: These data show that safety shields and direct-view trocars cannot prevent serious injuries. Retroperitoneal vascular injuries should be largely avoidable by following safe techniques. Bowel injuries often went unrecognized, in which case they were highly lethal. Device malfunction was rarely a cause of trocar injuries.

Revue / Journal Title

Journal of the American College of Surgeons    ISSN  1072-7515 

Source / Source

2001, vol. 192, no6, pp. 677-683 (19 ref.)

Langue / Language

Anglais

Editeur / Publisher

Elsevier, New York, NY, ETATS-UNIS  (1994) (Revue)

Mots-clés anglais / English Keywords

Endoscopic surgery

;

Laparoscopy

;

Trauma

;

Abdomen

;

Iatrogenic

;

Trochar

;

Risk factor

;

Epidemiology

;

Complication

;

Treatment

;

Human

;

Surgery

;

Endoscopy

;

Abdominal disease

;

Mots-clés français / French Keywords

Chirurgie endoscopique

;

Laparoscopie

;

Traumatisme

;

Abdomen

;

Iatrogène

;

Trocart

;

Facteur risque

;

Epidémiologie

;

Complication

;

Traitement

;

Homme

;

Chirurgie

;

Endoscopie

;

Abdomen pathologie

;

Mots-clés espagnols / Spanish Keywords

Cirugía endoscópica

;

Laparoscopia

;

Traumatismo

;

Abdomen

;

Iatrógeno

;

Trócar

;

Factor riesgo

;

Epidemiología

;

Complicación

;

Tratamiento

;

Hombre

;

Cirugía

;

Endoscopía

;

Abdomen patología

;

Localisation / Location

INIST-CNRS, Cote INIST : 6004, 35400009649949.0010

Nº notice refdoc (ud4) : 1054114



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