Complicações de procedimentos laparoscópicos em urologia: análise retropectiva de 1990 a 2002 / Analysis of the complications of laparoscopic procedures in urology. Between 1990 and 2002: a retropective review

Although laparoscopic surgery is a safe and effective procedure, it is not exempt from risks of complications and death. Complication rates have decreased in various procedures, with means of 1 percent, 3.9 percent and 9.2 percent, for those considered easy, difficult and very difficult, respectively, while death rates have ranged from zero to 0.09 percent. To analyze the characteristics and the incidence of complications regarding the technique, the patient, the surgeon and the various types of laparoscopic procedures used in urology. A literature review between January 1990 and June 2002 in Medline and Lilacs was undertaken, including approximately 22,000 patients submitted to laparoscopic surgery, classified according to the type of procedure. The complications were considered as major or minor in accordance with various criteria adopted by the authors for appraising their seriousness. The complications regarded as minor ones occurred mainly in the phases of access and insufflation, and were more common in the postoperative period. The ones considered as major were associated with the dissection phase, with more serious characteristics, with vascular lesions predominating over visceral ones. The laparoscopic urological procedures proved to be well tolerated by pediatric and obese patients. Complications rates with this technique were inversely proportional to theexperience of the surgeon; they were associated with the complexity of the procedures and were similar to those of the corresponding procedures performed through an open approach. Over ten years, in spite of the increasing complexity of laparoscopic procedures, complications rates have fallen to figures comparable to those of the corresponding open techniques.

Laparoscopic approach in the ovarian vein syndrome

INTRODUCTION: The main objective of this article is to describe ureterolysis and ovarian vein resection laparoscopic technique. SURGICAL TECHNIQUE: With the patient in a 45o flank position, 3 trocars are used, 1 of 12 mm in the umbilicus for the optic passage, and 2 of 5 and 10 mm inserted in right hypochondrium and iliac fossa, respectively, for the forceps and stapler passage. The ureter and ovarian vein are identified after the mobilization of the colon. Both structures are dissected, with one ovarian vein segment is resected between metallic clips. COMMENTS: the ureteral approach by transperitoneal laparoscopy and colon mobilization facilitates its dissection, identify its relation to other structures, as well as making possible the concomitant treatment of gynecological diseases. For the ovarian syndrome treatment, ureterolysis and ovarian vein resection are performed, using only 3 trocars. Owing to its simplicity, low morbidity, and good results obtained, this procedure represents a good option for the surgical management of this syndrome