Arieh Shalhav, MD

This addendum includes advice on managing gas emboli/vascular insufflation,vascular injuries, subcutaneous emphysema, pneumomediastinum, and pneumothoraxArieh L. Shalhav, MD, is associate professor of surgery and directorof minimally invasive urology, and Marcelo A. Orvieto, MD, is a fellowin minimally invasive urology, University of Chicago.As discussed in a recent "Hands On" article ("How to preventand manage laparoscopic injuries," July 2003, page 50), the overallcomplication rate related to urologic laparoscopy is approximately 4%, varyingwidely according to the procedure's technical difficulty. In this addendumto the article, we discuss how urologists can prevent and manage additionalcomplications associated with laparoscopy, including gas emboli/vascularinsufflation, vascular injuries, subcutaneous emphysema, pneumomediastinum,and pneumothorax.

Urologic laparoscopy has assumed an important role as an alternative to open surgery. Advancement in techniques and equipment result in continuous expansion of the indications for urologic laparoscopy.