Managing laparoscopic injuries: An addendum

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.