Abstract
Background
Injuries during initial port placement in minimally invasive abdominal surgery are rare but can cause major morbidity. We aimed to characterize the incidence, consequence, and risk factors for injury occurring on initial port placement.
Methods
This is a retrospective review of a General Surgery quality collaborative database with supplementary input from the Morbidity and Mortality conference database at our institution between 6/25/2018 and 6/30/2022. Patient characteristics, operative details, and postoperative course were assessed. Cases with an injury on entry were compared to cases without an injury to identify risk factors for injury.
Results
8844 minimally invasive cases were present between the two databases. Thirty-four injuries (0.38%) occurred during initial port placement. Seventy-one percent of injuries were bowel injuries (full or partial thickness) and the majority (79%) of injuries were recognized during the index operation. Median surgeon experience for the cases with an injury was 9 years (IQR 4.25–14.5) compared to 12 years of experience for all surgeons contributing to the database (p = 0.004). Previous laparotomy was also significantly correlated with the rate of injury on entry (p = 0.012). There was no significant difference in the rate of injury based on method of entry (cut-down: 19 (55.9%), optical entry without Veress: 10 (29.4%), Veress followed by optical entry: 5 (14.7%), p = 0.11). BMI > 30 kg/m2 (injury: 16/34 vs no injury: 2538/8844, p = 0.847) was not associated with an injury. Fifty-six percent (19/34) of patients with an injury on initial port placement required laparotomy at some point in their hospital course.
Conclusions
Injuries are rare during initial port placement for minimally invasive abdominal surgery. In our database, history of a previous laparotomy was a significant risk factor for an injury and appears to be more consequential than commonly implicated factors such as technique, patient body habitus, or surgeon experience.
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Special thanks to Judith French, PhD and Jie Dai, Phd for assistance with the database queries.
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Clayton Petro has research grants from Central Surgical Association, American Hernia Society and SAGES. Michael Rosen is the medical director of Abdominal Core Health Quality Collaborative and has stock options with Ariste. Ajita Prabhu accepts speaking fees and research support paid to institution from Intuitive Surgical, consulting fees and is on the Advisory Board for CMR Surgical, and accepts consulting fees from Verb Surgical. Lucas Beffa accepts honoraria from Intuitive Surgical. Sara Maskal, Ryan Ellis, Benjamin Miller, and David Krpata have no conflicts of interest or financial ties to disclose.
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Maskal, S., Ellis, R., Prabhu, A. et al. Injuries incurred from minimally invasive access for abdominal surgery. Surg Endosc 37, 5368–5373 (2023). https://doi.org/10.1007/s00464-023-10031-y
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DOI: https://doi.org/10.1007/s00464-023-10031-y