Intraoperative Accidents

Abstract

In spite of standardization and improvements in technique, colorectal surgery remains subject to an intraoperative accident rate that has undergone a slight increase with the advent of laparoscopy [1]. This fact can be correlated to the technical limitations of laparoscopic access, which are its two-dimensional imaging and the loss of tactile sensation [1]. The most updated studies report a global incidence of intraoperative accidents of 10-13% [2, 3]; for rectal surgery this incidence is significantly higher than for colonic surgery (13% vs. 7%) [3]. The most frequent intraoperative complications are hemorrhage, lesions to the bowel, spleen, urethra and bladder, as well as technical difficulties during anastomosis. The risk of technical difficulties during mini-invasive operations for colorectal cancer is higher for surgeons in the learning phase, a phase that is often longer for laparoscopy than for the same procedures carried out in laparotomy; the learning curve for laparoscopic rectal surgery seems to be about 35 operations [4–6]. In analyzing the learning curve of a junior surgeon, the most significant data are the complication rate, the length of the hospital stay and the incidence of re-hospitalization, and not the conversion rate and the length of the operation; indeed, if the operating time does not go down as the experience of the surgeon increases, this often reflects the fact that the more complex individual cases are generally performed by expert surgeons [7].