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When and How to "Open" in Laparoscopic or Robotic Surgery
1LSU Health Sciences Center, CHRISTUS Shreveport-Bossier Health System, Shreveport, LA, USA. pbsurgkj@aol.com.
Obesity Surgery
|February 19, 2016
Summary
This study presents a rapid surgical technique for emergent open conversion during minimally invasive procedures. It aims to help surgeons quickly manage acute hemorrhage or complications when laparoscopic instruments are insufficient.
Area of Science:
- General Surgery
- Surgical Education
Background:
- Minimally invasive surgery dominates current surgical training.
- Surgeons often lack experience and confidence in emergent open conversion.
- There is a need for efficient techniques to manage unexpected complications during laparoscopic procedures.
Purpose of the Study:
- To provide a rapid technique for emergent open conversion.
- To assist surgeons inexperienced in open procedures.
- To enable quick recognition and management of acute hemorrhage or critical issues.
Main Methods:
- Utilizes a left subcostal or high transverse incision.
- Describes a 3-cm midline incision extending into a 12-cm left subcostal "hockey stick" incision.
- Focuses on rapid application of a tamponading sponge and control of bleeding.
Main Results:
- The described left subcostal incision technique has been used in over 4000 bariatric cases.
- Achieved incisional hernia and major wound infection rates below 1% over a 30-year career.
Conclusions:
- Laparoscopic techniques have reduced emphasis on open visceral procedures in training.
- This rapid technique aids inexperienced surgeons in managing acute complications.
- Prevents long-term issues like wound infection, dehiscence, and hernia.
