Laparoscopic repositioning of a dislocated pacemaker into the rectovesical pouch

Area of Science:

• Cardiology
• Minimally Invasive Surgery
• Gastrointestinal Surgery

Background:

• Epicardial pacemaker implantation is a critical procedure for cardiac rhythm management.
• Dislocation into the peritoneal cavity is an uncommon yet severe complication.
• Abdominal pacemaker migration poses significant risks, including infection and organ damage.

Observation:

• A 74-year-old patient presented with an abdominally implanted epicardial pacemaker that migrated to the rectovesical pouch.
• The patient's comorbidities increased the risks associated with traditional surgical approaches.
• Laparoscopic surgery was selected to minimize perioperative morbidity and mortality.

Findings:

• Successful laparoscopic retrieval of the dislocated epicardial pacemaker was achieved.
• The pacemaker generator was repositioned in a sub-sheath pocket.
• The pacemaker lead was secured using peritonealization with a running suture.

Implications:

• Laparoscopic retrieval is a safe and effective treatment for displaced pacemakers in the rectovesical pouch.
• Minimally invasive techniques can mitigate risks in high-risk surgical patients.
• This case highlights the importance of secure lead placement and monitoring for pacemaker migration.