"You can get an inadvertent enterotomy from mechanical stresses when you pull on one organ which is bonded onto another," Dr. Kavic explained. The problem may also result from the use of energy within the body cavity. Medical instruments introduce many forms of energy that might accidentally be conducted into the bowel or other healthy structures.

"We use scissors and scalpels to produce mechanical energy; we use laser energy; electrosurgical devices with electrical energy; we use harmonic devices, which is ultrasonic energy. So we use a variety of energy sources. With electricity you can get capacitance coupling. That is an electrical charge built up in the tube you are working through (the cannula). Then if that cannula touches the bowel and discharges you can burn the bowel."


That accident may not be visible to the surgeon at all and so may not become apparent until a few days after the procedure.

What can be done to minimize risks? It's important that equipment be properly maintained and surgeons trained to avoid, yet search for and recognize these problems. Patients should take care to communicate with their surgeon about any prior procedures that might present complications in organ structure.

"Even under so-called normal procedures, there is a defined risk, under one percent, of having an enterotomy under the best of circumstances, so it is a recognized complication of surgical intervention," Dr. Kavic said. But he noted, "If laparoscopy didn't work better we wouldn't be doing it ... The benefits are tremendous and not the least of which is cosmetic. Do you want an eight-inch incision on your tummy? Nobody does."


Back to HCB News

More Industry Headlines