TAILIEUCHUNG - Prevention and Management of Complications from Gynecologic Surgery

It is more enjoyable to read about complications than to manage them. Surgical complications are challenging for several reasons. It is difficult to watch patients and their families suffer. Although some complications are minor setbacks that resolve over time, some lead to longstanding disability. As surgeons, we sometimes doubt ourselves in the wake of a complication and lose confidence in our abilities. In some cases, surgeons avoid surgery or practice heightened defensive surgery, rendering them surgically dysfunctional. We should ask ourselves, ‘‘Is there something I should have done differently?’’ ‘‘Could this have been avoided?’’ and ‘‘Should I have recognized something earlier?’’ These are questions I ask each week. | Prevention and Management of Complications from Gynecologic Surgery Contents Foreword xi William F. Rayburn Preface Surgical Complications xiii Howard T. Sharp Preventing Electrosurgical Energy-Related Injuries 369 Gary H. Lipscomb and Vanessa M. Givens Electrosurgery is used on a daily basis in the operating room but it remains poorly understood by those using it. In addition the physics of electrosurgery are far more complicated than those of laser. Common belief notwithstanding electrosurgery has an enormous capacity for patient injury if used incorrectly even though technology has markedly reduced the likelihood of patient or surgeon injuries. This article is intended to educate the clinician regarding the basis of electrosurgery and provide an explanation on how injuries may occur as well as how they may be prevented. Prevention Diagnosis andTreatment of Gynecologic Surgical Site Infections 379 Gweneth B. Lazenby and David E. Soper Surgical site infections SSIs have a significant effect on patient care and medical costs. This article outlines the risks that lead to SSIs and the preventive measures including antimicrobial prophylaxis which decrease the incidence of infection. This article also reviews the diagnosis and treatment of gynecologic SSIs. Avoiding MajorVessel Injury During Laparoscopic Instrument Insertion 387 Stephanie D. Pickett Katherine J. Rodewald Megan R. Billow Nichole M. Giannios and William W. Hurd Major vessel injuries during laparoscopy most commonly occur during insertion of Veress needle and port trocars through the abdominal wall. This article reviews methods for avoiding major vessel injury while gaining laparoscopic access including anatomic relationships of abdominal wall landmarks to the major retroperitoneal vessels. Methods for periumbilical placement of the Veress needle and primary trocar are reviewed in terms of direction and angle of insertion and alternative methods and locations are discussed. Methods for secondary port .

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