Review
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jan 16, 2022; 14(1): 1-16
Published online Jan 16, 2022. doi: 10.4253/wjge.v14.i1.1
Safety considerations in laparoscopic surgery: A narrative review
Brij Madhok, Kushan Nanayakkara, Kamal Mahawar
Brij Madhok, Kushan Nanayakkara, Upper GI Surgery, University Hospitals of Derby and Burton NHS Foundation Trust, Derby DE22 3NE, United Kingdom
Kamal Mahawar, Department of General Surgery, South Tyneside and Sunderland NHS Foundation Trust, Sunderland SR4 7TP, United Kingdom
Author contributions: Madhok B wrote the initial draft and outline of the article, and reviewed, edited, and finalised the manuscript written by Nanayakkara K; Nanayakkara K reviewed the current literature, wrote the initial paper, and reference list; Mahawar K reviewed final version and rewrote parts of the article; all authors have approved the final version.
Conflict-of-interest statement: Brij Madhok–None; Kushan Nanayakkara–None; Kamal Mahawar–Mr. Mahawar has been paid honoraria and consultancy fees by Ethicon®, Medtronic®, Olympus®, Gore®, and various NHS Trusts for educational and mentoring activities.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Brij Madhok, FRCS, MBBS, MD, MS, Surgeon, Upper GI Surgery, University Hospitals of Derby and Burton NHS Foundation Trust, Uttoxeter Road, Derby DE22 3NE, United Kingdom. brijeshmadhok@gmail.com
Received: March 18, 2021
Peer-review started: March 18, 2021
First decision: July 17, 2021
Revised: August 11, 2021
Accepted: December 10, 2021
Article in press: December 10, 2021
Published online: January 16, 2022
Abstract

Laparoscopic surgery has many advantages over open surgery. At the same time, it is not without its risks. In this review, we discuss steps that could enhance the safety of laparoscopic surgery. Some of the important safety considerations are ruling out pregnancy in women of the childbearing age group; advanced discussion with the patient regarding unexpected intraoperative situations, and ensuring appropriate equipment is available. Important perioperative safety considerations include thromboprophylaxis; antibiotic prophylaxis; patient allergies; proper positioning of the patient, stack, and monitor(s); patient appropriate pneumoperitoneum; ergonomic port placement; use of lowest possible intra-abdominal pressure; use of additional five-millimetre (mm) ports as needed; safe use of energy devices and laparoscopic staplers; low threshold for a second opinion; backing out if unsafe to proceed; avoiding hand-over in the middle of the procedure; ensuring all planned procedures have been performed; inclusion of laparoscopic retrieval bags and specimens in the operating count; avoiding 10-15 mm ports for placement of drains; appropriate port closures; and use of long-acting local anaesthetic agents for analgesia. Important postoperative considerations include adequate analgesia; early ambulation; careful attention to early warning scores; and appropriate discharge advice.

Keywords: Laparoscopy, Laparoscopic surgery, Minimally invasive surgery, Key-hole surgery, Patient safety, Safe surgery, Safe laparoscopy

Core Tip: Check for pregnancy in women of the childbearing age group. Make an alternative advanced plan with the patient regarding unexpected intra-abdominal circumstances. Consider adequate thromboprophylaxis and antibiotic prophylaxis. Intraoperatively, surgeons should ensure correct patient positioning and placement of stack and monitor(s). Establishing pneumoperitoneum safely, proper use of energy devices/staplers, use of lowest possible intra-abdominal pressure, avoidance of 10-15 millimetre ports for placement of drains; and a thorough “time out” at the end are some of the other important intraoperative considerations. The operating count by nurses should include specimens and retrieval bags. Important postoperative considerations include analgesia, early ambulation, and careful attention to early warning scores.