Most Common Mistakes in Laparoscopic Surgery
The beginnings of laparoscopic surgery can be challenging, and small mistakes can significantly hinder learning and affect patient safety. In this article, we discuss the 6 most common mistakes in laparoscopy – from improper ergonomics, through uncontrolled instrument movements, to issues with visualizing the surgical field. You’ll learn how to avoid them and which habits to adopt to operate confidently and safely.
Have you ever wondered why the beginnings of laparoscopy seem so challenging? Mastery of this technique requires both manual skills and a solid understanding of the theoretical principles related to maneuvering and ergonomics – only such a combination allows a surgeon to reach a level that enables safe patient operations. Here are six of the most common problems encountered by beginner operators.
Lack of ergonomic posture
This factor leads to rapid fatigue, reduces movement precision, and makes access to the surgical field more difficult.
Pro tip: A proper posture involves standing upright during the procedure, with the operating table set at a height that creates a 90º–110º angle at the elbow joint. The monitor should be at eye level or slightly below, and trocars positioned in a triangular arrangement. Following these principles significantly reduces muscle tension and allows for long operations without exhaustion.
Holding instruments outside the field of view
In laparoscopy, it is crucial to keep instruments within the camera’s field of view at all times. Uncontrolled movements can cause damage to structures and lead to intraoperative complications. To avoid this, the operator should always move instruments within the visible area.
Sudden movements and instrument crossing
Due to the nature of laparoscopic access, crossing instruments should be avoided as it can cause uncontrolled movement of one instrument while moving another. Rapid and abrupt movements may also result in accidental injury to structures in the surgical field. To prevent this, movements should be calm and controlled, always monitoring both instruments.
Leaving instruments in the surgical field
When a tool change is necessary, it is best to cooperate with the scrub nurse or assistant rather than leaving instruments in the field. Communicate the need for a new instrument, hand over the previous one, and then introduce the next. This ensures smooth operation flow and prevents accidental contact with non-sterile areas around the operating table.
Improper use of electrosurgical instruments
Each energy-based instrument has its specific characteristics, which must be understood for safe usage. Lack of knowledge regarding the differences between monopolar and bipolar instruments, the extent of coagulation, and the functions of each tool can lead to risks such as burns, excessive coagulation margins, or accidental tissue damage.
Poor visualization of the surgical field
This can result from two factors: misunderstanding the camera’s construction and operation, leading to handling difficulties, or lens fogging due to condensation in the surgical field. The first problem can be avoided by thoroughly reviewing the camera’s design and functionality, while the second can be mitigated by using surfactant solutions to prevent water accumulation on the lens.
You can train each of the above-mentioned skills in a safe environment using our laparoscopic trainers – Aspire and Advance.
Author: Adam Hajdaniak
