How can we reduce the risks associated with the creation of a pneumoperitoneum in digestive surgery ?

What is it about?

Laparoscopy requires a pneumoperitoneum, the creation of which entails specific risks: bowel injuries and vascular injuries (aorta, vena cava, iliac vessels), potentially life-threatening.

The severity of these accidents, along with the non-decisional nature of published clinical research, more so than their incidence, have resulted in the development of this Patient Safety Solution, relating to pneumoperitoneum creation. This risk management solution raises awareness about the technical recommendations validated by the profession and the barriers that can be used to prevent complications or reduce their severity.

This Patient Safety Solution concerns professionals in the operating theatre (surgeon, anaesthetist and reresuscitation specialist, state registered theatre nurse) when creating pneumoperitoneum.

Method

The consequences of injuries occurring when creating a pneumoperitoneum were analysed in the feedback database of the doctors and medical teams accreditation system. 204 adverse events related to a pneumoperitoneum were reported by surgeons from the approved accreditation body for visceral and digestive surgery between 2008 and 2010. Their analysis resulted in the publication of consensual recommendations in 2012.

A new database analysis found 478 new adverse events related to pneumoperitoneum from January 2012 to April 2014, leading to the creation of the Patient Safety Solution in 2014. This document has been updated following work carried out by the approved accreditation body for paediatric surgery.

Moreover, a literature search has been conducted by the approved accreditation body.

Risk-reduction tools

The adverse events in-depth analysis allowed identification of causes and circumstances of adverse events related to the creation of pneumoperitoneum and proposes the following solutions :

• Prevent: list safety prerequisites of “what not to do” actions and of essential elements to prevent accidents related to the 2 pneumoperitoneum creation techniques.
• Recover: list actions to perform for incidents occurring during pneumoperitoneum creation.
• Attenuate: list actions to implement following a pneumoperitoneum creation related-incident (monitoring actions to mitigate risks to patients).