Commentary on the article “Diaphragm perforation during laparoscopic left adrenalectomy” of Stanisław Głuszek, Monika Kozłowska

The presented research belongs to the relevant and important kind of publications which contain important and “embarrassing” issues such as surgical complications. That issue has remained difficult to discuss.
The complications accompanying surgical procedures often become adverse, unwanted effects of invasive treatment. Early recognition allows us to take appropriate measures so that we can reverse or repair existing problems. Consequently the patient may be fully recovered. The evaluated presentation concerns such relevant matters, even though it concerns initially mini-invasive procedures.
The complications arising from videoscopy/laparos­copy are related to the use of mini-invasive techniques and to the kind of performed operations.
The particular problems for videoscopy/laparos­copy are caused by insufflations of CO2 (to produce a pneumoperitoneum), insertion of the first trocar, stabilization of all trocars, and obtaining a clear and safe field of vision, which enables correct anatomical identification. Other specific problems are related to technical aspects concerning the use of medical devices.
The postoperative surgical complications depend on the type of surgery that was performed by laparoscopy. The percentage of such unwanted cases varies.
If we compare these findings to the number of complications after open surgery, we will assess non-invasive methods reliably.
One of the common criteria is the incidence of biliary tract injury associated with laparoscopic cholecystectomy. Currently it is reported to be 2.5 times that of the open procedure. The rate varies across continents: in the USA 0.5-2.7% vs. 0.33% in Europe.
According to A. Tocchie, 30-day mortality after laparoscopic cholecystectomy occurs in 2.2% of all cases. Therefore, the frequency of occurrence of biliary tract damage is about 0.1-2% in the laparoscopic method and 0-0.7% in classic cholecystectomy. That is why the summation of the number of complications which results from laparoscopic methods and technical aspects dependent on the type of operation seems to be erroneous as well as quotation of such pieces of information while discussing laparoscopy performed in adrenal gland diseases. In adrenal gland surgical procedures complications are connected with injury of the parenchyma organs (liver, spleen, pancreas) or large vessels and very rarely with diaphragm injuries which can result in intraopera­tive occurrence of tension...


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