Splenic Injury
- Prevention: Achieved through meticulous dissection
- Management: Hemostasis using robotic methods (e.g., coagulation, hemostatic agents); splenectomy should only be considered as a last resort
Esophageal or Gastric Wall Injury
- Prevention: Careful and precise dissection techniques
- Diagnosis: Can be confirmed intraoperatively using a methylene blue dye test
- Treatment:
- Suture repair of the defect, ideally covered by the wrap
- Intraoperative endoscopic evaluation if required
- For esophageal injuries, a Nissen fundoplication is preferable, avoiding additional sutures on the esophagus
Bleeding
- Short Gastric Arteries:
- May occur during their transection for fundus mobilization
- Hemostasis can be challenging in cases of significant visceral adiposity or poor exposure
- Diaphragmatic Veins:
- Located close to the esophageal hiatus
- Hemostasis in this area can also be demanding
- Aorta:
- Positioned posterior to the esophageal hiatus
- Injury, although rare, is possible and should be managed with extreme caution
Pneumothorax
- Cause: Occurs due to injury to the parietal pleura during mediastinal dissection
- Significance:
- Only critical if cardiopulmonary problems arise intraoperatively
- No immediate intervention is necessary if the patient is stable
- Management:
- If increased ventilation pressures or poor oxygenation are noted, reduce intra-abdominal pressure
- If necessary, place an intraoperative chest drain
- Continue and complete the operation robotically with the chest drain in place
- At the end of the surgery, ensure proper lung ventilation through manual ventilation with open trocars