Management of intraoperative complications during laparoscopic left colectomy

INTRODUCTION: Minimally invasive surgery has gained a major role in the current management of colorectal disease since the introduction of laparoscopy in the early 1990s for colorectal procedures. The laparoscopic approach, in fact, is not exempt from the risk of intraoperative complications, some of which can occur outside the field of view. The aim of this chapter was to review the different types of complications that can happen during left colectomy, analyzing the causes, how to prevent them and what to do in case they occur. EVIDENCE ACQUISITION: A literature search was carried out using the MEDLINE and PubMed databases for studies published between January 1980 and October 2020. The following terms were used for the search: “complications,” “risk factors,” “colorectal surgery,” “colorectal resection,” “laparoscopy,” “left colectomy,” “intraoperative complications,” “splenic injury,” and “intraoperative bleeding.” EVIDENCE SYNTHESIS: From our literature search we identified twenty-four studies, including two systematic reviews and metanalyses, that were the most pertinent to the subject. CONCLUSIONS: Many different complications can occur during laparoscopic left colectomy. Maintaining control of the situation is important to provide a prompt solution to the occurred injury. Increasing the reporting rate of complications may help, in the future, to analyze the causes and improve management strategies, keeping in mind that the only surgeon who does not have complications is the one who does not operate.