Tension Pneumothorax During Laparoscopy

Laparoscopy is one of the most common minimally invasive modalities for abdominal and pelvic surgery. Procedures using laparoscopy range from minor procedures such as hernia repair and pyloromyotomy to major procedures such as sleeve gastrectomy and bowel resection. These procedures require trocar placement and abdominal insufflation for visualization. Trocars are placed with limited information and can cause trauma to important structures. Hemodynamic changes with insufflation and patient repositioning during a procedure can rapidly evolve into emergent situations that require interdisciplinary communication and coordination for the successful management of the patient. This chapter will review the risks of laparoscopic abdominal surgery, discuss signs and symptoms of intraoperative tension pneumothorax, and review the management of a tension pneumothorax. In addition, this comprehensive chapter contains the materials needed to develop and implement a successful simulation, including a case scenario, narrative, and progression as well as a scoring rubric for evaluation of perioperative management of complications associated with laparoscopic procedures.