COMPLICATIONS OF

LAPAROSCOPIC SURGERY
• complications associated with a laparoscopic approach is overall
low
• half of complications occur at the time of abdominal access
• Severe complications such as vascular injury and bowel perforation
can be catastrophic
• Conversion to an open procedure may be needed to manage
complications
COMPLICATIONS OF LAPAROSCOPIC SURGERIES

1. Anaesthetics Complications

2. Complications due to pneumoperitonium

3. Surgical complications

4. Diathermy related injuries

5. Patients factors related complications

6. Post operative complications

ANAESTHETICS COMPLICATIONS
1. Inadequate Muscle Relaxation

Contraction of muscle during procedure

Difficulty in Causes pain during port

Pneumoperitoneum insertion

Management
- Endotracheal intubation
- Pharmacological neuromuscular blockade
Mask hyper ventilation

Prior to induction 100% oxygen is given by mask ventilation

Hyperventilation

Distended stomach

injury during port insertion.

Or veress needle insertion.

Management
- Nasogastric tube prior to surgery.
COMPLICATIONS DUE TO PNEUMOPERITONIUM
Air Embolism

CO2 used for pneumoperitonium

Gets absorbed into circulation

Embolus may form and block pulmonary circulation

• Loud and clear murmur heard in (R) atrium and (R) ventricle (Mill-Wheel murmur)
• Management
• Stop and release pneumoperitoneum
• Repositioning the patient
• Ventilation
Extra-peritoneal gas insufflation

• Failure to introduce the Veress' needle into the peritoneal cavity may
produce extra-peritoneal emphysema.
• diagnosis is made by palpation of crepitus caused by bubbles of CÓ2
under the skin
• The laparoscope should be withdrawn and attempts made to express
the gas.
• The needle may then be re-introduced through the same or another
site. Alternatively the trocar and cannula may be introduced by 'open
laparoscopy
Pneumothorax

• Pneumothorax may result from insertion of the Veress' needle into the pleural
cavity.
• Whenever a high site of insertion is chosen the needle should be directed
away from the diaphragm and, as always, the standard protocol of aspiration
and sounding tests employed.
• Pneumothorax should be suspected if there is difficulty in ventilating the
patient. There may be a contra-lateral mediastinal shift and increased
tympanism over the affected area.
• The procedure should be abandoned and the gas allowed to escape. The
patient should be kept under observation.
• Occasionally assisted ventilation and insertion of a pleural tube may be
required
Pneumo-omentum

• The omentum is penetrated by the Veress' needle.

• The misplacement should be recognised by the aspiration test and the
position of the tip altered to free the needle.
• The condition is usually innocuous unless and omental blood vessel is
punctured.
SURGICAL COMPLICATIONS
Injury to Viscus : (Stomach)

Hyperventilation by Mask

Distended stomach

May be injured with trochar or needle

Diagnosis
• Laparoscopic view of inside of stomach
Management
• Extend trocar incision into a mini laparotomy.
• Laparosocpically
- Pursestring suture or a figure of 8 suture in the seromuscular layer surround the defect.
- Nasogastric tube drainage for two days.
Bowel

May be injured due to trocar or veress needle

If due to veress needle it is managed conservatively

Diagnosis
• The emanation of foul smelling gas through pneumo-peritoneal needle
• There may be GI contents at the tip of needle.

Management
• Mini laprotomy and repair of perforation.
• Laparoscopically it may be sutured of laparoscopic stapler (ENDO-GIA) can be used.
• Colostomy
Small Bowel Perforation

Most often during insertion of umblical or lower quadrant trocars

Usually recognized later in the procedure
If adhesions are not freed from anterior abdominal wall perforation may not be
recognized

Management
• One should consider higher primary site if adhesions are found through
umblical port.
• If injury is free of adhesions bowel can be withdrawn through 12 mm trocar
tract and repaired
Bladder

Injury caused by second puncture trocar usually .

Diagnosis : Appearance of gas and blood in Foley’s catheter bag.
Management
• Early detection is important.
• Place an indwelling catheter for 7-10 days and prophylactic antibiotics
• If defect is larger. Repaired by a figure of 8 suture through muscularis of
bladder & second suture to close peritonium

* A water tight seal should be. documented by filling bladder with indigo carmine
dye solution
Ureter
May be injured in adenexal surgeries.
• Thermal injury will result in ureteral narrowing and hydroureter.

Management –
• Placement of ureteric stent for 3 – 6 weeks
Vessel Injury :
• Larger vessels may be injured by trocar or veress needle.
• CO2 peritoneum may tamponade a large vessel injury.
• When pressure normalizes it starts bleeding.

Management
• Examine the course of large vessels.
• Overlying peritoneum is opened with laproscopic scissors or a CO2 laser.
• Hematoma evacuated by alternate suction and irrigation.
* Laprotomy is required if hematoma is expanding or persistent bleeding
DIATHERMY RELATED INJURIES
Due to
• Inadvertent activation of the diathermy pedal.
• Faulty insulation
• Direct coupling
• Capacitative coupling
• Cautery should be used under vision
Injuries
• Thermal necrosis of organs.
• Inadvertent organ ligation.
• Unrecognized haemorrhage.
PATIENTS FACTORS RELATED COMPLICATIONS

• Obesity
• Ascites
• Organomegaly – organ damage
• Clotting problems – haemorrhage
POST OPERATIVE COMPLICATIONS

• Infection
• Pain  Carbon dioxide is converted to carbonic acid when it is in solution with
body fluids. This is irritant to the peritoneum. Diaphragmatic peritoneal
irritation produces pain which is referred to the shoulder by the phrenic nerve
• Incision Hernia  Failure to close facial defects from incisions for secondary
trocars. Incised fascia should be located with help of skin hooks and repaired.
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