Laparoscopy Complications

by Laurence A. Jacobs, MD, FACOG

Laparoscopy involves the surgical placement (under general anesthesia) of a Veres needle to inflate the abdominal cavity followed then by placement of a sharp trocar through which a telescopic instrument (laparoscope) can be placed through or below the navel. This allows for visualization of the abdominal and pelvic organs. Subsequently several other smaller instruments (trocars) are then inserted under direct visualization for use of various operating instruments such as scissors, grasping instruments, lasers or cautery instruments. Laparoscopy complications may involve bowel, bladder or blood vessel injuries.

Gynecologic laparoscopy may be done for diagnostic purposes only, tubal ligation, removal of ovarian cysts or ovaries, ectopic pregnancies, laparoscopic assisted vaginal hysterectomy, appendectomy, pelvic inflammatory disease, chronic pelvic pain, adhesions and endometriosis.

Laparoscopy complications may occur despite excellent surgical techniques. Placement of the Veres needle or the sharp trocars can seriously injure bowel, bladder or large blood vessels requiring further intervention or surgery. Anesthetic complications and infection may also develop. Delay in diagnosis of complications can also worsen the problem. Individuals with pre-existing medical conditions (for example, previous major abdominal surgeries, pelvic adhesions, obesity) are at increased risk for complications. All gynecologic laparoscopy cases with adverse outcomes should be reviewed by an expert in this field in order to determine if there is malpractice versus an unfortunate outcome.

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