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Laparoscopy Complications
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Laparoscopic surgeries have increased in scope and frequency over the last thirty years. At the present time, laparoscopic surgery is being done on joint surgeries, plastic surgery, abdominal surgeries and other surgeries. At the current time, it is being used for sterilization procedures and for treatment of ectopic pregnancies as well as for appendectomies. A laparoscope is a device that involves a rigid rod with a camera attached to the end of it. Part of the rod is hollow so that surgical tools can be passed into the rod and can be used at a distance.
Laparoscopic surgery has revolutionized medicine today. Instead of large, open incisions, the laparoscopic surgeries involve multiple small incisions that the laparoscope is inserted into and out of through the course of the procedure. Laparoscopic surgery is considered relatively safe, with a complication rate of 1 percent to 5 percent in minor procedures to a rate of 2.5 percent to 6 percent in major procedures.
Complications of laparoscopy can be from several things. One of those things involves the anesthesia. This is what laparoscopy has in common with general surgery and, because laparoscopic surgery is generally longer than regular surgery, the chances of an anesthetic complication are potentially higher. In addition, the patient is often put into the Trendelenberg position, which involves slanting downward toward the head, can cause the lungs to distend poorly. It can cause elevated CO2 levels in the bloodstream and respiratory difficulty.
If the anesthesia is not deep enough, there can be a vasovagal response with a resulting blood pressure and pulse drop, causing shock and circulatory collapse. There can also be allergic reactions to the anesthesia which can cause circulatory collapse.
During the use of a laparoscope in an abdominal exam, you need to introduce air into the abdomen in order to be able to see the structures. If you fail to introduce the Veress' needle, you can get an emphysema or air collection of the extra-peritoneal spaces. This can happen about 2 percent of the time. One can feel air bubbles underneath the skin; attempts to use a laparoscope when this happens can be a problem so the air should be expressed from the tissues. Air can accidentally get into the mediastinal space, the space around the heart, and it can cause the heart to pump poorly. In addition, the air can get between the lungs and the chest wall, leading to a condition called pneumothorax. Air can get into the omentum of the abdomen and cause a puncture of the omental blood vessels.
Penetration of the intestinal, stomach or esophageal cavities can lead to serious infection, sepsis and death. This happens when a needle or the cannula is inserted through the wall of an aspect of these viscera. Penetration of the bowel or other viscera needs antibiotics and complete repair so as to avoid leakage of the contents and peritonitis of the tissue around the hole. Failure to recognize a perforated intestine or other bowel part is a serious complication. Bladder injury can occur with an abdominal laparoscopy and can result in the necessity of repair of the bladder and antibiotics to prevent infection.
Blood vessel injury can occur if the Veress' needle penetrates the omentum or gets at the mesenteric vessels. This can be life threatening if the bleeding is not gotten under control. It can usually be repaired through the laparoscope unless the bleeding is severe, in which a laparotomy and repair is necessary (open surgery).
A gas embolism can occur, which involves gas entering a blood vessel through the laparoscope. This can easily be fatal. This happens when the Veress' needle punctures a vessel and this isn't repaired before air is insufflated into the abdomen. The repair involves a cardiac puncture to release air built up inside the heart. It is a life threatening injury.
The liver or spleen can be punctured in an abdominal laparoscopy. This is especially true if the spleen or liver is enlarged. If the spleen or liver becomes punctured by the Veress' needle, repair is necessary before proceeding with the surgery.
The CO2 used to distend the abdomen in a laparoscopy is absorbed quickly by the system so that even if it becomes an embolus, it dissolves before reaching a vital area. Too much CO2 absorbed, however, can lead to a heart arrhythmia. It also causes pain after surgery. Nitrous oxide has a lesser chance of problems and is used by some anesthetists and surgeons who are using in place of CO2.