By Dr Ananya Mandal, MD
Laparoscopic surgery is now widely used in preference to traditional open surgery due to the advantages the procedure offers over open surgery such as reduced bleeding, increased recovery time and shorter hospital stay. However, laparoscopy is still associated with a number of risks and some of these are described below.
One of the main risks associated with laparoscopic surgery is injury as a result of trocar placement. The trocar is the device that is inserted into the abdomen at the beginning of surgery so that other tools can be passed through it to access the operational site. Examples of injuries that can occur include abdominal wall hematoma, large bowel penetration, blood vessel penetration, and umbilical wound infection. Vascular injury can cause life threatening hemorrhage and bowel injury can lead to peritonitis. The risk of such injuries occurring is higher among those with a history of abdominal surgery.
The electrodes used during surgery can leak current into surrounding tissue and cause electrical burns. These burns can lead to perforated organs and peritonitis. Active electrode monitoring should be used to prevent this from happening.
The insufflation of cold, dry gases during surgery can increase the risk of hypothermia and surgical humidification therapy should be administered to reduce this risk.
Not all of the carbon dioxide insufflated is removed from the abdominal cavity during surgery. This gas can form a pocket and rise in the abdomen, placing pressure on the diaphragm and phrenic nerve. This can lead to pain in the shoulders, particularly in the right shoulder when appendectomy is performed. Breathing may also be painful. However, the pain is transient and subsides as the carbon dioxide is absorbed by bodily tissues and expelled through respiration.
The presence of air or gas in the abdomen may not be tolerated by patients who have a pulmonary disorder and open surgery may be required instead.
Coagulation disorders are considered contraindications to laparoscopic surgery.
Reviewed by Sally Robertson, BSc
Last Updated: Jul 30, 2014