Vascular complications of laparoscopic surgery

Laparoscopic surgery as an alternative to traditional laparotomies has become an important modality in the management of gynecologic diseases; however, it is not without potential risks. Case reports describe numerous complications, including ureteral injuries, persistent ectopic pregnancies, hospital readmissions, unintended laparotomies to manage bowel or urinary tract injury, and hemorrhage. We retrospectively analyzed 195 women who underwent laparoscopic procedures to determine the frequency and severity of operative complications. Several procedures were often involved, including ablations of endometriosis and endometriomata, salpingo-oophorectomies, tubo-ovarian adhesiolyses, salpingo-salpingostomies, laser uterosacral nerve ablations, and laparoscopically assisted vaginal hysterectomies. Four major vascular complications were identified (2%), as well as one uterine perforation (0.5%) and two cases of subcutaneous emphysema (1%). There were no deaths. Three (1.5%) patients had an intraoperative laceration of the epigastric vessels during trocar placement, and one (0.5%) had a hematoma of the left common iliac vein that was self-contained. Management options included immediate laparotomy versus close observation with or without delayed laparotomy.