Laparoscopy is an exploratory or diagnostic technique that is also used to perform surgical interventions through small incisions, which allows the patient to recover earlier and better.
In this article, we will present the problem of complications that arise during laparoscopic operations in gynecological practice. In recent years, endosurgical intervention occupies a major place among all surgical interventions in gynecology, while the frequency of endosurgical interventions of increased complexity has increased.
The widespread of laparoscopic surgery and the adaptation of laparoscopic surgery hospitals in India to it has led to the appearance of new complications that must be perfectly known to avoid as far as possible the causes that trigger them. Of great importance in the favorable outcomes of reconstructive endoscopic operations are some measures to prevent the formation of adhesions.
Laparoscopic surgery is in full development although the indications in which its use is universally accepted are still limited. It is necessary that the morbidity rates be equal to or lower than those of conventional surgery so that patients benefit from the advantages of less aggressive surgery.
Laparoscopy is a safe and widely used technique today, but it is not without risks, as with any surgical operation. The complications that occur most frequently are:
1. Bleeding from incisions due to poor healing.
2. Hernias or eventrations through the incisions.
3. Postoperative surgical wound infections; taking antibiotics before the operation largely avoids them. In extreme situations, the infection may be inside the abdomen and cause peritonitis.
4. Injury during the operation of arteries, veins, intestines, stomach, ureters or other abdominal viscera. This complication forces the abdomen to be opened immediately by laparotomy.
5. Problems caused by general anesthesia, as in other procedures.
6. Shoulder pain- It seems to be related to the irritation of the diaphragms by CO 2, and the rapid insufflation of the same in the abdominal cavity; Therefore, it is advised not to use flows in the pneumoperitoneum setting greater than 1 or 1.5 l per minute.
7. Gas insufflation in the abdominal wall- The insufflation of CO 2 in the omentum, mesentery or retroperitoneum produces emphysema that has no major impact and disappears rapidly. When this insufflation occurs in the abdominal wall, it causes subcutaneous emphysema, which, although it does not have clinical significance, can make it difficult to achieve pneumoperitoneum. It is convenient to be very attentive to the pressures that the insufflator marks and that warn us of the incorrect placement of the needle.
8. Gas embolism- Produced by direct insufflation in a large caliber venous vessel, or by the existence of venous nozzles produced in wide dissections, it is a serious complication that occurs in one of every 65,000 laparoscopic procedures and that forces a rapid decompression of the abdominal cavity followed by cardiorespiratory recovery maneuvers.
Laparoscopic surgery has characteristics, such as two-dimensional vision, the use of very long instruments and the absence of direct touch of the tissues, which basically differentiate it from conventional surgery and which force the laparoscopic surgery hospitalsto adapt and learn; the lack of this is what has led to the responsibility for the technique of complications due to its executors.