Laparoscopy Health Article

Risks

Complications may be associated with the laparoscopy procedure in general, or may be specific to the type of operation that is performed. Patients should consult with their doctors regarding the types of risks that are specific for their procedures. The most serious complication that can occur during laparoscopy is laceration of a major abdominal blood vessel resulting from improper positioning, inadequate insufflation (inflation) of the abdomen, abnormal pelvic anatomy, and too much force exerted during scope insertion. Thin patients with well-developed abdominal muscles are at higher risk, since the aorta may only be an inch or so below the skin. Obese patients are also at higher risk because more forceful and deeper needle and scope penetration is required. During laparoscopy, there is also a risk of bleeding from blood vessels, and adhesions may require repair by open surgery if bleeding cannot be stopped using laparoscopic instrumentation. In laparoscopic procedures that use electrosurgical devices, burns to the incision site are possible due to passage of electrical current through the laparoscope caused by a fault or malfunction in the equipment.

Complications related to insufflation of the abdominal cavity include gas inadvertently entering a blood vessel and causing an embolism, pneumothorax, or subcutaneous emphysema. One common but not serious side effect of insufflation is pain in the shoulder and upper chest area for a day or two following the procedure.

Any abdominal surgery, including laparoscopy, carries the risk of unintentional organ injury (punctures and perforations). For example, the bowel, bladder, ureters, or fallopian tubes may be injured during the laparoscopic procedure. Many times these injuries are unavoidable due to the patient's anatomy or medical condition. Patients at higher risk for bowel injury include those with chronic bowel disease, PID, a history of pervious abdominal surgery, or severe endometriosis. Some types of laparoscopic procedures have a higher risk of organ injury. For instance, during laparoscopic removal of endometriosis adhesions or ovaries, the ureters may be injured due to their proximity to each other.

Several clinical studies have shown that the complication rate during laparoscopy is associated with inadequate surgeon experience. Surgeons who are more experienced in laparoscopic procedures have fewer complications than those performing their first 100 cases.

Normal results

In diagnostic laparoscopy, the surgeon will be able to see signs of a disease or condition (for example, endometriosis adhesions; ovarian cysts; diseased gallbladder)immediately, and can either treat the condition surgically or proceed with appropriate medical management. In diagnostic laparoscopy, biopsies may be taken of tissue in questionable areas, and laboratory results will govern medical treatment. In therapeutic laparoscopy, the surgeon performs a procedure that rectifies a known medical problem, such as hernia repair or appendix removal. Because laparoscopy is minimally invasive compared to open surgery, patients may experience less trauma and postoperative discomfort, have fewer procedural complications, have a shorter hospital stay, and return more quickly to daily activities. The results will vary, however, depending on the patients's condition and type of treatment.

Morbidity and mortality rates

Laparoscopic surgery, like most surgeries, is not without risk. Risks should be thoroughly explained to the patient. Complications from laparoscopic surgeries arise in 1–5% of the cases, with a mortality of about 0.05%. Complications may arise from the laparoscopic entry during procedure, and the risks vary depending on the elements specific to a particular procedure. For example, the risk of injury to the common bile duct in laparoscopic biliary surgery is 0.3–0.6% of cases. The factors that contribute to morbidity are currently under study and debate. Injury may occur to blood vessels and internal organs. Some studies examining malpractice data indicate that trocar injury to the bowel or blood vessels may account up to one-fourth of laparoscopic medical claims. It has been suggested that these injuries can be reduced by alterations in the placement and use of the Verses needle, or by using an open technique of trocar insertion in which a blunt cannula (non-bladed) is inserted into the abdominal cavity through an incision. The insertion of secondary trocars may be of particular interest as a risk factor. There is still some debate, however, as to which method of trocar insertion is most appropriate in a particular situation, as no technique is without risk. The most commonly cited injury in laparoscopic malpractice claims has been injury to the bile duct (66%). Proper identification of this structure by an experienced surgeon, or by a cholangiogram, may reduce this type of injury. Other areas of the body may be injured during access including the stomach, bladder, and liver. Hemorrhages may also occur during the operation.

Laparoscopic entry injuries have been the subject of recent study. Data collected from insurance companies and medical device regulation indicate that bowel and vascular injuries may account for 76% of the injuries that occur when a primary port is created. Delayed recognition of bowel injuries was noted to be an important factor in mortality. The risk of possible injury or death in laparoscopy depends on such factors as the anatomy of the patient, the force of entry, and the type operative procedure being performed.