Complications of Laparoscopy

  • Jamal Mourad
  • Stephanie Henderson
  • Javier Magrina


Overall complication rates for gynecologic laparoscopy have remained at <1% with an overall mortality rate of 3.33 per 100,000 patients. This chapter is designed to discuss possible complications related to laparoscopic surgery from the time of abdominal access to the postoperative period. Mastery of surgical technique, superior anatomical knowledge, and a continuous quest to improve are essential tools for all surgeons, while prevention remains the most important factor in avoiding complications. Early recognition and management of complications in a timely, safe, and efficient fashion is the key to overcoming the pitfalls of laparoscopy.


Complications Laparoscopy Abdominal wall injury Vascular injury Bowel injury Urinary injury Nerve injury Morcellation Gas embolism 


  1. 1.
    Hatzinger M, Häcker A, Langbein S, Kwon S, Hoang-Böhm J, Alken P. Hans-Christian Jacobaeus (1879-1937): the inventor of human laparoscopy and thoracoscopy. Urologe A. 2006;45(9):1184–6.PubMedCrossRefGoogle Scholar
  2. 2.
    Sutton C. Past, present, and future of hysterectomy. J Minim Invasive Gynecol. 2010;17(4):421–35.PubMedCrossRefGoogle Scholar
  3. 3.
    Jansen FW. Complications. In: Istre O, editor. Minimally invasive gynecological surgery. 1st ed. Berlin: Springer; 2015. p. 177–90.Google Scholar
  4. 4.
    Miranda CS, Carvajal AR. Complications of operative gynecological laparoscopy. JSLS. 2003;7:53–8.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Chapron C, Queleu D, Bruhat MA, et al. Surgical complications of diagnostic and operative gynaecological laparoscopy: a series of 29,966 cases. Hum Reprod. 1998;13:867–72.PubMedCrossRefGoogle Scholar
  6. 6.
    Jansen FW, Kapiteyn K, Trimbos-Kemper T, et al. Complications of laparoscopy: a prospective multicentre observational study. Br J Obstet Gynaecol. 1997;104:595–600.PubMedCrossRefGoogle Scholar
  7. 7.
    Johnston K, Rosen D, Cario G, et al. Major complications arising from 1265 operative laparoscopic cases: a prospective review from a single center. J Minim Invasive Gynecol. 2007;14:339–44.PubMedCrossRefGoogle Scholar
  8. 8.
    Mac Cordick C, Lécuru F, Rizk E, Robin F, Boucaya V, Taurelle R. Morbidity in laparoscopic gynecological surgery: results of a prospective single-center study. Surg Endosc. 1999;13(1):57–61.PubMedCrossRefGoogle Scholar
  9. 9.
    Hashizume M, Sugimachi K. Needle and trocar injury during laparoscopic surgery in Japan. Surg Endosc. 1997;11:1198–201.PubMedCrossRefGoogle Scholar
  10. 10.
    Molloy D, Kaloo PD, Cooper M, et al. Laparoscopic entry: a literature review and analysis of techniques and complications of primary port entry. Aust N Z J Obstet Gynaecol. 2002;42:246–54.PubMedCrossRefGoogle Scholar
  11. 11.
    Garry R. Towards evidence-based laparoscopic entry techniques: clinical problems and dilemmas. Gynaecol Endosc. 1999;8:315–26.CrossRefGoogle Scholar
  12. 12.
    Ahmad G, Gent D, Henderson D, O’Flynn H, Phillips K, Watson A. Laparoscopic entry techniques. Cochrane Database Syst Rev. 2015;8:CD006583. Scholar
  13. 13.
    Cuss A, Bhatt M, Abbott J. Coming to terms with the fact that the evidence for laparoscopic entry is as good as it gets. J Minim Invasive Gynecol. 2015;22(3):332–41.PubMedCrossRefGoogle Scholar
  14. 14.
    Pryor A, Gracia G. Abdominal access techniques used in laparoscopic surgery. UpToDate. 2015.Google Scholar
  15. 15.
    Angioli R, Terranova C, De Cicco Nardone C, et al. A comparison of three different entry techniques in gynecological laparoscopic surgery: a randomized prospective trial. Eur J Obstet Gynecol Reprod Biol. 2013;171:339–42.PubMedCrossRefGoogle Scholar
  16. 16.
    Byron JW, Markenson G, Miyazawa K. A randomized comparison of Verres needle and direct trocar insertion for laparoscopy. Surg Gynecol Obstet. 1993;177:259–62.PubMedGoogle Scholar
  17. 17.
    Celik H, Cremins A, Jones KA, Harmanli O. Massive subcutaneous emphysema in robotic sacrocolpopexy. JSLS. 2013;17(2):245–8.PubMedPubMedCentralCrossRefGoogle Scholar
  18. 18.
    Makai G, Isaacson K. Complications of gynecologic laparoscopy. Clin Obstet Gynecol. 2009;52(3):401–11.PubMedCrossRefGoogle Scholar
  19. 19.
    Ott DE. Subcutaneous emphysema—beyond the pneumoperitoneum. JSLS. 2014;18(1):1–7.PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Kalhan SB, Reaney JA, Collins RL. Pneumomediastinum and subcutaneous emphysema during laparoscopy. Cleve Clin J Med. 1990;57:639–42.PubMedCrossRefGoogle Scholar
  21. 21.
    Magrina J. Complications of laparoscopic surgery. Clin Obstet Gynecol. 2002;45:469–80.PubMedCrossRefGoogle Scholar
  22. 22.
    Murdock CM, Wolff AJ, Van Geem T. Risk factors for hypercarbia, subcutaneous emphysema, pneumothorax, and pneumomediastinum during laparoscopy. Obstet Gynecol. 2000;95(5):704–9.PubMedGoogle Scholar
  23. 23.
    Kim CS, Kim JY, Kwon JY, Choi SH, Na S, An J, Kim KJ. Venous air embolism during total laparoscopic hysterectomy: comparison to total abdominal hysterectomy. Anesthesiology. 2009;111(1):50–4.PubMedCrossRefGoogle Scholar
  24. 24.
    Park EY, Kwon JY, Kim KJ. Carbon dioxide embolism during laparoscopic surgery. Yonsei Med J. 2012;53(3):459–66.PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    Mintz M. Risks and prophylaxis in laparoscopy: a survey of 100,000 cases. J Reprod Med. 1977;18:269–72.PubMedGoogle Scholar
  26. 26.
    Hynes SR, Marshall RL. Venous gas embolism during gynaecological laparoscopy. Can J Anaesth. 1992;39(7):748–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Bonjer HJ, Hazebroek EJ, Kazemier G, et al. Open versus closed establishment of pneumoperitoneum in laparoscopic surgery. Br J Surg. 1997;84:599–602.PubMedCrossRefGoogle Scholar
  28. 28.
    Cottin V, Delafosse B, Viale JP. Gas embolism during laparoscopy: a report of seven cases in patients with previous abdominal surgical history. Surg Endosc. 1996;10(2):166–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Hurd WW, Pearl ML, DeLancey JO, et al. Laparoscopic injury of abdominal wall blood vessels: a report of three cases. Obstet Gynecol. 1993;82(S):673–6.PubMedGoogle Scholar
  30. 30.
    Hurd WW, Rude RO, DeLancey JO, Newman JS. The location of abdominal wall blood vessels in relationship to abdominal landmarks apparent at laparoscopy. Am J Obstet Gynecol. 1994;174(3):642–6.CrossRefGoogle Scholar
  31. 31.
    Saber AA, Meslemani AM, Davis R, Pimentel R. Safety zones for anterior abdominal wall entry during laparoscopy: a CT scan mapping of epigastric vessels. Ann Surg. 2004;239(2):182–5.PubMedPubMedCentralCrossRefGoogle Scholar
  32. 32.
    Burnett TL, Garza-Cavazos A, Groesch K, et al. Location of the deep epigastric vessels in the resting and insufflated abdomen. J Minim Invasive Gynecol. 2016;23(5):798–803.PubMedCrossRefGoogle Scholar
  33. 33.
    Luijendijk RW, Jeekel J, Storm RK, et al. The low transverse Pfannenstiel incision and the prevalence of incisional hernia and nerve entrapment. Ann Surg. 1997;225:365–9.PubMedPubMedCentralCrossRefGoogle Scholar
  34. 34.
    Rahn DD, Phelan JN, Roshanravan SM, White AB, Corton MM. Anterior abdominal wall nerve and vessel anatomy: clinical implications for gynecologic surgery. Am J Obstet Gynecol. 2010;202(3):234.PubMedCrossRefGoogle Scholar
  35. 35.
    Whiteside JL, et al. Anatomy of ilioinguinal and iliohypogastric nerves in relation to trocar placement and low transverse incisions. Am J Obstet Gynecol. 2003;189(6):1574–8.PubMedCrossRefGoogle Scholar
  36. 36.
    Philips PA, Amaral JF. Abdominal access complications in laparoscopic surgery. J Am Coll Surg. 2001;192:525–36.PubMedCrossRefGoogle Scholar
  37. 37.
    Sandadi S, Johannigman JA, Wong VL, Blebea J, Altose MD, Hurd WW. Recognition and management of major vessel injury during laparoscopy. J Minim Invasive Gynecol. 2010;17(6):692–702.PubMedCrossRefGoogle Scholar
  38. 38.
    Pryor A, Mann W, Garcia G. Complications of laparoscopic surgery. UpToDate. 2016.Google Scholar
  39. 39.
    Chapron C, Fauconnier A, Goffinet F, Breart G, Dubuisson JB. Laparoscopic surgery is not inherently dangerous for patients presenting with benign gynaecologic pathology. Hum Reprod. 2002;17:1334–42.PubMedCrossRefGoogle Scholar
  40. 40.
    Gemer O, Simonovsky A, Huerta M, Kapustian V, Anteby E, Linov L. A radiological study on the anatomical proximity of the ureters and the cervix. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(9):991–5.PubMedCrossRefGoogle Scholar
  41. 41.
    Sharp HT, Swenson C. Hollow viscus injury during surgery. Obstet Gynecol Clin N Am. 2010;37:461–7.CrossRefGoogle Scholar
  42. 42.
    Cardosi RJ, Cox CS, Hoffman MS. Postoperative neuropathies after major pelvic surgery. Obstet Gynecol. 2002;100:240–4.PubMedCrossRefGoogle Scholar
  43. 43.
    Milad MP, Sokol E. Laparoscopic morcellator-related injuries. J Am Assoc Gynecol Laparosc. 2003;10:383–5.PubMedCrossRefGoogle Scholar
  44. 44.
    Nagai T, Yakahori TY, Ishida H, Hanaoka T, et al. Highly improved accuracy of the revised Preoperative Sarcoma Score (PRESS) in the decision of performing surgery for patients presenting with a uterine mass. Springer Plus. 2015;4:520.PubMedPubMedCentralCrossRefGoogle Scholar
  45. 45.
    Sasmal PK, Mishra TS, Rath S, Meher S, Mohapatra D. Port site infection in laparoscopic surgery: a review of its management. World J Clin Cases. 2015;3(10):864–71.PubMedPubMedCentralCrossRefGoogle Scholar
  46. 46.
    Montz FJ, Holschneider CH, Munro MG. Incisional hernia following laparoscopy: a survey of the American Association of Gynecologic Laparoscopists. Obstet Gynecol. 1994;84(5):881.PubMedGoogle Scholar
  47. 47.
    Bunting DM. Port-site hernia following laparoscopic cholecystectomy. JSLS. 2010;14(4):490–7.PubMedPubMedCentralCrossRefGoogle Scholar
  48. 48.
    Bensley RP, Schermerhorn ML, Hurks R, Sachs T, Boyd CA, O'Malley AJ, Cotterill P, Landon BE. Risk of late-onset adhesions and incisional hernia repairs after surgery. J Am Coll Surg. 2013;216(6):1159–67.PubMedPubMedCentralCrossRefGoogle Scholar
  49. 49.
    Marks JM, Phillips MS, Tacchino R, Roberts K, et al. Single-incision laparoscopic cholecystectomy is associated with improved cosmesis scoring at the cost of significantly higher hernia rates: 1-year results of a prospective randomized, multicenter, single-blinded trial of traditional multiport laparoscopic cholecystectomy vs single-incision laparoscopic cholecystectomy. J Am Coll Surg. 2013;216(6):1037.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Jamal Mourad
    • 1
  • Stephanie Henderson
    • 1
  • Javier Magrina
    • 1
  1. 1.The Women’s Institute, Banner University Medical Center - PhoenixUniversity of Arizona College of Medicine—PhoenixPhoenixUSA

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