Laparoscopic surgery has been developed by surgeons in an effort to be as minimally invasive as possible in the treatment of surgical disease. It has been used in a variety of settings--abdominal, urologic and gynecologic procedures, for example--and offers many benefits such as decreased risk of infection and less pain after surgery. However, it does have its own unique set of complications that must be weighed by the patient before undertaking surgery.
Inherent Drawbacks
Since laparoscopic surgery is done with cameras, and full control of the surgical field is limited to two mechanical tools, it has inherent drawbacks. Proper visualization of 3-dimensional structures on a 2-dimensional screen is difficult, and coupled with the loss of direct hand contact, can render minor situations very stressful to handle (such as bleeding or organ damage).
Needle and Trocar Injury
Special needles (known as Veress needles) and trocars (hollow cylinders with pointed ends) are used in laparoscopic procedures to penetrate and gain access to the abdomen. They are inserted blindly and can cause direct trauma to underlying organs and blood vessels. In addition, gas is pumped into the abdomen to help in visualization, and damage to a blood vessel can allow gas to enter the bloodstream; this is known as gas embolization and can result in death.
Hemostasis Complications
Hemostasis, or the management of bleeding, can be done in a variety of different ways; but not during laparoscopic procedures. In laparoscopic surgery, only electrical cauterization can be employed to control bleeding, and this can cause damage to organs when used excessively. In structures filled with fluid, like the bile duct, the fluid can conduct the electrical current and damage structures like the bile duct or adjacent structures such as the bowel wall.
Cardiovascular Complications
Carbon dioxide is pumped into the abdomen for better structure visualization during laparoscopic surgery, which can result in increased pressure inside the abdomen. This increased pressure can affect blood flow, resulting in decreased blood pressure and increased tendency to form blood clots. In addition, carbon dioxide can cause the release of stress hormones which, in excessive amounts, can also cause collapse of the blood circulation system.
References
- "Sabiston Textbook of Surgery, 18th Edition;" Townsend; 2007
- "Journal of the American College of Surgeons"; Safety Profile of Trocar and Insufflation Needle Access Systems in Laparoscopic Surgery; Passerotti, Begg, et al.; August 2009
- David Anaise, M.D.: Laparascopic Surgery
