Laparoscopic Perforations

A laparoscopic procedure is one in which an endoscope or laparoscope is inserted through small incisions in the skin into the abdomen or chest of the individual in order to do surgery through the scope. Instruments are associated with the tips of the laparoscope that can cut tissue, tie off tissue and otherwise manipulate abdominal or chest organs. Most laparoscopic surgery is actually done in the abdomen and surgery can be done on the liver, bowel, spleen or gallbladder.

There has been an increase in laparoscopic surgeries in the last thirty years. Laparoscopic surgeries, while mostly done in the abdomen, can be done in joint surgeries, plastic surgeries and other types of surgery, including the chest. It can be used to treat appendectomies and ectopic pregnancies, as well as gallbladder removals. The scope is rigid and the instruments are at the end of the scope. Surgery is then done at a distance from the surgeon's hands.

This type of surgery has revolutionised the way surgery is done. Long incisions are replaced by several small incisions that work together to manipulate the tissue, and cut and stitch tissue together. The rate of complication of laparoscopic surgery is, at a minimum, one to five percent but is as high as six percent in procedures that are major and in very sick patients.

There are several complications of laparoscopic surgery. Anesthesia risks exist and there can be an elevation of CO2 in the bloodstream because the patient is put in a head down position, called Trendelenberg, which causes poor distension of the lungs. CO2 in the blood can result in respiratory acidosis and breathing problems. Shock and circulatory collapse can occur if the anesthesia isn't deep enough. Reactions to the anesthesia can result in circulatory collapse as well.

There is a need to put air into the abdomen via a needle in order to see the abdominal structures well. If you don't do this, you can get air where it doesn't belong. It happens about two percent of the time and results in bubbles beneath the skin where the needle inadvertently put the air into. Air can get into the pericardium, which can cause poor pumping action of the heart. Air in the wrong place can wind up in the space between the lungs and the chest wall, causing a pneumothorax. Air can puncture the blood vessels of the omentum.

You can penetrate the intestinal, esophageal or stomach cavities with instruments used in the laparoscopic procedure. Penetration of bowel is dangerous and requires IV antibiotics and repair of the perforation so as to avoid peritonitis and a bloodborne infection called sepsis. It's a serious complication to perforate the bowel and not notice it because sepsis and death is likely. The same is true of bladder perforation, which is common in lower abdominal surgeries. The bladder is fortunately fairly sterile so that sepsis is less likely but urine will leak into the abdominal space if the perforation is not noticed.

There can be a blood vessel perforation from the needle that blows air into the abdomen. It can penetrate the omentum or can get into the mesenteric blood vessels, which can impair blood flow to the stomach, intestines or colon. Doctors can repair the damage via the laparoscope or may need to switch to an open surgery in order to get the best access to the damaged blood vessel.

A gas embolism can happen if air is introduced into a blood vessel via the laparoscope. This is an often fatal complication of laparoscopic procedure. It occurs when the needle introducing air into the abdomen punctures a blood vessel and introduces air into the blood vessel instead. Doctors may need to puncture the heart and drain out the air from the heart in order to save the person's life.

Doctors can puncture the liver or spleen in a laparoscopic procedure. This is more common if the spleen or liver is enlarged. If it is punctured, it needs to be repaired so that excessive bleeding doesn't occur.