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Complications of laparoscopic surgery

Aurora Pryor, MD
William J Mann, Jr, MD
Gerald Gracia, MD
Section Editors
Jeffrey Marks, MD
Tommaso Falcone, MD, FRCSC, FACOG
Deputy Editor
Wenliang Chen, MD, PhD


The rate of serious complications associated specifically with a laparoscopic approach is overall low. Up to half of complications occur at the time of abdominal access for camera or port placement [1]. Complications can also arise from abdominal insufflation, tissue dissection, and hemostasis [2]. Conversion to an open procedure may be needed to manage complications that have been identified intraoperatively, while others may not be recognized until the postoperative period. Severe complications such as vascular injury and bowel perforation can be catastrophic and are the main cause of procedure-specific morbidity and mortality related to laparoscopic surgery.

Much of the literature discussing the complications associated with laparoscopic surgery is drawn from the gynecologic literature, which has provided the most comprehensive study of these injuries [3]. It is presumed that results from these studies can be generalized to other abdominal and retroperitoneal surgeries, but wherever possible, outcomes of laparoscopic surgery in gynecology, general surgery, and urology are distinguished.

Surgical complications unique to a laparoscopic approach are discussed here. Surgical techniques and their specific complications are discussed in individual topic reviews. Other general issues relating to laparoscopic surgery, including abdominal access and instrumentation, are reviewed elsewhere. (See "Abdominal access techniques used in laparoscopic surgery" and "Instruments and devices used in laparoscopic surgery" and "Overview of gynecologic laparoscopic surgery and non-umbilical entry sites" and "Overview of laparoscopy in children and adolescents".)


The rate of complications associated specifically with a laparoscopic approach is overall low. Complications related to initial abdominal access occur in less than 1 percent of patients [4-7]. Once abdominal access is established, complications during the course of the procedure are similarly rare; however, late hernia at port sites can affect up to 6 percent of patients. The incidence of specific complications for specific laparoscopic procedures is discussed more fully in the sections below. The following studies illustrate typical findings:

One survey reported results of claims arising from abdominal access injuries between 1980 and 1999, and medical device reports to the United States Food and Drug Administration (FDA) [8]. The incidence of abdominal access injury was 5 to 30 per 10,000 procedures. Bowel and retroperitoneal vascular injuries comprised 76 percent of all injuries, and almost 50 percent of small and large bowel injuries were unrecognized for at least 24 hours. The type and proportion of organ injury during abdominal access were as follows:


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