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Abdominal Laparoscopy: Complications

Laparoscopic surgeries are usually performed over open surgeries because laparoscopic procedures are less invasive, which allows for early recovery and return to normal activities. Laparoscopic surgery is not indicated for patients who are unable to tolerate increased intraabdominal pressure and patient who cannot tolerate the potential respiratory or cardiovascular complications listed below. This may include patients with severe COPD, prior upper abdominal surgery, or severe cardiac disease.

Intraabdominal insufflation (high intraabdominal pressures) can lead to:

  • Respiratory complications (due to cephalad displacement of the diaphragm)
    1. Atelectasis
    2. Decreased FRC
    3. Increased PIP
    4. Increased PaCO2
    5. Decreased PaO2
  • Cardiovascular complications
    1. Decreased venous return
    2. Decreased CO à increased SVR
    3. Decreased blood flow to the splanchnic and renal circulation à decreased UOP
  • Other complications
    1. Pneumothorax secondary to retroperitoneal dissection byinsufflated CO2.
    2. Subcutaneous emphysema.
    3. Hemorrhage due to vascular injury from trocar placement.
    4. Vascular injection of CO2 (VAE).