1. Complications due to Positioning
To improve organ exposure, patients are often placed in extreme positions during laparoscopic procedures, which can compromise superficially running, long nerves. Particularly at risk are:
- N. peroneus
- N. ulnaris
- N. radialis right
Prophylaxis
- Padded shoulder supports in anticipation of a head-down position.
- In the lithotomy position, the leg holders should be particularly well padded in the area of the fibular heads.
- When using a vacuum mattress, damage to the N. radialis right is largely excluded. The vacuum mattress should definitely be preferred over side supports!
- Position extended arms on a padded splint and do not abduct more than 90°.
2. Complications due to Trocar Insertion
Inserting the trocars, especially the first trocar, can lead to injuries of hollow organs and vessels.
3. Organ-specific Complications
- Injuries to the intestine
- Thermal damage using bipolar scissors or ultrasonic dissector
- Vascular injury
- Ureter injury: In cases of superficial injuries, a laparoscopic suture can be attempted; otherwise, a small laparotomy is recommended directly over the injury site to openly suture the ureter under vision. In any case, the placement of a ureteral stent is indicated.
- Injury to the sacral venous plexus
- Vaginal perforation
- Rectal perforation