Complications - complete hysterectomy, bilateral adnexectomy, sentinel node biopsy pelvic bilateral laparoscopic, robot-assisted laparoscopy (DaVinci)

Bleeding:

• Blood loss > 1000 ml in 1–3% of cases
• Injury to the iliac artery or uterine arteries
• Pelvic hematomas due to inadequate hemostasis
• Injury to the iliac vein or iliac artery, need for vascular reconstruction very rare

Lymphatic vessel injuries:

• Lymphorrhea common, usually self-limiting, lymphatic fistula formation very rare

Injuries to adjacent organs:

• Bladder injury (0.59–1.0%), increased with previous surgeries (e.g., cesarean section)
• Ureteral injury (0.09–0.3%), often recognized postoperatively
• Bowel injury (0.2–0.4%), more common with adhesions or endometriosis

CO₂ insufflation complications:

• Subcutaneous emphysema or gas embolism
• Pneumothorax or mediastinal emphysema with excessive insufflation pressure

Nerve injuries:

• Lesion of the obturator nerve or sacral plexus
• Postoperative neuropathic pain

Technical complications:

• Conversion to laparotomy (2–4%), e.g., in cases of massive adhesions
• Inadequate coagulation or hemostasis

Bleeding & Hematomas:

• Postoperative bleeding (0.94–1.8%)
• Pelvic hematoma or abdominal hematoma

Urinary tract complications:

• Urinary retention (0.5–1.6%) due to bladder neck edema
• Urinary tract infections (0.7–2.2%) due to catheterization
• Fistula formation with unrecognized bladder or ureter injury

Bowel dysfunction:

• Postoperative ileus (0.09–1.0%), especially with adhesions
• Constipation due to altered pelvic floor statics

Infections:

• Wound infection (0.9–2.4%) at trocar sites
• Pelvic infection, hematoma, or abscess (1.0–5.4%)
• Sepsis (0.03%)

Thromboembolic events:

• Deep vein thrombosis or pulmonary embolism (0.02–0.03%)

Vaginal complications:

• Dyspareunia due to scar formation
• Vaginal cuff dehiscence (0.64–1.64%), risk increased with laparoscopic technique

Lymphocele

• Fluid accumulation in the pelvic wall after sentinel node biopsy, usually self-limiting, drainage may be necessary, significantly less common than with systematic pelvic and para-aortic lymphadenectomy (here 20%)

Pelvic Floor Weakness & Prolapse:

• Increased risk for vaginal vault prolapse
• Possible need for a follow-up surgery

Urinary Incontinence & Bladder Dysfunction:

• Stress or urge incontinence
• Altered bladder position with postoperative dysfunction

Bowel Dysfunction:

• Chronic constipation due to altered anatomy
• Risk for rectocele or enterocele

Sexual Dysfunction:

• Dyspareunia due to vaginal shortening or scar traction
• Decreased lubrication after oophorectomy

Chronic Pain:

• Neuropathic complaints due to nerve irritation
• Scar pain in the pelvis

Psychological Consequences:

• Postoperative depression or anxiety disorders
• Feeling of "loss of femininity"

Lymphedema: very rare

Persistent Lymphocele: very rare

1. Brummer TH, Jalkanen J, Fraser J, Heikkinen AM, Kauko M, Makinen J, et al. FINHYST, a prospective study of 5279 hysterectomies: complications and their risk factors. Hum Reprod. 2011;26(7):1741-51. 
2. Chapron C, Querleu D, Bruhat MA, Madelenat P, Fernandez H, Pierre F, et al. Surgical complications of diagnostic and operative gynecological laparoscopy: a series of 29,966 cases. Hum Reprod. 1998;13(4):867-72. 
3. McPherson K, Metcalfe MA, Herbert A, Maresh M, Casbard A, Hargreaves J, et al. Severe complications of hysterectomy: the VALUE study. BJOG: an international journal of obstetrics and gynecology. 2004;111(7):688-94
4. AQUA Institute for Healthcare GmbH Mh-, 37073 Göttingen. AQUA. Federal evaluation for the procedure year 2012. 15/1 Gynecological Operations. https://wwwsqgde/downloads/Bundesauswertungen/2012/bu_Gesamt_15N1-GYNOP_2012pdf. 2013;Last accessed: 05.01.2015. 
5. Zikan M, Fischerova D, Pinkavova I, Slama J, Weinberger V, Dusek L, Cibula D. A prospective study examining the incidence of asymptomatic and symptomatic lymphoceles following lymphadenectomy in patients with gynecological cancer. Gynecol Oncol. 2015 May;137(2):291-8. doi: 10.1016/j.ygyno.2015.02.016. Epub 2015 Feb 24. PMID: 25720294.