Complications - Adnexectomy, laparoscopic, robot-assisted laparoscopy (DaVinci)

Bleeding

Injury to Large Blood Vessels

• The ovarian artery arises directly from the aorta and is highly vascularized.
• The uterine artery and its branches also supply the ovary → risk of severe bleeding, especially with adhesions or tumors.
• Increased risk with inflammation, endometriosis, or large ovarian tumors.
• Measures: Coagulation, if bleeding persists, possibly switch to laparotomy.

Diffuse Bleeding from the Adnexal Area

• After detachment of the adnexa, diffuse bleeding from the ovarian stump or peritoneum may occur.
• Measures: Careful hemostasis using coagulation or suturing.

Injuries to Adjacent Organs

Bowel Injuries (Small Intestine, Colon, Rectum)

• Especially with adhesions after previous inflammations, endometriosis, or tumors.
• Risk of perforations or fistula formation.
• Measures: Immediate care, in severe cases, stoma placement may be necessary.

Ureteral Injuries

• The ureter runs close to the ovary and can be injured during coagulation or by traction.
• Risk of thermal damage or transection.

Bladder Injuries

• Especially during adnexectomies after pelvic inflammations or endometriosis.
• Risk of urinary fistulas.
• Measures: Suturing of the bladder wall, possibly an indwelling catheter for several days.

CO₂ Insufflation Complications

• Gas Embolism:
  • Entry of CO₂ into venous vessels → acute circulatory problems, hypoxia.
• Subcutaneous Emphysema:
  • CO₂ can escape into the tissue due to incorrect trocar placement.
• Diaphragmatic Irritation with Shoulder Pain:
  • CO₂ can irritate the diaphragm → radiating pain to the shoulders.

Anesthesia-Related Risks

• Allergic Reactions to medications, latex, or CO₂ gas.
• Cardiovascular Complications: Hypotension, arrhythmias.
• Aspiration Pneumonia due to aspiration of gastric contents.

Diaphragmatic Irritation with Shoulder Pain:

• CO₂ gas introduced into the abdominal cavity during laparoscopy can irritate the diaphragm, leading to shoulder pain via the phrenic nerve.
• Symptoms: Pain in the shoulder area, usually a few hours to days after surgery.
• Treatment: Movement and early ambulation help absorb the gas faster, pain relief can be provided by NSAIDs, metamizole.

Postoperative Bleeding:

• Can occur due to uncontrolled vascular bleeding from the ovarian stump or inadequate coagulation.
• Symptoms: Abdominal pain, hypotension, tachycardia.
• Treatment: Conservative monitoring or re-operation.

Hematoma Formation:

• A postoperative hematoma can exert pressure on surrounding structures (intestine, bladder, ureter).

Infections

• Wound Infections:
  • Infections at the trocar incisions with redness, swelling, and pus discharge.
• Pelvic Abscesses:
  • Especially after inflammatory adnexal changes.
  • Can lead to sepsis or peritonitis.
• Peritonitis:
  • Due to infected or spilled cyst contents (e.g., endometriosis, dermoid cysts) or bacterial colonization.

Bowel and Urinary Problems

• Paralytic Ileus:
  • Due to peritoneal irritation, absence of bowel peristalsis.
• Mechanical Ileus:
  • Due to adhesions or postoperative adhesions.
• Urinary Retention:
  • Possible due to ureter injury or loss of bladder tone post-surgery.

Thrombosis and Embolism

• Deep Vein Thrombosis:
  • Increased risk due to reduced postoperative mobilization.
• Pulmonary Embolism:
  • A dislodged thrombus can cause a life-threatening embolism.

Pain

• Chronic Pelvic Pain:
  • Due to scar formation or adhesions.