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.