| Complication | Description / Cause | Management |
|---|---|---|
| Injury to Organs | Bladder, ureter, bowel in adhesions, deep situs, or endometriosis | Immediate identification, if necessary intraoperative consultation (urology/surgery), primary suture, if necessary stent placement |
| Bleeding (near large vessels / pelvic) | Iliac vessels, uterine arteries, parauterine vessels | Bipolar coagulation, clips, if necessary conventional vessel ligation, emergency conversion |
| CO₂ Embolism | Insufflation during direct vessel puncture | Immediate stop of insufflation, lowering of the operating table, resuscitation team, if necessary transfer to ICU |
| Trocar/Entry Injuries | Bowel, vessels during Veress needle / trocar placement | Preferred optical trocar placement, consider conversion laparotomy if suspected |
| Thermal Tissue Damage | Due to monopolar/bipolar energy (e.g., on ureter, bowel, bladder) | Careful use of energy, good preparation, |
| Technical Problems / Failure | Robotic arm blocked, system error, instrument jammed | Reboot the system, re-dock the arm, if necessary switch to laparoscopy or laparotomy |
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Intraoperative Complications
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Postoperative Complications
Complication Description / Cause Management Infections (Wound / Pelvic Abscess) Trocar site, retroperitoneal hematomas, endometritis Antibiotics, possibly CT-guided drainage, laparoscopic revision Urinary Retention / Bladder Emptying Disorder Plexus injury, prolonged catheter, intraoperative manipulation Spontaneous resolution, intermittent catheter, urology consultation if persistent problem Ileus / Bowel Atony Adhesion, manipulation, analgesics Conservative: fasting, IV fluids, mobilization; surgery if perforation Bleeding / Hematoma (Delayed Bleeding) After coagulation of larger vessels or in coagulation disorder Observation, hemoglobin monitoring, possibly revision Thrombosis / Pulmonary Embolism Postoperative immobility, inadequate prophylaxis Early mobilization, adequate prophylaxis dosing, if suspected VTE: CT / heparinization Nerve Injuries Due to Positioning Brachial plexus, peroneal nerve, femoral nerve Prevention through correct positioning (vacuum mattress, padded boots), neurological evaluation if deficit -
Long-term Complications
Complication Description / Risk Management Adhesions Especially in endometriosis / oncological surgery Anti-adhesion gel, secondary adhesiolysis if necessary Chronic Pelvic Pain Scar neuroma, adhesion, associated with endometriosis Multimodal: NSAIDs, neuromodulation, laparoscopic reevaluation if necessary Pelvic Floor Disorders After radicality or nerve injury Pelvic floor training, urogynecological co-treatment