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

Intraoperative Bleeding:

• Injury to the ovarian artery
• Increased risk of bleeding with large or inflamed cysts
• Possible bleeding from diffuse capillary hemorrhages from the ovarian cortex
• Treatment: Bipolar coagulation, suture, or conversion to laparotomy

Injuries to Adjacent Organs

Bowel injuries (small intestine, colon, rectum):

• Especially with adhesions after previous inflammations or surgeries
• or with large cysts 

Ureteral injuries:

• Since the ureter runs close to the ovary, there is a risk of thermal damage from coagulation

Bladder injuries:

• Especially with low-lying ovarian cysts or adhesions

Anesthesia-related Risks

• Allergic reactions to medications or latex
• Cardiovascular complications:
  • Arrhythmias, hypotension
• Aspiration pneumonia due to inadequate fasting

CO₂ Insufflation Complications

• Gas embolism:
  • Entry of CO₂ into venous vessels → can lead to severe cardiopulmonary complications
• Subcutaneous emphysema:
  • CO₂ can enter the tissue due to incorrect trocar placement
  • Leads to swelling and crepitus

Bleeding/Postoperative Bleeding

• Occurs when vessels in the ovarian fossa or at the cyst bed are inadequately coagulated
• Symptoms: abdominal pain, drop in blood pressure, tachycardia
• Treatment: Conservative monitoring or re-operation

Hematoma Formation:

• A postoperative hematoma in the ovarian fossa can exert pressure on surrounding structures
• Risk of compression effects on the bowel or ureter

Infections

Wound Infections:

• Infection of the trocar incisions

Pelvic Abscess:

• Especially with ruptured or infected ovarian cysts (e.g., endometriosis cysts or purulent cysts)
• Can lead to peritonitis

Peritonitis:

• Occurs with leakage of cyst contents (especially with dermoid cysts or endometriosis cysts)
• Symptoms: fever, guarding, leukocytosis

Bowel and Urinary Tract Problems

Paralytic bowel obstruction:

• Due to manipulation of the peritoneum or as a result of intraoperative bowel irritation
• Symptoms: bloating, absence of stool and gas passage, nausea

Mechanical bowel obstruction:

• Due to adhesions, blood clots, or scar formation in the pelvic cavity

Urinary Retention:

• Possible due to irritation of the bladder nerve plexus (hypogastric plexus) or postoperative swelling

Thrombosis and Embolism

Deep Vein Thrombosis:

• Due to prolonged immobilization after surgery
• Prevention: Thrombosis prophylaxis with heparin, early mobilization

Pulmonary Embolism:

• Acute shortness of breath, chest pain, tachycardia due to embolus in the pulmonary artery

Pain

• Diaphragmatic Irritation with Shoulder Pain:
  • Due to residual CO₂ gas after laparoscopy

Infertility

• With bilateral ovarian cystectomy or removal of a large amount of ovarian tissue, the egg reserve (AMH value) may decrease
• Risk of secondary ovarian insufficiency

Chronic Pain

• Adhesions/scar traction on the ovaries can lead to persistent cycle-dependent pain

Adhesions

• Most common long-term complication after invasive procedures on the ovary
• Can lead to:
  • Persistent lower abdominal pain
  • Bowel obstruction (ileus)
  • Fallopian tube obstruction with infertility

Altered Hormonal Regulation

• Ovarian cystectomy can reduce ovarian blood flow, which may lead to an earlier onset of menopause
• Particularly relevant in women with pre-existing low ovarian reserve

Psychological Stress

• Loss of fertility in extensive procedures can be psychologically distressing
• Risk of depressive moods, anxiety disorders