Complications in laparoscopic and robotic-assisted surgery: definitions, classifications, incidence and risk factors - an up-to-date review.

Abstract

Almost all gynecological and general-surgical operations are – or can be – performed laparoscopically. In comparison to an abdominal approach, the minimally invasive access offers several advantages; however, laparoscopy (both conventional and robotic-assisted) can be associated with a number of approach-specific complications. Although the majority of them are related to the laparoscopic entry, adverse events may also occur due to the presence of pneumoperitoneum or the use of laparoscopic instruments. Unfortunately, a high proportion of complications (especially affecting the bowel and ureter) remain unrecognized during surgery. This narrative review provides comprehensive up-to-date information about definitions, classifications, risk factors and incidence of surgical complications in conventional and robotic-assisted laparoscopy, with a special focus on gynecology. The topic is discussed from various perspectives, e.g. in the context of stage of surgery, injured organs, involved instruments, and in relation to malpractice claims.

Robot‐assisted scaffold implantation and two‐stage flap raising of the greater omentum for reconstruction of the facial skeleton: Description of a novel technique

“…19 In some cases, surgical complications are detected only postoperatively, which increases the mortality and the risk for surgical malpractice. 20 In this study, no organ injuries, adhesions, or other surgical complications were detected while second-stage procedure for both surgical modalities. Nevertheless, advantages of the robotassisted surgery as tremor reduction, image magnification, and a stable camera platform lead to less tissue trauma and lower intraoperative blood loss, enable early bowel movements in abdominal surgery, faster mobilisation as well as reduced pain.…”

“…In some cases, surgical complications are detected only postoperatively, which increases the mortality and the risk for surgical malpractice 20 . In this study, no organ injuries, adhesions, or other surgical complications were detected while second‐stage procedure for both surgical modalities.…”

Assessment of the Versius Robotic Surgical System in Minimal Access Surgery: A Systematic Review

“…Robotic-assisted procedures revolutionized minimal access surgery (MAS) and overcame the technical limitations of laparoscopy [1,2]. With robotic assistance, the indications for MAS could be extended to include delicate and complex procedures.…”

Editorial: Changing backgrounds and groundbreaking changes: Gynecological surgery in the third decade of the 21st century

“…In the third decade of the 21st century, gynecological surgeons are faced with new technical developments but also with new expectations. The surgical evolution is reflected by individualized approaches to patients and treatments (1), increasing role of "omics" and advanced imaging methods for surgical decisions (2,3), the substantial shift from vaginal to laparoscopic concepts in urogynecology (4)(5)(6), increasing role of the robotic-assisted surgery or increased awareness about surgical complications and their prevention (7).…”

“…These favorable developments do not eliminate unresolved problems of the past (e.g., the role of the human factor in surgical complications) and add new pitfalls and uncertainties, e.g., the controversy about laparoscopic tissue morcellation (7), the doubts about the oncological risks and long-term results of minimally invasive procedures following the LACC trial (8)(9)(10), or issues regarding fertility preservation in oncological patients (11).…”