Intraoperative and postoperative complications of gynecological laparoscopic interventions: incidence and risk factors

Abstract

Purpose The aims of this study were to determine the incidence of intraoperative and postoperative complications of laparoscopic gynecological interventions and to identify risk factors for such complications. Methods All patients who underwent laparoscopic interventions from September 2013 to September 2017 at the Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital were identified retrospectively using a prospectively compiled clinical database. Binary logistic regression analysis was used to identify independent risk factors for intra- and postoperative complications. Results Data from 3351 patients were included in the final analysis. Overall, 188 (5.6%) intraoperative and 219 (6.5%) postoperative complications were detected. On multivariate analysis, age [odds ratio (OR), 1.03; 95% confidence interval (CI) 1.01–1.04], surgery duration (OR, 1.02; 95% CI 1.02–1.03), carbon dioxide use (OR, 0.99; 95% CI 0.99–1.00), and surgical indication (all p ≤ 0.01) were independent risk factors for intraoperative and duration of surgery (OR, 1.01; 95% CI 1.01–1.02; p ≤ 0.01), carbon dioxide use (OR, 0.99; 95% CI 0.99–1.00; p ≤ 0.01), hemoglobin drop (OR, 1.41; 95% CI 1.21–1.65; p ≤ 0.01), and ASA status (p = 0.04) for postoperative complications. Conclusion In this large retrospective analysis with a generally low incidence of complications (5.6% intraoperative and 6.5% postoperative complications), a representative risk collective was identified: Patients aged > 38 years, surgery duration > 99 min, benign or malignant adnex findings were at higher risk for intraoperative and patients with surgery duration > 94 min, hemoglobin drop > 2 g/dl and ASA status III at higher risk for postoperative complications.

Multi-Institutional Trends in Gynecological Robotic Surgery in India: A Real-World Scenario

“…The overall minor complications such as port site discomfort/pain and minimal bleeding during surgery were <2%, and major complications such as port site hernia, bowel injury/bowel ischemia/gangrene, or massive bleeding due to vessel injury were <1% [ 26 ]. Acceptable low morbidity and complications were seen in the current study and have been similarly reported in the literature [ 27 , 28 ]. The limitations of the current study are as follows: in India, we have four different robotic platforms approved for clinical use, and under this study, all cases were operated by the da Vinci system, and not all centers in India performing RALS for gynecological cases have participated for the study.…”

Hybrid argon plasma coagulation (HybridAPC) versus sharp excision for the treatment of endometriosis: a prospective randomized clinical trial

“…Endometriosis therapy focuses on pain relief, improvement of fertility or the prevention of organ dysfunction [1]. In addition to medical interventions, a laparoscopic approach is generally accepted as the mainstay to remove endometrial implants and restore anatomy [2,3]. For peritoneal endometriosis, this is commonly achieved by different minimally invasive techniques such as sharp excision and subsequent haemostasis, ablation with monopolar or bipolar energy, CO 2 laser vaporization, thermal destruction with helium plasma as well as ablation with plasma technology (e.g.…”

Use of a microsurgical vascular clip system for temporary bilateral occlusion of the four main uterine vessels for laparoscopic enucleation of very large intramural uterine fibroids

“…Bleeding is not the only problem encountered during the surgical treatment of large uterine myomas; the need for intracorporal reconstruction of the uterine wall with its excessive cut edges due to expansion of the myometrial layer by a large intramural fibroid also poses another challenge. This procedure can result in excessive blood loss requiring transfusion, prolongation of the operating time, and postoperative complications requiring prolonged hospital stays [ 2 , 8 ].…”