Some of the risks are briefly described below: * The major problems during<unk> c surgery are related to the cardiopulmonary effect of pneumoperitoneum, systemic carbon dioxide absorption, venous gas embolism, unintentional injuries to intra-abdominal structures and patient positioning. * The most significant risks are from trocar injuries during insertion into the abdominal cavity, as the trocar is typically inserted blindly. Injuries include abdominal wall hematoma, umbilical hernias, umbilical wound infection, and penetration of blood vessels or small or large bowel. The risk of such injuries is increased in patients who have a low body mass index or have a history of prior abdominal surgery. While these injuries are rare, significant complications can occur, and they are primarily related to the umbilical insertion site. Vascular injuries can result in hemorrhage that may be life-threatening. Injuries to the bowel can cause a delayed peritonitis. It is very important that these injuries be recognized as early as possible. * In oncologic<unk> c procedures there is a risk of port site metastases, especially in patients with peritoneal carcinomatosis. This incidence of iatrogenic dissemination of cancer might be reduced with special measures as trocar site protection and midline placement of trocars. * Some patients have sustained electrical burns unseen by surgeons who are working with electrodes that leak current into surrounding tissue. The resulting injuries can result in perforated organs and can also lead to peritonitis. * About 20% of patients undergo hypothermia during surgery and peritoneal trauma due to increased exposure to cold, dry gases during insufflation. The use of surgical humidification therapy, which is the use of heated and humidified CO2 for insufflation, has been shown to reduce this risk. * Not all of the introduced into the abdominal cavity is removed through the incisions during surgery. Gas tends to rise, and when a pocket of CO2 rises in the abdomen, it pushes against the diaphragm (the muscle that separates the abdominal from the thoracic cavities and facilitates breathing), and can exert pressure on the phrenic nerve. This produces a sensation of pain that may extend to the patient's shoulders in about 80% of women for example. In all cases, however, the pain is transient, as the body tissues will absorb the CO2 and eliminate it through respiration. * Coagulation disorders and dense adhesions (scar tissue) from previous abdominal surgery may pose added risk for<unk> c surgery and are considered relative contra-indications for this approach. * Intra-abdominal adhesion formation is a risk associated with both<unk> c and open surgery and remains a significant, unresolved problem. Adhesions are fibrous deposits that connect tissue to organ post surgery. Generally, they occur in 50-100% of all abdominal surgeries, with the risk of developing adhesions being the same for both procedures. Complications of adhesions include chronic pelvic pain, bowel obstruction, and female infertility. In particular, small bowel obstruction poses the most significant problem. The use of surgical humidification therapy during<unk> c surgery may minimise the incidence of adhesion formation. Other techniques to reduce adhesion formation include the use of physical barriers such as films or gels, or broad-coverage fluid agents to separate tissues during healing following surgery. * The gas used to make space and the smoke generated during surgical procedures can leak into the operating room through or around access devices as well as instruments. The gas plume can pollute the airspace shared by the operating team and patient with particles and potentially pathogens, including viral particles.
Laparoscopy
Frozen section procedure
Rectovaginal examination
Frozen pelvis
Fertiloscope
Hysteroscopy
Vaginoscopy
Hysterosalpingography