Editing Laparoscopy (section)

==Risks==
Some of the risks are briefly described below:
* The major problems during laparoscopic 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.<ref name="Srivastava Niranjan 2010 p=91"/>
* 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 vessel]]s or small or [[Colon (anatomy)|large bowel]].<ref name="MayolGarcia-Aguilar1997">{{cite journal | vauthors = Mayol J, Garcia-Aguilar J, Ortiz-Oshiro E, De-Diego Carmona JA, Fernandez-Represa JA | title = Risks of the minimal access approach for laparoscopic surgery: multivariate analysis of morbidity related to umbilical trocar insertion | journal = World Journal of Surgery | volume = 21 | issue = 5 | pages = 529–33 | date = June 1997 | pmid = 9204743 | doi = 10.1007/PL00012281 | s2cid = 29945805}}</ref> The risk of such injuries is increased in patients who have a low [[body mass index]]<ref>{{cite journal | vauthors = Mirhashemi R, Harlow BL, Ginsburg ES, Signorello LB, Berkowitz R, Feldman S | title = Predicting risk of complications with gynecologic laparoscopic surgery | journal = Obstetrics and Gynecology | volume = 92 | issue = 3 | pages = 327–31 | date = September 1998 | pmid = 9721764 | doi = 10.1016/S0029-7844(98)00209-9 | s2cid = 24631884}}</ref> 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.<ref>{{cite web | vauthors = Fuller J, Scott W, Ashar B, Corrado J | title = Laparoscopic Trocar Injuries | publisher = A report from a U.S. Food and Drug Administration (FDA) Center for Devices and Radiological Health (CDRH) Systematic Technology Assessment of Medical Products (STAMP) Committee | url = https://www.fda.gov/cdrh/medicaldevicesafety/stamp/trocar.html | archive-url = https://web.archive.org/web/20070409123945/https://www.fda.gov/cdrh/medicaldevicesafety/stamp/trocar.html | archive-date = 9 April 2007 | url-status = dead}}</ref>
* In [[Oncology|oncologic]] laparoscopic 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.<ref>{{Cite journal|last1=Segura-Sampedro|first1=Juan José|last2=Morales-Soriano|first2=Rafael|last3=Pineño Flores|first3=Cristina|last4=Craus-Miguel|first4=Andrea|last5=Sugarbaker|first5=Paul H.|date=13 March 2021|title=Laparoscopy technique in the setting of peritoneal metastases to avoid port site relapse|url=https://www.sciencedirect.com/science/article/pii/S0960740421000323|journal=Surgical Oncology|volume=37|language=en|pages=101543|doi=10.1016/j.suronc.2021.101543|pmid=33773282|s2cid=232386740|issn=0960-7404}}</ref>
* Some patients have sustained electrical burns unseen by surgeons who are working with [[electrode]]s that leak current into surrounding tissue. The resulting injuries can result in perforated organs and can also lead to peritonitis.<ref name=karadag2015>{{cite journal |vauthors=Karadag MA, Cecen K, Demir A, Bagcioglu M, Kocaaslan R, Kadioglu TC |title=Gastrointestinal complications of laparoscopic/robot-assisted urologic surgery and a review of the literature |journal=J Clin Med Res |volume=7 |issue=4 |pages=203–10 |date=April 2015 |pmid=25699115 |pmc=4330011 |doi=10.14740/jocmr2090w |doi-access = free}}</ref>
* About 20% of patients undergo [[hypothermia]] during surgery and peritoneal trauma due to increased exposure to cold, dry gases during [[Insufflation (medicine)|insufflation]]. The use of [[surgical humidification]] therapy, which is the use of heated and humidified CO<sub>2</sub> for insufflation, has been shown to reduce this risk.<ref name="Dean Ramsay Heriot Mackay 2017 pp. 128–136">{{cite journal | last1=Dean | first1=Meara | last2=Ramsay | first2=Robert | last3=Heriot | first3=Alexander | last4=Mackay | first4=John | last5=Hiscock | first5=Richard | last6=Lynch | first6=A. Craig | title=Warmed, humidified CO2 insufflation benefits intraoperative core temperature during laparoscopic surgery: A meta-analysis | journal=Asian Journal of Endoscopic Surgery | publisher=Wiley | volume=10 | issue=2 | date=May 2017 | issn=1758-5902 | pmid=27976517 | pmc=5484286 | doi=10.1111/ases.12350 | pages=128–136}}</ref>
* Not all of the {{chem|CO|2}} introduced into the abdominal cavity is removed through the incisions during surgery. Gas tends to rise, and when a pocket of CO<sub>2</sub> rises in the abdomen, it pushes against the [[Thoracic diaphragm|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, the pain is transient, as the body tissues will absorb the CO<sub>2</sub> and eliminate it through respiration.<ref name="Kaloo Armstrong Kaloo Jordan p.">{{cite journal | last1=Kaloo | first1=Philip | last2=Armstrong | first2=Sarah | last3=Kaloo | first3=Claire | last4=Jordan | first4=Vanessa | title=Interventions to reduce shoulder pain following gynaecological laparoscopic procedures | journal=The Cochrane Database of Systematic Reviews | publisher=Wiley | volume=1 | date=30 January 2019 | issue=1 | pages=CD011101 | issn=1465-1858 | pmid=30699235 | pmc=6353625 | doi=10.1002/14651858.cd011101.pub2}}</ref>
* [[Coagulation]] disorders and dense [[adhesions]] ([[scar|scar tissue]]) from previous abdominal surgery may pose added risk for laparoscopic surgery and are considered relative contra-indications for this approach.
* [[Intra-abdominal adhesion]] formation is a risk associated with both laparoscopic and open surgery and remains a significant, unresolved problem.<ref name="dörthe769">{{cite journal | vauthors = Brüggmann D, Tchartchian G, Wallwiener M, Münstedt K, Tinneberg HR, Hackethal A | title = Intra-abdominal adhesions: definition, origin, significance in surgical practice, and treatment options | journal = Deutsches Ärzteblatt International | volume = 107 | issue = 44 | pages = 769–75 | date = November 2010 | pmid = 21116396 | pmc = 2992017 | doi = 10.3238/arztebl.2010.0769}}</ref> [[Adhesion (medicine)|Adhesions]] are fibrous deposits that connect tissue to organ post surgery. Generally, they occur in 50-100% of all abdominal surgeries,<ref name="dörthe769"/> with the risk of developing adhesions the same for both procedures.<ref name="dewilde161">{{cite journal | title = Postoperative abdominal adhesions and their prevention in gynaecological surgery. Expert consensus position | doi = 10.1007/s10397-007-0338-x | volume=4 | issue = 3 | year=2007 | journal=Gynecological Surgery | pages=161–168 | author=Leon DeWilde R| doi-access=free}}</ref><ref>{{cite journal | vauthors = Lower AM, Hawthorn RJ, Clark D, Boyd JH, Finlayson AR, Knight AD, Crowe AM | title = Adhesion-related readmissions following gynaecological laparoscopy or laparotomy in Scotland: an epidemiological study of 24 046 patients | journal = Human Reproduction | volume = 19 | issue = 8 | pages = 1877–85 | date = August 2004 | pmid = 15178659 | doi = 10.1093/humrep/deh321 | doi-access = free}}</ref> Complications of adhesions include [[chronic pelvic pain]], [[bowel obstruction]], and [[female infertility]]. In particular, [[small bowel obstruction]] poses the most significant problem.<ref name="dewilde161"/> The use of [[surgical humidification]] therapy during laparoscopic surgery may minimise the incidence of adhesion formation.<ref name="Heated and humidified CO2 prevents">{{cite journal | vauthors = Peng Y, Zheng M, Ye Q, Chen X, Yu B, Liu B | title = Heated and humidified CO2 prevents hypothermia, peritoneal injury, and intra-abdominal adhesions during prolonged laparoscopic insufflations | journal = The Journal of Surgical Research | volume = 151 | issue = 1 | pages = 40–7 | date = January 2009 | pmid = 18639246 | doi = 10.1016/j.jss.2008.03.039}}</ref> 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.<ref name="dewilde161"/>
* 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.<ref>{{Cite journal|pmid=32856306|doi=10.1002/bjs.11977 |doi-broken-date=1 November 2024 |year=2020 |last1=Cahill |first1=R. A. |last2=Dalli |first2=J. |last3=Khan |first3=M. |last4=Flood |first4=M. |last5=Nolan |first5=K. |title=Solving the problems of gas leakage at laparoscopy |journal=The British Journal of Surgery |volume=107 |issue=11 |pages=1401–1405 |pmc=7461047 }}</ref><ref>{{Cite journal|url=https://jamanetwork.com/journals/jamasurgery/article-abstract/2748067|doi=10.1001/jamasurg.2019.2515|title=Surgical Smoke Exposure in Operating Room Personnel|year=2019|last1=Limchantra|first1=Ice V.|last2=Fong|first2=Yuman|last3=Melstrom|first3=Kurt A.|journal=JAMA Surgery|volume=154|issue=10|pages=960–967|pmid=31433468|s2cid=201116813}}</ref>