Keyhole Surgery Complications

Keyhole surgery is also known as laparoscopic or minimally invasive surgery. It involves using long, thin tools to perform surgery through long tubes, called catheters. A miniature camera is also passed through the catheter so surgeons can see, on a screen, what they are doing. Only small incisions, perhaps half an inch in length, are needed. Keyhole surgery can be done instead of traditional "open surgery" for a variety of cardiac, urological, gynecological, orthopedic and other procedures. The idea is to reduce pain, recovery time and the chance of complications. Some complications, however, can still occur.

Minor Complications

• Keyhole surgery carries a risk of several minor complications, along with a few more severe complications. Among the minor complications you may experience are mild infections, bruising at the site of incision and abnormal scar formation. These problems are generally short-lived and easily treated. Symptoms such as nausea and vomiting can also occur in response to various anesthetic agents used.

Anesthetic Reactions

• Depending on the procedure, you may receive a general anesthetic for keyhole surgery, with all of the attendant risks. As with any medication, an allergic reaction can occur. Beyond nausea, hives or other skin reactions are the most common type of allergic reaction. Occasionally, a person's body can go into shock from anesthesia, but this is not common. Even in cases where shock does occur, it's not generally life-threatening. A few people have conditions that make their bodies susceptible to more severe reactions from anesthetic agents. For example, about 1 in 3,000 people can't metabolize the drug succinylcholine, which is frequently administered during surgery to relax the muscles. As a result, people take much longer to wake up than would be normal.

Tool Injuries

• The tools used to perform laparoscopic surgery--particularly the Veress needle and the trocar--can injure blood vessels. If the aorta or other important parts of the vascular system are punctured, death can quickly ensue. Adding to the problem, it's likely the doctor won't notice the perforation as quickly as with open surgery; the injury may not become apparent until the patient goes into shock from blood loss. To expand the space in which they are working, surgeons often inflate the body cavity with carbon dioxide gas. In the case of a vascular injury, the gas can enter the vessel and reach the heart. This complication, too, can be deadly. The bowel, lung and other organs can also be punctured, also with potentially disastrous results for the patient.

Carbon Dioxide

• The carbon dioxide used to insufflate the body during many operations carries other risks besides causing an embolism and reaching the heart. In gynecologic surgery, the gas is put into the abdomen at relatively high pressure. This, combined with the head-up positioning used in such surgeries, causes an increase in the rate at which blood flows back to the heart. In patients with poor cardiac function, the heart can be overwhelmed and heart failure can result. In some cases, carbon dioxide is absorbed directly into the bloodstream and can cause abnormal heart rhythm. The release of several hormones that can harm the heart is also stimulated by carbon dioxide. They include catecholamine and vasopressin. They can cause the circulatory system to fail.

Conversion

• Sometimes a surgeon starts a surgery with keyhole techniques but, during the procedure, feels a need to create a larger incision and perform the surgery in traditional "open" fashion. This is called a conversion. It may be required because of bleeding, injury to an organ or in order to better visualize the anatomy being worked on in the case of sudden problems. Assuming you have a skilled surgeon, this complication need not prevent you from having a good outcome. Your doctor must feel comfortable performing the surgery both ways and feel confident in converting if the need arises.