Laparoscopic surgery can be described as “keyhole surgery”. It is also important to break down the steps of the operation:

• The procedure is performed under general anaesthesia.
• Once asleep, a small cut is usually made in the region of the belly button (umbilicus).
• A small plastic sheath is inserted into the abdomen and gas is pumped into the abdominal cavity. (The gas used is carbon dioxide because it is highly soluble and rapidly excreted by the body).
• The gas pumped into the abdomen elevates the front of your abdominal wall away from the internal organs. This creates the necessary space for us to obtain good views and perform the operation.
• Further small incisions of 15 - 20mm are made through in which we place further plastic sheaths. Through these plastic sheaths, we insert our instruments.
• Most often two further incisions are made, however, this number can vary depending on the pathology identified and the intended operation. The location of these incisions depends on the indications for the procedure including the pathology identified.
• Conversion to an open procedure is often wrongly included as a risk when patients are being consented for laparoscopic operations. This is not a risk and should be included as part of the standard operation. The percentage rate of conversion depends on the procedure being undertaken and the experience of the surgeon performing the operation. The important point to emphasise is that if the operation cannot be safely completed laparoscopically, it will be necessary to convert to open.

General Complications

Complications of laparoscopic surgery are primarily related to the surgery or due to the secondary effects of the Pneumoperitoneum.

Potential risks / complications include:

• Infections
• Bleeding/hematoma
• Thromboembolism
• Adhesion formation
• Port site hernia formation
• Basal atelectasis/pneumonia
• Damage to surrounding structures/lactogenic injury
• Solid organ damage
• Small bowel/colon
• Major vascular injury
• Bile duct injuries
• Bladder

The injuries can occur during trocar insertion (increased risk with Veress needle), due to electrocautery conductivity or as a result of technical failure.  Such injuries can go unrecognised at the time of laparoscopy, and therefore a high index of clinical suspicion is necessary in postoperatively unwell patients. 

Complications due to Pneumoperitoneum

When absorbed, the systemic effects of carbon dioxide, the gas used for insufflation of the abdomen, include:

• Increase in PaCO²
• Increase in respiratory rate
• Myocardial instability / cardiac dysrhythmia
• Decrease in pH

Abdominal compartment syndrome is a rare, serious complication as a result of intra-abdominal hypertension.  It is most commonly due to prolonged carbon dioxide insufflation, and is it is unrecognised, it can lead to severe organ dysfunction.

Cardiac Complications

• Increased venous return
• Decreased cardiac output (CO)
• Increased systemic vascular resistance
• Increased risk of bradycardia (vagal stimulation)
• Gas embolism

Respiratory Complications

• Ventilation / perfusion mismatching
• Displacement of the diaphragm
• Pneumothorax
• Pneumomediastinum
• Respiratory failure

A two-surgeon, four-cannula technique is used. In almost all patients, an abnormal presence of air or other gas can be identified with use of a closed technique. Cautery provides excellent haemostasis during dissection of the gallbladder from its attachments. Cholangiography through the gallbladder or the cystic duct is easily performed in selected patients.

What are the possible complications?

The operation is usually straightforward and you will usually be able to go home the following day. There are however risks with any operation and although they are rare, these are detailed below:

• Shoulder pain: This often happens after keyhole surgery, but tends to last less than 24-hours. It is due to the gas used to inflate the inside of the abdomen during the operation.
• Infection:This can occur in the wound(s), in the lungs, at the site of the intravenous drip, or at the position where the gallbladder was located.
• Bleeding:This can occur during or after the operation, as with any surgery.
• Bile leak: Bile can leak from tiny accessory ducts or the main bile duct after the operation. This may settle spontaneously, but in some cases may require further intervention.
• Damage to surrounding structures: Rarely, nearby structures can be damaged inadvertently during this operation, as with any operation. These structures include the bile duct, bowel, and the blood supply to the liver. A bile duct injury is potentially very serious but is rare, occurring in approximately 3 in every 1000 operations.
• Deep vein thrombosis (DVT)/Pulmonary embolus (PE): Clots forming in the veins can occur with any surgery, but the risk is increased with laparoscopic surgery. We give you a blood thinning agent to decrease this risk and ask you to wear compression stockings.

Retained stone: Before or during the operation a stone can move into the bile duct. This often causes no problem and passes into the bowel. However, if it does not pass, a second procedure may be necessary to remove it.