Risks And Complications

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Risks And Complications

Any surgery carries the risk of complications, including death, which is true of robotic surgery also.

There are some risks specific to the procedure and some with the patient having other associated medical conditions.

Risks associated with any modality of surgery

  1. During surgery
    • Blood loss which may or may not need blood transfusion
    • Any inadvertent injury to organs, structure or tissue, including, but not limited to:
      • Major blood vessels
      • Hollow organs such as the bowel or bladder
      • Solid organs such as the spleen or liver
      • Nerves
    • Loss of a needle, piece of an instrument, particulate or any other object used during the surgery in the patient’s body

      Anaesthesia risks:

      • Hemodynamic shock
      • Heart attack
      • Stroke
      • Deep vein thrombosis or blood clotting in deep veins
      • Pulmonary embolism or blocked lung artery
      • Pneumonia
      • Dental injury
      • Injury to the vocal cord or other soft tissues
      • Death
  2. After surgery
    • Bleeding
    • Urinary tract infection
    • Blocked intestine or small bowel, nausea or vomiting
    • Deep vein thrombosis or blood clots in deep veins
    • Blood clot in a vessel that breaks away and travels to another part of the body like lungs or brain
    • Infection
    • Large amount of drainage from the wound or drainage which lasts for a long period of time
    • Bursting of the wound at the incision site
    • Hernia (bulging of organ or fatty tissue) at the incision site
    • Symptoms or the disease may return
    • Death

      Risks associated with da Vinci robotic assisted laparoscopic surgery

      1. During surgery
        • Surgeon may need to switch to open surgery which requires a large incision and hand-assisted surgery. This is usually due to:
          • Patient anatomy / frame
          • Severe scarring or swelling of tissues
          • Injury during surgery
          • Technical challenges
          • Cancer or disease that is more extensive than first thought
          • The patient being unable to tolerate the gas / air in the abdomen which is used to inflate the abdomen during minimally invasive surgery
        • Longer operating and anaesthesia time
        • Surgical instrument or equipment injures to hollow or solid organ(s) or blood vessel(s)
        • Short-term nerve damage caused by how the patient was positioned on the operating table
        • Temporary swelling of tissue due to gas in the tissue
        • Changes in heart rate, blood pressure or blood values due to absorption of the gas used during minimally invasive surgery
      2. After Surgery
        • Shoulder pain
        • Pain from the gas used during the surgery
      3. Others
        • Malfunction of theda Vinci ;robotic surgical system
        • System failure leading to serious injury
        • Need to switch to another type of surgical approach which could also result in longer procedure time, longer time under anaesthesia and increased complications.

          Risks associated with specific procedures in gynaecology

          1. Hysterectomy, Benign (removal of the uterus and possibly nearby organs)
            • Injury to the ureters (the ureters drain urine from the kidney into the bladder)
            • Vaginal cuff problems (scar tissue in the vaginal incision, infection, bacterial skin infection, pooling  / clotting of blood, incision opening or separating)
            • Injury to the bladder (organ that holds urine)
            • Bowel injury
            • Vaginal shortening
            • Problems urinating (cannot empty the bladder, urgent or frequent need to urinate, leaking urine, slow or weak stream)
            • Abnormal hole from the vagina into the urinary tract or rectum
            • Vaginal tear or deep cut
            • Uterine tissue may contain unsuspected cancer
            • The cutting or morcellation of uterine tissue during surgery may spread cancer and decrease the long-term survival of patients.
          2. Hysterectomy, Cancer (removal of the uterus and possibly nearby organs)
            • Injury to the ureters (the ureters drain urine from the kidney into the bladder,
            • Vaginal cuff problems (scar tissue in the vaginal incision, infection, bacterial skin infection, pooling / clotting of blood, incision opening or separating)
            • Injury to the bladder (organ that holds urine)
            • Bowel injury
            • Vaginal shortening
            • Problems urinating (cannot empty the bladder, urgent or frequent need to urinate, leaking urine, slow or weak stream)
            • Abnormal hole from the vagina into the urinary tract or rectum
            • Vaginal tear or deep cut
            • Uterine tissue may contain unsuspected cancer
            • The cutting or morcellation of uterine tissue during surgery may spread cancer and decrease the long-term survival of patients.
          3. Myomectomy (removal of fibroid tumours)
            • Tear or hole in the uterus
            • Split or bursting of the uterus
            • Pre-term (early) birth
            • Spontaneous abortion
            • Uterine tissue may contain unsuspected cancer. The cutting or morcellation of uterine or fibroid tissue during surgery may spread cancer and decrease the long-term survival of patients.
          4. Sacrocolpopexy (pelvic prolapse surgery
            • Mesh erosion / infection caused by mesh moving from vaginal wall into surrounding organs causing the need for another operation
            • Injury to the rectum / bowel
            • Injury to the bladder (organ that holds urine)
            • Injury to the ureters (the ureters drain urine from the kidney into the bladder)
            • Front wall of the rectum pushing into the back wall of the vagina
            • Prolapsed bladder (bladder budges into vagina when supportive tissue weakens)
            • Vaginal incision opening or separating
            • Loss of bladder control
            • Pooling of blood between the bladder and pubic bone
            • Pooling of blood between the anus and vagina
          5. Endometriosis resection (endometriosis surgery to remove implants)
            • Injury to the bowel, bladder (organ that holds urine) or ureters (the ureters drain urine from the kidney into the bladder)