Complications in Gynecologic Surgery

This chapter reviews complications of gynecologic surgery relevant to the various organ systems of the pelvis and abdomen. Strategies for preventing, recognizing, and treating injury to nerves, vascular structures, the genitourinary system, and the gastrointestinal system will be presented. Neurologic injury in gynecologic surgery can usually be attributed to one or more of three factors: positioning, retraction, or direct surgical injury. Contributing factors include prolonged surgery, radical dissections, patient weight, and patient anatomy. Most neurologic complications are minor, transient, and resolve spontaneously. Neurologic injury to the upper extremity is almost entirely due to positioning issues. The brachial plexus is susceptible to stretch or compression injuries. The use of shoulder braces for women undergoing laparoscopic surgery with the use of steep Trendelenburg can be associated with stretch injuries when the brace is placed too far laterally and compression injuries when placed too medi-ally.