Complications during gynecologic surgery can result from the close proximity of the uterus and ovaries to other vital structures in the abdomen and pelvis. These structures include the urinary tract, bowel, nerves, and blood vessels. It is paramount that the gynecologic surgeon possess a good fund of knowledge with respect to pelvic anatomy in order to anticipate and avoid potential injuries and complications and to deal with them effectively when they do occur to afford the best possible outcome for the patient. Recognition and repair of an unintended injury gives the best chance for minimizing sequelae from these complications. This chapter will review the most common and potentially life-threatening complications encountered during the intraoperative phase of gynecologic surgery.
Scope of the Problem
Gynecologic surgery often involves meticulous dissection near the bladder, rectum, ureters, and blood supply of the pelvis. Complications of gynecologic surgery include hemorrhage, infection, thromboembolism, and damage to surrounding organs and pelvic structures. The risk of complications depends on the extent of and approach to surgery and patient characteristics. The more common complications from pelvic surgery occur during extensive resections for the treatment of cancer or when anatomy is distorted due to infection, endometriosis, or adhesive disease. Other complications, such as pulmonary embolus, myocardial infarction, pneumonia, and fluid or electrolyte imbalance, are common to all types of surgery.
Intraoperative hemorrhage is defined as blood loss in excess of 1,000 ml or that requires a blood transfusion . Massive hemorrhage refers to either acute blood loss of more than 25 percent of a patient's blood volume or bleeding that requires emergency intervention to save the patient's life . Severe postoperative anemia has significant impact on perioperative morbidity and mortality .
Management of Intraoperative Bleeding
Complications cannot always be avoided, even with the most experienced surgeons. Because of this fact, the surgeon and team should be prepared to handle complications, such as hemorrhage, when they arise. Studies have shown in both the gynecologic and obstetric fields that simulation drills helps identify deficiencies in both knowledge and clinical skill and can help prepare the surgeon and team for success in real life situations [4–7].