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 also with patient having other associated medical conditions

Risks associated with any modality of surgery

  1. During Surgery

    Anesthesia risks:

    • Blood loss may or may not need blood transfusion
    • Any inadvertent injury to organ, structure, or tissue, including, but not limited to:
      • Major blood vessel
      • Hollow organ, such as the bowel or bladder
      • Solid organ, such as the spleen or liver
      • Nerves
    • Loss of a needle, piece of an instrument, particulate or any other object used during surgery in patient’s body
      • 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/vomiting
    • Deep vein thrombosis or blood clotting 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 wound, or drainage which lasts 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 disease may return
    • Death

Risks associated with da Vinci robotic assisted laparoscopic surgery

  • 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 cannot tolerate gas/air in abdomen, which is used to inflate the abdomen during minimally invasive surgery
    • Longer operating and anesthesia time
    • Surgical instrument or equipment injures 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
  • After Surgery
    • Shoulder pain
    • Pain from the gas used during the surgery
  • Others
    • Malfunction of the da Vinci robotic surgical system
    • System fail leading to serious injury
    • Need to switch to another type of surgical approach, which could also result in longer procedure time, longer time under anesthesia and increased complications.

Risks associated with specific procedures in gynecology

    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 vaginal incision, infection, bacterial skin infection, pooling/clotting of blood, incision opens or separates),
      • injury to bladder (organ that holds urine)
      • Bowel injury,
      • Vaginal shortening
      • Problems urinating (cannot empty 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 vaginal incision, infection, bacterial skin infection, pooling/clotting of blood, incision opens or separates),
      • injury to bladder (organ that holds urine)
      • Bowel injury,
      • Vaginal shortening
      • Problems urinating (cannot empty 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 tumors):
      • Tear or hole in 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 rectum/bowel
      • Injury to bladder (organ that holds urine)
      • Injury to the ureters (the ureters drain urine from the kidney into the bladder)
      • Front wall of the rectum pushes into the back wall of the vagina
      • Prolapsed bladder (bladder budges into vagina when supportive tissue weakens)
      • Vaginal incision opens or separates
      • Loss of bladder control
      • Pooling of blood between 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)