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Reported surgical complication rates for laparoscopy and laparotomy vary. Initial reports suggested that surgical complications occurred with a lower frequency for laparoscopy, but as the complexity of procedures performed using this approach has increased, the complication rate is now more comparable [32, 33]. Complication rates and surgical time, which can additionally contribute to morbidity, tend to decrease with surgeon experience [12].

Surgical complications may be related specifically to the procedure, positioning for the procedure (discussed later), or be of a more general nature. Again, prior preparation will facilitate rapid treatment should this occur.

Hemorrhage from inadvertent puncture of organs or vessels during placement of the Veress needle or introduction of the trocars is a reported complication in human and animal patients (Figure 7.1) even during entry into the abdomen for routine procedures and requires a quick response from the anesthetist [32–38]. Hemorrhage from either cause might also necessitate conversion from the laparoscopic to open approach during which time the patient will need to continue to be supported aggressively until the surgeon can visualize and control the source of hemorrhage. A recent report in veterinary patients indicates excessive hemorrhage as one of the significant causes for conversion to celiotomy during diagnostic procedures [39]. Although the occurrence of hemorrhage within the pneumoperitoneum is typically readily identified, the increased intra‐abdominal pressure may cause venous tamponade and delay recognition of active bleeding into the postoperative period [7]. Hemorrhage has also been reported at the surgical site during routine procedures such as ovariectomy in dogs [35, 40] suggesting vigilance on the part of the anesthetist for this complication is important. A recent study in 161 dogs undergoing laparoscopic ovariectomy performed by supervised novice surgeons, reported only minor blood loss, caused by splenic puncture during insertion of the Veress needle (12.4%), and bleeding from the ovarian pedicle (2.5%), but conversion to laparotomy was not required in any dogs [37].

Figure 7.1 Inadvertent splenic puncture.

Source: Courtesy of Eric Monnet.

Figure 7.2 Radiographic image showing inadvertent placement of insufflation gas into the bladder.

Source: Courtesy of David Twedt.

In addition to vascular entry and organ puncture with subsequent hemorrhage as previously mentioned, surgical complications include bladder (Figure 7.2), bowel or stomach puncture and gas distention, trauma to the bile duct, peritoneal detachment, etc. A 7.5% emergent conversion rate from laparoscopy to laparotomy due to surgical complications such as hemorrhage and biliary tract rupture was reported in dogs and cats [39].

Other causes of surgical complications are related to the unique equipment used for intervention. Just as it is important for the surgeon to have basal knowledge of anesthesia, it is important for the anesthetist to have at least a similar level of understanding of the surgical equipment used to facilitate laparoscopy. Complications associated with puncture of organs/vessels with the Veress needle have already been discussed. Additional complications may arise from use (intentional or accidental) of high insufflation pressures, intra‐abdominal use of cautery (especially if a potentially flammable gas is used), heat from the light source and cable, etc.