Although uncommon with experienced laparoscopists, vascular injury leading to hemorrhage is a possibility. Injury to the aorta, vena cava and iliac vessels can result in rapid blood loss. It is important to have an IV access of reasonable size even though the procedure may be considered to have a low potential for blood loss. It should be remembered that a retroperitoneal hematoma may result in major blood loss without a great deal of blood being visible in the peritoneal cavity. Particular attention should be paid in the case of an inexperienced surgeon or in the case of a patient in whom difficulty in placement of needle or trocar is anticipated.
Ventilation is impaired by abdominal distention and patient position.
In addition, carbon dioxide is absorbed from the abdominal cavity and may be absorbed from subcutaneous emphysema. Elevation of the diaphragm results in a mismatch of ventilation and pulmonary perfusion. An increase in the arterioalveolar CO 2 difference results from increased physiological dead space. Reduced FRC, total lung volume and pulmonary compliance result from a steep head down position, especially in obese or debilitated patients. The head down position may also result in the development of atelectasis.