Intraoperative injury in reconstructive pelvic surgery

Injury during gynecologic surgery is an unfortunate yet often unavoidable occurrence. Risks involved with surgery must be carefully detailed to patients during preoperative counseling sessions rather than skimmed through briefly. After a through informed consent is obtained, it is imperative that the medical record reflect this discussion. Patients will better understand and cope with complications postoperatively if they were educated in advance. Preoperatively, a careful history, physical examination, and imaging can adequately prepare the surgeon for what might be encountered. While operating, the surgeon can minimize the risks of injury by adhering to basic surgical techniques such as traction and countertraction, sharp dissection, and good exposure. If an injury is encountered, it is most important that the injury is promptly repaired. Injuries that are immediately identified and properly repaired tend to heal without any further consequence. After surgery, surgeons should document the important details of the surgery, including the preventive measures taken for patient safety. If an injury is encountered, the operative note should clearly reflect this occurrence and all steps taken to identify and repair the injury. If diagnosis is delayed, results are typically poorer. Regardless, postoperatively, a high index of suspicion should remain in any patient with unusual or prolonged symptoms. Whenever a diagnosis is made, attempts to correct the situation should be done quickly and efficiently. Encountering complications during surgery is inevitable. The management of such complications is of paramount importance and can significantly alter patient outcomes.