From Theatre to Intensive Care: A Narrative Review of Life-Threatening Complications in Gynaecological Laparoscopy and Hysteroscopy.

Abstract

This narrative review examines life-threatening complications of gynaecological laparoscopy and hysteroscopy, synthesising their historical evolution, complication classification, and clinical implications. A structured search of PubMed and EMBASE (from January 2000 to August 2025), supplemented by guidance from international surgical and anaesthetic societies, identifies studies reporting catastrophic events, including major haemorrhage, visceral and vascular injury, fluid overload, electrolyte imbalance, gas embolism, thromboembolism, and pneumoperitoneum-related cardiopulmonary instability. Because of heterogeneity and frequent case-based evidence, the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology and meta-analysis are not applied. The review explores how patient, procedure, and operator factors can cause rapid deterioration from intraoperative incident to critical illness requiring intensive care. It summarises prevention and management strategies from current guidelines, emphasising careful patient selection, robust perioperative monitoring, anaesthetic vigilance, protocolised escalation pathways, and simulation-based team training, particularly relevant to outpatient hysteroscopy. Timely recognition and effective multidisciplinary coordination are key factors in ensuring patient survival and recovery. The review also discusses technological innovations, such as fluorescence-guided imaging, safer distension and insufflation systems, and predictive analytics, combined with the requirement for institutional adoption of safety culture, structured escalation frameworks, and continuous education. Persistent challenges include under-reporting, variability in definitions, and scarce long-term outcome data, which obscure true incidence and limit comparative analyses. By combining historical and recent evidence within a pragmatic clinical framework, this review provides clinicians with an integrated approach to anticipate, recognise, and manage life-threatening complications effectively. Future progress depends on standardised reporting, multicentre collaboration, and the evaluation of emerging monitoring technologies to ensure that minimally invasive gynaecology continues to advance while safeguarding patient safety.