Laparoscopic surgery provides numerous advantages over conventional open surgery, but patient safety always depends on careful preoperative assessment. Patients with hypercoagulable and hypocoagulable conditions require special consideration because abnormalities in blood clotting can significantly increase the risk of serious perioperative complications.

In a hypercoagulable state, the body has an abnormal tendency to form blood clots. Pneumoperitoneum during laparoscopy increases intra-abdominal pressure and may reduce venous return from the lower extremities. Combined with prolonged surgical positioning and reduced mobility after surgery, this can promote venous stasis and increase the possibility of thromboembolic complications. High-risk patients may develop deep venous thrombosis, and in severe cases, a clot may travel to the lungs and cause a potentially life-threatening pulmonary embolism.

Patients in a hypocoagulable state, on the other hand, face the opposite problem—an increased tendency to bleed. Conditions such as severe thrombocytopenia, clotting factor deficiencies, advanced liver disease, or the use of anticoagulant medications can make surgery hazardous. Trocar placement and laparoscopic dissection can injure blood vessels, and uncontrolled bleeding may be difficult to manage, particularly when visibility is reduced by accumulated blood within the operative field.

For these reasons, surgeons must carefully evaluate the patient's platelet count, PT/INR, aPTT, medication history, liver function, and individual thrombotic or bleeding risk before proceeding with laparoscopic surgery. Anticoagulant drugs may need appropriate perioperative adjustment, while coagulation defects may require correction before an elective procedure.

The important principle is that laparoscopic surgery should not automatically be rejected in every patient with a coagulation disorder. Instead, the decision should be individualized. Uncontrolled hypercoagulability or hypocoagulability should be optimized before surgery, and appropriate preventive measures should be taken to reduce both bleeding and thromboembolic complications.