Purpose of Review <p>This review seeks to deliver a comprehensive summary of the types, locations, and management strategies for gastrointestinal and genitourinary complications linked to gynecologic laparoscopic surgery. It will cover injury mechanisms, surgical methods to prevent complications, intraoperative recognition strategies, and detailed management protocols to enhance patient outcomes.</p> Recent Findings <p>The incidence of GI and GU injury at the time of gynecologic laparoscopic surgery is low but associated with substantial patient morbidity. The majority of GI injuries occur at the time of abdominal entry. Small serosal abrasions can be expectantly managed while injuries to the bowel mucosa or muscularis requires immediate surgical repair. Delayed diagnosis of bowel injury is associated with significant patient morbidity and clinical presentation is widely variable. Bladder injury is more common than ureteral injury, and bladder injury is more often recognized intraoperatively. In the setting of complex injuries, a multi-disciplinary approach is necessary to ensure proper repair and optimal patient outcomes.</p> Summary <p>Gynecologic surgeons should have a thorough understanding of the possible GI and GU injuries that can occur at the time of laparoscopic surgery and should remain vigilant in the OR to aid in early recognition of these injuries. Careful technique, thorough inspection, and the use of adjunctive tests are critical in reducing the risk of operative injuries. When patient symptoms deviate from the expected postoperative course, delayed recognition of operative injury should be considered. Timely recognition and management of such complications are crucial to optimizing patient outcomes.</p>