Trocar injuries during laparoscopic gynaecological surgery. Report from the French Society of Gynaecological Laparoscopy

Objective To review laparoscopic complications resulting from trocar insert ions and to define their risk factors. Methods The French register of laparoscopic complications was reviewed for this study. Results A total of 47 complications due to trocar insertions were recorded between 1994 and 1997: 29 vascular injuries (18 parietal vascular injuries) , 12 bowel injuries, three bladder perforations and three incisional hernia s were noted in this survey. Regardless of the operator, the indication for laparoscopy or the type of trocar used, some patients seem to be more at r isk for complications at laparoscopic surgery: 72% of the studied group had undergone previous abdominal surgery and 54% were overweight; and in 30% i nfringement of the recognized safety rules for trocar insertion was the mai n cause of injury. Laparotomy was needed for these complications in 64% of all cases, and in 90% of cases if vascular injuries of the abdominal wall w ere not included. Laparotomy for repair of the injury was delayed in 21% of cases, and it was done by the same surgeon who performed the laparoscopic procedure in 83%. Conclusions To reduce the risk of trocar injuries, surgeons must be careful and must respect the rules for safe trocar insertion, particularly when th ere is a history of previous surgery. 'Open laparoscopy' may be useful in f acilitating a laparoscopic procedure which is as safe as possible, but the technique is not yet validated. Laparoscopists must inform the patient conc erning the risk of laparotomy becoming necessary should trocar injury occur . Other clinicians should participate in recording complications in registe rs, similar to that of the French Society of Gynaecological Laparoscopy, to accumulate valuable information concerning trocar injuries.