Morbidity in laparoscopic gynecological surgery - Results of a prospectivesingle-center study

Background: We set out to investigate prospectively the morbidity rate for gynecological laparoscopy patients at a tertiary care center. Methods: We prospectively recorded data on 743 laparoscopic procedures perf ormed between January 1, 1992 and December 31, 1996. The procedures include d 36 diagnostic laparoscopies (4.8%), 115 laparoscopies carried out for min or surgical acts (15.4%), 523 for major surgical acts (70.4%), and 69 for a dvanced surgical acts (9.4%). A total of 127 patients had a history of prio r laparotomy (17%). All those procedures were performed by young senior sur geons. We defined a complication as an event that had modified the usual co urse of the procedure or of the postoperative period, For statistical analy sis, we used the chi-squared test or Fisher's exact test. Results: Complications occurred in 22 cases; the overall complication rate was 2.9% when all events were considered. One complication (injury of the l eft primitive iliac artery) was related to insertion of the Veress needle ( 0.13%), A total of 2,578 trocars were inserted, giving rise to 10 complicat ions (1.3%). Three unintended laparotomies were required for bowel or bladd er injuries (0.4%). Finally, the introduction of the laparoscope was respon sible for 11 complications (1.4%); this figure represents 50% of all the co mplications of this series. Eight intraoperative complications (1%) occurre d during the laparoscopic surgery (seven severe bleedings and one ureter in jury, but no intestinal lesions); laparotomy was required in six of these c ases. Three complications occurred during the postoperative stage: one gran ulomatous peritonitis after intraabdominal rupture of a dermoid cyst, one i ncisional hernia, and a fast-resolving cardiac arrhythmia. Conclusions: In our experience, operative gynecological laparoscopy is asso ciated with an acceptable morbidity rate. Moreover, about half of the compl ications occur during the installation of the laparoscopic procedure, under scoring the usefulness of safety rules.