SURGICAL COMPLICATIONS OF DIAGNOSTIC AND OPERATIVE GYNECOLOGICAL LAPAROSCOPY - A SERIES OF 29,966 CASES

A multicentre study was carried out in seven top French centres for la paroscopic gynaecological surgery. This series covers a period of 9 ye ars, in which 29 966 diagnostic and operative laparoscopic operations were performed. The risk of complications has been assessed according to the complexity of the laparoscopic procedure in question. The means of diagnosis and treatment of the complications have been analysed, t ogether with the importance of the surgeon's degree of experience. The mortality rate was 3.33 per 100 000 laparoscopies, The overall compli cation rate was 4.64 per 1000 laparoscopies (n = 139), The rate of com plications requiring laparotomy was 3.20 per 1000 (n = 96), The compli cation rate was significantly correlated with the complexity of the la paroscopic procedure (P = 0.0001). One in three complications (34.1%; n = 43) occurred while setting up for laparoscopy, and one in four (28 .6%) were not diagnosed during the operation. As new indications for l aparoscopic surgery in gynaecology have appeared, there has been a par allel and statistically significant increase in the rate of urological complications (P = 0.001), Increased experience by the surgeons has h ad three consequences: a statistically significant drop in the number of bowel injuries (P = 0.0003), a drop in the rate of complications re quiring laparotomy for those laparoscopic surgical procedures that are well defined (P = 0.01), and a change in the way complications are tr eated, with a significant increase in the proportion of incidents trea ted by laparoscopy (P = 0.0001).