Perioperative morbidity of gynecological laparoscopy - A prospective monocenter observational study

Background. To study the morbidity rate of gynecological laparoscopy and to the most influential variables. Methods. We conducted a prospective observational study from January 1st 19 92 to December 31st 1998 in a single tertiary care center, It concerned pat ients who underwent gynecological laparoscopic surgery performed by seniors and residents, We have prospectively recorded patients characteristics, in dications for laparoscopy, leading diagnosis, main operative procedures, po st-operative course, surgical and anesthetic incidents and accidents. Compl ications were defined as any event that would modify the usual course of la paroscopy or of the postoperative period. Results. One thousand and thirty-three laparoscopies were included. 80.1% o f the procedures were major or advanced laparoscopies. The overall complica tion rate was 3%, with a laparotomy rate of 1.2%. About half of those compl ications (54.8%) occurred during the installation of laparoscopy. Veress ne edle and first trocar insertion accounted for 23.5% of those accidents (0.3 % of the procedures) and suprapubic trocar insertion for 76.5%. Hemorrhages constituted almost all of the complications occurring during the operative stage (80%). The risk increased with the level of surgery and decreased wi th surgeon's experience. Prior abdominal surgery had no significant effect on the overall morbidity rate. Post-operative and anesthetic complications were rare. The overall complication rate as well as the laparotomy rate wer e stable all along the course of the study. Conclusions. Complication rate of gynecological laparoscopy is not negligib le. Efforts should be made to lower the complications induced by the instal lation of laparoscopy, especially for secondary trocars.