Institutes: Department of Obstetrics & Gynaecology Antrim & Cragiavon Area Hospitals. Northern Ireland
Background: The use of laparoscopy in gynaecology has expanded dramatically in recent years from diagnostic procedures and sterilisation to complete gynaecological operations. As an increasing number of indications for operative gynaecological laparoscopy evolve, the numbers being performed also increase, as does the laparoscopists’ skill and experience. Traditionally associated with higher complications than vaginal and abdominal approaches, this is no longer the case. The advantages and safety of this approach are now well established.
Objective: To review the incidence of major complications following operative gynaecological laparoscopic procedures, including visceral/urinary tract/vascular injury and death.
Design and Methods: Prospective multicenter study of 1577 operative gynaecological laparoscopies over a 106 month period, by three advanced benign laparoscopic surgeons. Any unexpected or unplanned event requiring intra-operative or post-operative intervention was defined as a complication and subsequently anaylsed.
Results: Of 1577 laparoscopic procedures, 20 complications occurred (rate 1.26 per 1000). Specifically damage to bowel 0.38% (6/1577), urinary tract 0.38% (6/1577) vascular injury 0.44% (7/1577) and death 0.06% secondary to pulmonary embolism.
Analysis: The timing of recognition of the complications revealed “at entry” 10% (2/20), “intra-operatively” 60% (12/20) and “delayed” 30% (6/20)
The majority of the complications were managed laparoscopically 60% (12/20) with 55% (11/20) successfully managed by the gynaecologists.
Conclusions: Prevention of complications of laparoscopy starts by raising awareness of the risk of this procedure and the precautions necessary to ensure safety. The surest way to reduce complications is to study them.1 This study shows the overall major complication rate associated with operative gynaecological laparoscopy is low, and compares favourably with those reported in the literature for open and vaginal equivalent procedures. The majority of major complications; can be managed successfully by the gynaecologist, using a laparoscopic approach, therefore avoiding the morbidity associated with laparotomy.
References:
1. Philips JM. Complications in laparoscopy. Int J Gynaecol Obstet 1977; 15: 157–162