Since 1992, the authors have maintained a database on all of the gynecological laparoscopic procedures performed at their institution. In this report, they discuss the complications, defined as ldquo;any event that would modify the usual course of laparoscopy or of the postoperative period,rdquo; of these procedures.From 1992 to 1998, 1033 women underwent laparoscopic surgery. Mean age was 37 years, and 202 of them had had previous abdominal surgery. All surgeries followed the same protocol. Eighty percent of the procedures performed were considered major (type III) or advanced (type IV). The surgeons were classified as either ldquo;beginnersrdquo; or ldquo;experts.rdquo; Beginners were residents working under supervision on type I (diagnostic) or II (minor) procedures or attending physicians less than 2 years out of training who were performing type IV procedures. Experts were senior attending physicians performing type I, II, and III procedures.There were 31 complications (3 percent) noted in the 1033 cases but no deaths. The most frequent injuries were vascular or hemorrhagic in nature (48 percent), followed by urinary tract (13 percent) and bowel (6 percent) injuries. Conversion to laparotomy was necessary in 11 women during the procedure and in 2 patients during the postoperative period (total of 13, 42 percent of complications, 1.2 percent of all laparoscopies).More than half of the complications (N equals; 17, 55 percent) occurred during initiation of laparoscopy. Two injuries occurred during insertion of the Veress needle in the umbilicus, and two others occurred during insertion of the transumbilical trocar; however, most injuries (N equals; 13) in the initial stage of the procedure occurred during insertion of suprapubic trocars.A history of surgery did not increase the likelihood of injury during this stage. Eighty percent of the intraoperative complications were hemorrhagic in nature and occurred during type III or IV procedures. In 80 percent of these cases, the operating surgeons were beginners (P equals; .03). Three-quarters of the hemorrhages resulted in conversion to laparotomy.The difference in the numbers of complications occurring in type I and II procedures compared with the numbers in type II and IV procedures was not significant. A history of abdominal surgery did not increase the complication rate. The experience of the surgeon did not have a significant effect on the overall probability of complications. Over the course of the study period, there were no significant differences in the rates of complications, laparotomies, or injuries during initiation of the procedure. There were no significant postoperative complications.Acta Obstet Gynecol Scand 2000;79colon;129ndash;134
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