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Complications in laparoscopic gynecologic surgery
1Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, CAMS & PUMC, Beijing 100730.
Objective:
To investigate retrospectively the complications and associated factors of gynecolgical laparoscopies.
Methods:
1 769 laparoscopic surgeries were carried out from January 1994 to October 1999 at our department. The procedures included 1421 surgeries of ovary and tube, 52 myomectomies and 296 cases of laproscopic-assisted vaginal hysterectomy (LAVH). A total of 312 patients had a history of prior laparotomy (17.6%).
Results:
Complications occured in 34 cases, the overall complication rate was 1.92%. Unintended laparotomies occured in 6 cases (0.34%). 12 complications were associated with insertion of Veresse needle or trocar and creation of pneumoperitoneum, including 5 severe emphysema and 7 vascular injuries, this figure represents 35.3% of all complications of this series. Five intraoperative complications (14.7%) occured during the laparoscopic surgery (3 severe bleedings, one bladder injury and one skin burn of leg caused by damaged electrode plate), laparotomy was required in four of these cases. Seventeen complications occured during postoperative stage: 2 intraperitoneal hemorrhages needing laparotomy, 2 bowel injuries, 4 nerve paresis and 9 febrile morbidities.
Conclusions:
Operative gynecologic laparoscopy is associated with acceptable morbidity rate, but can not be overlooked. Complication rate seems to be higher in advanced procedures such as LAVH.