[Necessity of training and safety in gynecological laparoscopy--a contradiction?]

At the Gynaecological University Hospital Göttingen 1659 laparoscopies were performed 1961-1978 by 67 gynaecologists with an average of 24,8 laparoscopies per gynaecologist. Most of the doctors were still in their training period, assistance was always given by a specialist gynaecologist. Only in 5 cases (0,3 per cent) laparotomy was necessary due to complications following laparoscopy or laparoscopicsterilization. Injuries of the transverse colon, the greater omentum and a mesenteric artery-caused by the trocar-were seen, also diffuse bleeding from the parietal peritoneum and from the ramus of the Fallopian tube. No deaths due to laparoscopic complications occurred. The incidence of severe complications can be kept within tolerable limits in a training hospital where the majority of the operations are performed by doctors in training, when the following conditions are strictly adhered to: Careful consideration of the risks involved in laparoscopy/laparoscopic sterilization and other less invasive diagnostic and contraceptive methods, strict attention to the contraindications of laparoscopy and performance of a standardized laparoscopic technique under the supervision of an experienced operateur.