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Am Fam Physician. 1999;60(7):2098-2100

Gynecologic procedures, including hysterectomy, are increasingly performed by laparoscopy. To counsel patients about such procedures, physicians must have information on the potential complications and risks of laparoscopic surgical techniques. Härkki-Siren and colleagues used Finnish national surgical databases to compile data on the complications associated with gynecologic laparoscopic surgery.

Data on complications were obtained from the monitoring agency of the national no-fault compensation system for patient injury. Data from 1995 and 1996 were compared with data from 1990 through 1994.

During 1995 and 1996, 32,205 gynecologic laparoscopic surgeries were performed and 130 complications were reported, for an overall complication rate of four major complications per 1,000 laparoscopic procedures. The complication rate was 0.6 per 1,000 diagnostic procedures, 0.5 per 1,000 sterilization procedures and 12.6 per 1,000 operative procedures.

Hysterectomy was the operation performed in 75 percent (88 of 118) of the instances of major complications during operative laparoscopy. Almost one half (48 percent) of the complications occurring during operative laparoscopy involved ureteral injury. Bladder injury accounted for 19 percent of the complications, and bowel injury accounted for 13 percent. Large-vessel injuries accounted for 2 percent of the complications.

In 1996, the incidence of ureteral injury was lowest at university hospitals (0.9 percent versus 2.6 percent at local hospitals). While the overall rate of major complications during laparoscopic hysterectomy decreased from 1993 through 1996, the rate of ureteral injury remained constant at 1 percent.

From 1990 through 1996, the annual rates of major complications after diagnostic and sterilization laparoscopies remained constant at below 1 per 1,000 procedures. With operative laparoscopies, however, the annual rates of major complications increased from zero per 1,000 in 1990 to 14 per 1,000 in 1996. The authors note that this increase is due at least in part to the increased proportion of hysterectomies being performed by means of laparoscopy.

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