[Clinical problems and complications in laparoscopic access].

OBJECTIVE

To analyse entry-related laparoscopic technique and complications.

DESIGN

Literary review.

SETTING

Department Gynaecology and Obstetrics, Endoscopic Training Centre, Hospital Kladno.

METHOD

Peri- and postoperative complications of laparoscopic entry were assessed and analysed from database Medline and Current Contents.

RESULTS

There is helpful to classify intra-abdominal entry complications occurring after laparoscopy into the two types (type I and II). The risk of bowel damage, calculated from analysed studies was 0.4/1,000 and for major vessel injuries the risk was 0.2/1,000.

CONCLUSION

The need to perforate the abdominal wall to perform laparoscopic intraabdominal surgery will probably always be associated with risk of damaging structures beneath. With good techniques and appropriate case selection, this risk of such complications should be occure less than 1 per 1,000 laparoscopies. None of the existing techniques or technologies completely eliminate the risk of type II damage.