[Risk and prevention of complications in gynecologic laparoscopy. Survey of 100,000 cases].

The author having learned the true character and the value for teaching of his own complications set out a questionnaire which would draw a line distinguishing between complications that seemed in retrospect to have been inevitable and those that could be attributed to the inexperience or lack of care of the operator. The analysis of 194 severe complications occurring in 100,000 laparoscopies performed over 20 years includes 53 cardio-respiratory complications, of which 15 were fatal, 122 injuries or burns due to the instrument, of which 4 were fatal and 18 different complications. No statistical conclusions can be drawn because the figures are approximate and probably below the true levels. But a calculated comparison of the risks can be significant, so long as one avoids mixing up the operators who are well trained, careful and personnally responsible for their actions with those who work hurriedly without proper estimation of the difficulties and dangers. Most opinions agree that apart from the risk of embolus and of general anaesthesia there is no risk of a fatal complication due to laparoscopy. This is particularly true of cardio-respiratory complications, which can be avoided if empirically proven prophylactic measures are taken which take into account the various theories of the aetiology and pathology, which are still being studies. From the results of this enquiry it emerges that certain criteria of care have to be followed which are too often neglected, but they should be applied systematically even when they appear to be unnecessary.