Complications of laparoscopic surgery in gynecology

Abstract

Objective To discuss the complications of laparoscopic surgery in gynecology. Methods From January 1, 2006 to December 31, 2016, a total of 12 036 patients underwent gynecologic laparoscopic surgery in Chengdu Fifth People′s Hospital were selected as study subjects, and their ages ranged from 14 to 79 years. According to different levels of gynecologic laparoscopic surgery of those 12 036 patients, they were divided into 4 groups. Group Ⅰ (n=6 962, who received laparoscopy, salpingectomy or ovariectomy or salpingo-ovariectomy under laparoscope, or salpingo and ovary preservation operation), group Ⅱ (n=1 083, who received preserving uterine surgery, such as elimination surgery of uterine fibroids or adenomyoma, uterus neoplasty, uterine artery ligation, and ventrosuspension under laparoscope); group Ⅲ (n=3 711, who received total hysterectomy or subtotal resection); group Ⅳ (n=280, who received radical resection of gynecologic malignant tumor, such as radical hysterectomy, pelvic lymphadenectomy, paraaortic lymphadenectomy, omentectomy or cytoreductive surgery). Retrospective analysis was conducted to collect the complications, damage location, treatments and treatment effects of gynecologic laparoscopic surgery in all subjects. Linear trend chi-square test was used to compare the complication rates of gynecologic laparoscopic surgery among 4 groups. This study met the requirements of the World Medical Association Declaration of Helsinki revised in 2013. There were no significant differences in the general clinical data of age, gravidity, parity, body mass index, and education level among 4 groups (P>0.05). Results ①Among the 12 036 patients who underwent gynecologic laparoscopic surgery, 66 had complications caused by gynecologic laparoscopic surgery and the complication rate was 0.55% (66/12 036). Among them, the rate of complications caused by gynecologic laparoscopic surgery in group Ⅰ-Ⅳ was 0.20% (14/6 962), 0.74% (8/1 083), 0.84% (31/3 711), and 4.64% (13/280), respectively. The overall incidence of complications in four groups was statistically significant (χ2=53.779, P<0.001). ②Among the 12 036 patients, there were 20 cases, 18 cases, 10 cases, 9 cases, 6 cases, 2 cases, and 1 case respectively developed complications of ureteral injury, bladder injury, pelvic infection, bowel injury, massive bleeding during or after operation, gastric injury, and venous thrombosis of the lower extremity, and the incidence of above complications was 0.17% (20/12 036), 0.15% (18/12 036), 0.08% (10/12 036), 0.07% (9/12 036), 0.55% (6/12 036), 0.02% (2/12 036), and 0.01% (1/12 036), respectively, and those complications accounted for 30.3% (20/66), 27.3% (18/66), 15.2% (10/66), 13.6% (9/66), 9.1% (6/66), 3.0%(2/66), 1.5% (1/66) of the complications of gynecologic laparoscopic surgery, respectively. All the 66 patients with complications of gynecologic laparoscopic surgery were cured after corresponding surgery or anti-infective treatment. ③The incidence of complications of gynecological laparoscopic surgery showed an upward trend from 2006 to 2013, while it declined from 2014 to 2016. Conclusions The occurrence of complications of gynecologic laparoscopic surgery is related to the difficulty of the operation, the surgical technique of the surgeon, and the expansion of the scope of the operation. Strictly grasping the indications of gynecologic laparoscopic surgery and improving surgical skills are the keys to prevent and avoid the complications of gynecologic laparoscopic surgery. Key words: Laparoscopes; Gynecologic surgical procedures; Postoperative complications; Intraoperative complications; Women