‘Classic’ laparoscopic entry in a university hospital: a series of 8324 cases

Objective To evaluate the complications of ‘classic’ laparoscopic entry in a university tertiary care centre. Design An analysis of the complications of classic laparoscopic entry for diagnostic and operative laparoscopies. We considered a consecutive series of 8324 cases with the same entry technique: CO2 insufflation, followed by insertion of the umbilical trocar and subsequent placement of accessory trocars under direct vizualization. Subjects Between November 1 1992 and December 31 1998, 8324 patients underwent laparoscopies. The 978 diagnostic laparoscopies (11.75%) and 7346 operative laparoscopies (88.25%) were performed by 14 experienced gynaecological surgeons or by trained surgeons under the supervision of one of the experienced surgeons. Main outcome measures Peri‐ and postoperative complications of laparoscopic entry were assessed and analysed. Results Laparoscopic entry complications occured in 10 cases out of 8324 laparoscopies (0.12%). These included six vascular injuries, three bowel perforations and one bladder complication. No death occurred and no blood transfusions were required. No adverse consequences were observed in five cases. A laparotomy was performed in four cases and in one instance the laparotomy was delayed. Conclusion The complication rate of classic laparoscopic entry was quite low in our experience. These results suggest that no modifications to the technique for classic laparoscopic entry are needed.