Despite the degree of caution used, complications occur during operative laparoscopy. Because sequelae can result from even relatively easy procedures, a surgeon must be able to recognize them promptly and carry out proper management. The risks increase with the complexity of the procedure, the relative inexperience of the surgeon, and the amount of deviation from standard technique. As laparoscopic operations become more complex, the ability to handle them endoscopically becomes important.

Diagnostic laparoscopy and laparoscopic tubal sterilization involve few risks. The rate of intraoperative and postoperative complications is less than 1% (Table 25.1). Most reports are from large practices with experienced gynecologists, surveys of American Association of Gynecologic Laparoscopists (AAGL) members, and tertiary referral clinics.

The intraoperative and postoperative complication rates in 361 women who underwent laparoscopic hysterectomy for benign pathologic conditions were evaluated. The overall complication rate for hysterectomy carried out by laparoscopy was 11.1%. Most of the complications were minor, including cystitis (1.66%), transient high fever (1.39%), abdominal wall ecchymosis (1.12%), and pneumonia and bronchitis (1.12%). There was no correlation between the type of laparoscopic hysterectomy and the complication rate. Complication rates associated with laparoscopic hysterectomy compare favorably with published complication rates for vaginal and abdominal hysterectomy.