5 Dealing with complications in laparoscopy Alan Lam, MBBS(Hons), FRACOG, FRCOG, Associate Professor a, * , Yuval Kaufman, BSc, MD, Fellow at CARE a , Su Yen Khong, MBChB, MRCOG, Fellow at CARE a , Andy Liew, MBBS, BSc(Hons), FANZCA a , Stephen Ford, MBBS, BSc(Hons), FANZCA, VMO Anaesthetist a , George Condous, MRCOG, FRANZCOG, Associate Professor b a Centre for Advanced Reproductive Endosurgery, (CARE), Royal North Shore Hospital, University of Sydney, Sydney, Australia b Early Pregnancy, Acute Gynaecology and Advanced Endosurgery Unit, Nepean Centre for Perinatal Care, Nepean Clinical School, University of Sydney, Nepean Hospital, Sydney, Australia Keywords: laparoscopy complications injury classification urinary tract bowel nerve anaesthesia management counselling With increasing adoption of laparoscopic surgery in gynaecology, there has been a corresponding rise in the types and rates of complications reported. This article sets out to classify complica- tions associated with laparoscopy according to the phases of the surgery; assess the incidence, the mechanisms, the presentations; and recommend methods for preventing and dealing with complications in laparoscopic surgery. Its aim is to promote a culture of risk management based on the development of strat- egies to improve patient safety and outcome. Ó 2009 Elsevier Ltd. All rights reserved. In the modern history of laparoscopy, the momentous transition from diagnostic to operative laparoscopic procedures accelerated following the first report of laparoscopic hysterectomy in the late 1980s. 1 Since then, there has been a rapid worldwide adoption of increasingly complex laparoscopic procedures across many surgical specialties, most notably in gynaecology. 2,3 Unfortunately, the increased adoption of laparoscopic surgery has also been accompanied by a corresponding rise in the rates and types of complications reported. 4–9 ‘Complication’ is defined in the Oxford English Dictionary as ‘‘a new problem or illness that makes treatment of a previous one more complicated or difficult’’. 10 Complications to laparoscopy are similar to * Corresponding author. Tel.: þ612 99669121; Fax: þ612 99669126. E-mail address: alanlam@sydneycare.com.au (A. Lam). Contents lists available at ScienceDirect Best Practice & Research Clinical Obstetrics and Gynaecology journal homepage: www.elsevier.com/locate/bpobgyn 1521-6934/$ – see front matter Ó 2009 Elsevier Ltd. All rights reserved. doi:10.1016/j.bpobgyn.2009.03.004 Best Practice & Research Clinical Obstetrics and Gynaecology 23 (2009) 631–646