Title: A French survey on gynaecological laparoscopy
Abstract: Nowadays operative laparoscopy is widespread and most procedures could be done by endoscopy in the future, but its evaluation is of real concern (Tulandi, 1996). Literature on the subject shows the following: data from referral centres show severe complication rates of 3.5–5 per thousand for major and advanced procedures (Querleu et al., 1993; Chapron et al., 1998). Such results from experienced operators are not representative of the everyday situation. Only a few surveys have tried to evaluate the results from non-selected gynaecological surgeons. Results from The American Association of Gynaecologic Laparoscopists survey (Hulka, 1995) may reflect bias due to volunteers answers from a limited number of the population of surgeons. Harkki-Siren and Kurki (1997) and Harkki-Siren et al. (1997) hope that their studies give a truer evaluation, but the very low complication rate they report for major procedures is troublesome; even if the severe complication rate is 10.1 per thousand for 3335 operative laparoscopies collected in 1994, it is only 2.3 per thousand (6 out of 2536) for major procedures (less than the rates for referral centres in most studies); and 35 per thousand (28 out of 799) for laparoscopic hysterectomies, mostly done by senior physicians! Nevertheless, some authors have recently published series of major complications that have occured either during the set-up phase of laparoscopy (Chapron et al., 1997) or during the operating phase, even for benign disease (Nezhat et al., 1997). Through collaborative surveys, we have tried to assess the prevalence of laparoscopic complications among nonselected populations of surgeons: (i) between October 1990 and March 1992 at 84 public centres, Pierre et al. (1993) surveyed 2528 major laparoscopic procedures with a 76% participation rate. The severe complications rate during major procedures was 17.4 per thousand; (ii) in an unpublished regional prospective survey among 31 surgeons from June 1992 to June 1993, with a 65% participation rate, the prevalence