Prospective Evaluation of Intraoperative and Postoperative Adverse Events in Laparoscopic Surgery

Aim: To assess the incidence of intraoperative events during laparoscopic surgery according to a new 5-grade classification based on the Satava approach to surgical error evaluation et postoperative complications according to Clavien's classification. Material and methods: two prospective and multicentre study were performed by seniors surgeons*, members of the Club Coelio. For the second study, the major analysed outcomes were the intraoperative incidents and accidents. Results: Creation of pneumoperitoneum and port placement were specifically responsible for 30 vascular injuries (0,53%) including 2 aortic injuries and 16 visceral injuries (0,28%). For thye whole surgical procedure 41 vascular injuries (0,72%) including 3 main vessel injuries and 54 visceral injuries (0,95%) were reported. For the second study of 1674 consecutive patients, 510 patients (30%) were scheduled in one-day clinic which succeed for 483 patients (29%). An intraoperative adverse event was noted in 118 (7%) according the classification. Uneventful operation was observed in 1556 patients (93%), an incident without intraoperative consequence (Grade I) in 68 (4%) and an incident with consequence treated by laparoscopy (Grade II) in 14 (0,8%). A conversion was required in 35 patients (2,1%). Surgery of the colon and rectum were associated with the highest rate of conversion. Only one patient had an event not recognized during operation with postoperative consequence (Grade III). About the 1498 uncomplicated patients at the discharge, 96 (6,41%) eventualy had a complication with 11 (0,73%) reoperations. Conclusion: The prevalence of intraoperative events is not well known in the literature. We propose a simple classification of the intraoperative adverse events appropriate for abdominal laparoscopic surgery that appears to be an effective tool for a better assessment of surgical outcomes.