Despite the growth of laparoscopic surgery, its complications must not be underestimated. We describe a retrospective (1987 to 1989) and prospective (1990 to 1991) study of the complications of laparoscopic gynecologic surgery at seven referral centers in France. A complication was defined as death or an event necessitating unintended laparotomy. Laparoscopies were classified as diagnostic or operative. Three subgroups of operative laparoscopies were defined: minor, major, and advanced. Minor laparoscopic procedures were minimal adhesiolysis, destruction of minimal foci of endometriosis, ovarian biopsy, ovarian puncture, tubal sterilization, and assisted fertility procedures. Major laparoscopic procedures included extensive adhesiolysis, tuboplasty, uterine suspension, and treatment for ectopic pregnancy, salpingitis, ovarian cyst, and moderate or severe endometriosis. Advanced laparoscopic procedures included hemostasis of large vessels or extensive dissections (hysterectomy, adnexectomy, myomectomy, bladder-neck suspension, and lymphadenectomy).