Incidence and risk factors of bladder injuries during laparoscopic hysterectomy indicated for benign uterine pathologies: a 14.5 years experience in a continuous series of 1501 procedures.
ABSTRACT Laparoscopic hysterectomy is indicated as an alternative to laparotomy when the vaginal route is potentially difficult because of an immobile uterus and a poor vaginal accessibility. The aim of this study was to evaluate the rate, the risk factors for bladder injuries in a series of 1501 laparoscopic hysterectomies indicated for benign uterine pathologies.
This study was conducted retrospectively from January 1993 to 2000 and prospectively from 2001 to July 2007.The indications, patients' characteristics and complications were recorded. The overall rate of bladder injuries, the comparison of means (t test) and percentages (exact chi(2) test) between the cases and the population with no injury, the odd ratios (OR) and multivariate analysis were performed using the statistical package for the social sciences software.
The rate of bladder injuries was 1% (15 patients). Risks factors were previous Caesarian section [OR: 4.33, 95% confidence interval (CI): 1.53-12.30] and previous laparotomy (OR: 4.69, 95% CI: 1.59-13.8). The rate of injury decreases with the surgeons' experience and reaches a plateau of 0.4% after 100 hysterectomies performed.
The rate of bladder injury during total laparoscopic hysterectomy is low and decreases with the surgeon's experience. Bladder injury is not linked to an increase of post-operative morbidity when recognized and repaired during the same laparoscopic procedure. The comparison with other routes of hysterectomies should take into account these risk factors.
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ABSTRACT: Laparoscopic techniques are being used increasingly more in gynecologic surgery and the introduction of modern laparoscopic instruments has allowed complex operations to be performed laparoscopically. The aim of this study is to evaluate our surgical technique with regard to the success of total laparoscopic hysterectomy (TLH) for the removal of the uterus, by analyzing its intraoperative and postoperative surgical outcomes and complications in the hope of reducing their occurrence. A retrospective observational study was carried out at KK Hospital, Singapore, based on TLH operations performed from January 2001 to June 2005. The KOH Colpotomizer System and the RUMI Uterine Manipulator were the surgical methods used. 435 women consented for a TLH. 427 women (98.2%) had a successful TLH with three mini-laparotomy and five laparotomy conversions (1.8% failure rate). Injuries included bowel injury (four), bladder base bleeding (one), uterine perforation (one), uterovaginal fistula (one) and vaginal laceration (four). 21 women (4.8%) encountered major complications (defined as laparotomy conversion, excessive bleeding requiring blood transfusion, hemorrhage >or=1000 mL, ureteric injury, bowel injury and pulmonary embolus), which compares favorably with previous reports (4.0-11.0%) of laparoscopic hysterectomy. Our mean operating time, mean estimated blood loss, mean hospital stay and readmission rate are similarly comparable. TLH is associated with a high success rate, and low morbidity with few complications.Journal of Obstetrics and Gynaecology Research 09/2007; 33(4):512-8. · 0.84 Impact Factor
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ABSTRACT: The objective of this review is to present the incidence of latrogenic bladder injury associated with diagnostic and/or operative laparoscopic surgery; to determine the type of primary laparoscopic operation, the time at which the reported injuries occurred, the location of injuries, and the method(s) used to repair those injuries; to decide which laparoscopic procedure carries the highest risk for bladder injury; and to establish the most frequent surgical instruments with which injuries happened. World literature published between 1970 and 1996 was reviewed. The appropriate Medical Subject Heading (MeSH) terms were selected and used in a search of the MEDLINE, ACOGNET, OVID Compact Disk Version database. A total of 1372 articles on laparoscopic surgery complications were reviewed. Of that number, a total of 77 articles identified bladder injuries, and these were analyzed for the objectives of this study. There are a wide range of bladder injuries during laparoscopic procedures. In the studied articles, the incidence of bladder injury during laparoscopic procedures ranged from 0.02 to 8.3 percent of cases. Most frequently, these injuries occurred during laparoscopic-assisted vaginal hysterectomy. Sharp electrosurgical dissection was the leading instrument causing injury. An intraoperative diagnosis of bladder injury was made in 53.24 percent of all bladder injury cases. The bladder dome was the most commonly injured structure. Less than half (29.87 percent) of the bladder injuries were corrected laparoscopically.Obstetrical and Gynecological Survey 03/1998; 53(3):175-80. · 2.51 Impact Factor
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ABSTRACT: A number of preexisting clinical conditions are generally accepted as contraindications to vaginal hysterectomy. The purpose of this study was to evaluate the validity of this concept. The study vaginal hysterectomy group consisted of 250 consecutive patients undergoing vaginal hysterectomy. These patients (1) had a large uterus (>180 g), (2) either were nulliparous or had no previous vaginal delivery, or (3) had a previous cesarean delivery or pelvic laparotomy. Three control groups used for comparison underwent (1) laparoscopically assisted vaginal hysterectomy, (2) vaginal hysterectomy, or (3) abdominal hysterectomy. The records for all patients were analyzed for age, weight, parity, primary diagnosis, uterine size, operative time, blood loss, analgesia, hospital stay, resumption of diet, incidence of morcellation, and surgical complications. Sample size calculations were based on previous studies of complications associated with vaginal hysterectomy (alpha =.05; beta =.20). Hysterectomy was successfully completed by the intended vaginal route in all study patients. Major and minor complications (3.2%) were significantly less (P <.001) than in the other groups as follows: vaginal hysterectomy, 10.4%; laparoscopically assisted vaginal hysterectomy, 11.6%; and abdominal hysterectomy, 13.6%. The decrease in hematocrit was 5.7% in the study vaginal hysterectomy group compared with 6.2% for vaginal hysterectomy, 6.5% for abdominal hysterectomy (P =.009), and 6.6% for laparoscopically assisted vaginal hysterectomy (P =.002). Hospital stay was shorter for the study group (2.1 days) than for vaginal hysterectomy (2.3 days; P <.001) and abdominal hysterectomy (2.7 days; P <.001). Operative time was shorter in the study vaginal hysterectomy group (49 minutes) than with laparoscopically assisted vaginal hysterectomy (76 minutes; P <.001) or abdominal hysterectomy (61 minutes; P <.001), although morcellation was carried out more frequently in the study group (34%) than with vaginal hysterectomy (4%) or laparoscopically assisted vaginal hysterectomy (11%). Our data indicate that a large uterus, nulliparity, previous cesarean delivery, and pelvic laparotomy rarely constitute contraindications to vaginal hysterectomy.American Journal of Obstetrics and Gynecology 06/2001; 184(7):1386-9; discussion 1390-1. · 3.88 Impact Factor