The laparoscopic route for the removal of uteri for benign conditions represents a well-established surgical route over the last 20 years, gaining popularity throughout the world. The modifications of the original technique and the variable involvement of the laparoscopic component necessitated the description of this surgical procedure, and therefore, classification systems were introduced. An attempt was hence made to standardize laparoscopic hysterectomy so that we all understand the same meaning when we describe a specific type. This standardization, however, has not incorporated factors such as simplicity, different types of energy use, and complications that have to be audited to a set standard that probably does not exist yet, due to the variable complication rates in the literature. We look into the different major proposed classification systems and their benefits and drawbacks and try to redefine a system that is simple to use and may improve our audit purposes. In order to achieve this, we review the complications of laparoscopic hysterectomy in the literature, using the Cochrane collaboration, the Medline, and Embase databases.Keywords Laparoscopic hysterectomy . Laparoscopically assisted vaginal hysterectomy . Total laparoscopic hysterectomy . Complications . Classification Laparoscopic hysterectomy (LH) and laparoscopically assisted vaginal hysterectomy (LAVH) represent an approach to the removal of uteri for benign and malignant gynecological diseases that has been evolving the last 20 years [1]. The slow uptake in this approach to hysterectomy may be due to variable complication rates and training necessary to standardize this procedure and reduce complications [2].The surgical approach to hysterectomy was also addressed by the Cochrane collaboration which found complication rates in the laparoscopic groups to be variable [3]. Comparisons were made with vaginal (VH) and abdominal hysterectomies (AH) in different groups and complications were categorized in primary and secondary. All urinary tract injuries were higher in the LH group when compared to AH and in the total LH (TLH) when compared to the VH groups with more intraoperative bleeding and postoperative blood transfusions in the LH versus the VH modalities, thereby Cochrane review shed some light in the subject of benefits and risks associated with LH. The individual bladder and ureteric injuries though, when LH and AH were compared did not reach statistical significance, when the confidence intervals of the odds ratios were seen. Similar findings were observed in the LH to VH arm, with even no significant increase, with regards to LH, in the combined ureteric and bladder injuries. The only group that showed statistical significance was the comparison of TLH to VH, where the combined urinary tract injuries favored the VH. This subgroup consisted of two studies, one underpowered showing no statistical significance and the randomized controlled trial by Morelli et al. describing 12 urinary tract injuries in 200 women who had LH, a 6% occurrenc...
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