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This study involves an audit of cases of endosalpingiosis diagnosed at a major teaching hospital and a review of the literature.

Objective To review complications of laparoscopic hysterectomy occurring in a citywide population of approximately 1 million people. Design All laparoscopic hysterectomy cases were analysed retrospectively independently of the surgeons involved. Setting All private and public hospitals (n = 19) in metropolitan Adelaide, South Australia. Subjects 1904 patients over the period 1991–98. Interventions The majority of cases involved a combined laparoscopic and vaginal approach with a proportion of total laparoscopic hysterectomies (n = 33). Surgical techniques involved both staples and diathermy. Main outcome measures Rates of major complications such as haemorrhage, haematoma formation, laparotomy and urinary tract injury. Results Significant haemorrhage occurred in 3.7% (n = 70) of cases with a haematoma incidence of 3.2% (n = 60). Laparotomy rates reduced from 5% (1991–93) to 1.7% (1996–98) with an overall incidence of 3.4% (n = 64). Overall urinary tract injury rates remained constant over the survey period, i.e. 3.3% (1991–93) vs. 3.1% (1996–98). However there was a significant reduction in ureteral damage but this was countered by an increasing cystotomy rate. Conclusions Laparotomy rates were comparable to those in published data but reduced significantly over the audit period. The incidence of haematoma formation was significantly greater than that in published data, but reduced over the period 1991–98. Urinary tract damage and haemorrhage exceeded expectations. This audit once again has suggested that the true rate of major complications with laparoscopic hysterectomy is higher than the literature suggests.

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To define the role of routine cystoscopy following laparoscopically assisted hysterectomy in the early detection of ureteric injuries. A retrospective observational study based on casenote review. A consecutive series of 436 women who underwent routine video cystoscopy after intrafascial laparoscopically assisted hysterectomy, with or without bilateral salpingo‐oöphorectomy. In 436 cystoscope evaluations, six cases aroused suspicion of a ureteric injury. Subsequent evaluation confirmed injury in two of these cases. A further two cases were not suspected on cystoscopic grounds but were detected in the early postoperative period. One ureteric injury was associated with endoscopic staples, two with electrosurgery and one with the harmonic scalpel. The staple injury was suspected clinically during the operative procedure; the remainder were not. Routine cystoscopy at intrafascial laparoscopically assisted hysterectomy has not contributed to the early diagnosis and treatment of ureteric injuries sustained with the authors' current technique. Thus cystoscopy ought to be done selectively according to clinical intraoperative concern. The distal pelvic ureter should be routinely inspected for dilatation, via peritoneal windows, at the end of the hysterectomy. Every endogynaecologist should review their data on cystoscopy and ureteric injuries associated with laparoscopically assisted hysterectomy to ascertain whether cystoscopy is justifiable in their practice, and whether surgical techniques need to be modified to enhance ureteric protection.

Objective  To compare outcomes in women undergoing total laparoscopic hysterectomy performed with the assistance of a colpotomizing tube (TLTH), with those in women in whom a laparoscopically assisted hysterectomy (LAH) procedure was performed. Design  A retrospective review of consecutive patients. Setting  State health service patients were treated at Flinders Medical Centre, Adelaide, South Australia, and private patients were treated by the same surgeons in three private hospitals in metropolitan Adelaide. Subjects  A total of 227 women who underwent operation between January 1996 and August 1999. Interventions  The women involved in the first two years of this study exclusively underwent an LAH, whilst those in the latter 18 months underwent a TLTH. Main outcome measures  These included intraoperative complications, including significant haemorrhage, ureteric, bladder, vascular and bowel injury; postoperative complication rates for vault infection, late bowel and ureteric injury, and miscellaneous febrile morbidity. Also documented were the operating time, nonautologous blood transfusion, operation–discharge interval, and readmission with a complication. Results  The women having the TLTH procedure had significantly fewer intraoperative complications (χ2 = 8.07, P = 0.004) in comparison with the LAH group; postoperative complications were not statistically different. The mean operating times and readmission rates with surgical complications were equivalent for the two groups. The hospital stay was shorter by 1.5 days for the women having a TLTH (t = 8.39, P < 0.001), and the estimated blood loss was less than half of that for the LAH patients (t = 8.94, P < 0.001); nonautologous blood transfusion was not needed in either group. Conclusion  Total laparoscopic hysterectomy utilizing the nondisposable colpotomizing tube and uterine manipulator has both fewer intraoperative complications and reduced blood loss when compared with laparovaginal hysterectomy, and is a safe alternative to LAH.

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