Complications of laparoscopic hysterectomy: the Monash experience

Abstract

A retrospective review of medical records was performed to assess the incidence and type of significant complications encountered during laparoscopic hysterectomy Two hundred and sixty-five consecutive patients were reviewed between the years 1994 and August 2001. Two hundred and thirty-two laparoscopic vaginal hysterectomies and 33 total laparoscopic hysterectomies were performed. The operations were performed at Monash Medical Centre, a Melbourne tertiary public hospital, and two Melbourne private hospitals, by three surgeons. Ten significant complications occurred. There were two cases of ureteric fistula, two bladder injuries, two bowel obstructions, two postoperative haematomas, one case of a bladder fistula and one superficial epigastric artery injury. In-patient stay ranged from two to six days. Our complication and in-patient stay rates are consistent with previously reported rates.

Retrospective study of the success rates and complications associated with total laparoscopic hysterectomy

“…Our rates of ureteric (0.2%) and bladder (0.2%) injury are comparable to other studies reporting 0.2–0.4% ureteric and 1.0–1.8% bladder injuries 4,21,22 . Prior cesarean section, prior pelvic surgery and endometriosis have been cited as the main determinants of intra‐ and postoperative complications 23 .…”

“…Our rates of ureteric (0.2%) and bladder (0.2%) injury are comparable to other studies reporting 0.2-0.4% ureteric and 1.0-1.8% bladder injuries. 4,21,22 Prior cesarean section, prior pelvic surgery and endometriosis have been cited as the main determinants of intra-and postoperative complications. 23 Our one case of ureteric injury (ureterovaginal fistula) had a previous cesarean section and severe pelvic endometriotic adhesions that obliterated the Pouch of Douglas along with dense endometriosis involving the uterosacral ligaments and rectovaginal septum.…”

Ureteral catheter placement for prevention of ureteral injury during laparoscopic hysterectomy

“…Although more than 70% of hysterectomies are performed by laparotomy, advances in endoscopic gynecologic surgery during the late 1980s and early 1990s have led to a patient preference for LH over AH 6 . Advantages of LH over AH include less scarring, less postoperative pain, shorter hospital stay, and patients return to normal activities sooner 7,8 …”

“…With any new technique, safety as well as clinical efficacy is a highly important consideration 18 . Accordingly, despite many advantages of LH, excess occurrence of ureteral injury in LH has impeded its worldwide acceptance 8,19 …”

Intraoperative Management And Urinary System Complications During Total Laparoscopic Hysterectomy

“…An urinary system complication for performing LH is reported 1.7 % in our series, correlatively. Tasaltas et al reported that complications in their series (232 LAVH and 33 TLH) (11) ; two cases of ureter fistula, one vesicovaginal fistula, one bladder injuries, two bowel obstructions and one postoperative pelvic hematoma. Also, they reported that one case of bladder injury, vaginal cuff hematoma and one superficial epigastric artery injury as a minor complications.…”