Laparoscopic management of bladder injury during total laparoscopic hysterectomy

Abstract

Hysterectomy is the most common surgical procedures in women. 1 Hysterectomy indications are benign reasons such as prolapse of pelvic organs, unresponsive menorrhagia to medical treatment, leiomyoma and chronic pelvic pain. 2 Various factors including the expertise of the surgeon, endometriosis and prior pelvic surgery linked to pelvic sticking, uterine size, vaginal stenosis, timing of surgery, operating room technical equipment availability and patient preference influence the selection of proper hysterectomy surgical technique. 2 As a result, the benefits of minimally invasive surgical procedures, laparoscopic hysterectomy (LH) has been the first choice in recent years. 3 Given the advantages of less blood loss,shorter hospitalisation and quicker convalescence, LH is more likely to cause injury to the urinary tract than hysterectomy to the abdomen. 4 In gynaecological surgeries, the embryological and anatomical relationships make pelvic genital organs and urinary tract organs more prone to bladder and ureteral damage. 5 The frequency of urinary tract injury in gynaecological surgery varies from 0.18% to 0.29% for whole gynaecological surgery, 1.3% for laparoscopic hysterectomy and 0.33% for gynaecologic laparoscopic surgery, respectively. 6 The aim of this study was to present the results of laparoscopic bladder repairs for bladder injuries that occurred during laparoscopic hysterectomy. AbstractPurpose: Iatrogenic bladder injury remains a major challenge. We compared the success and reliability of laparoscopic repair of intraperitoneal bladder rupture in patients who had undergone total laparoscopic hysterectomy.Methods: This retrospective study included patients who underwent total laparoscopic hysterectomy for benign gynaecological cases at a tertiary academic hospital between January 2018 and June 2019. All patient medical records included in the study were reviewed, and the causes, incidence and management of bladder injuries were assessed.Results: There were nine patients. The cause of all the ruptures was iatrogenic, and all were intra-operatively detected. In all patients, bladder injuries occurred in the posterior side of the bladder during vesicouterine dissection. Laparoscopic bladder perforation repair was performed successfully in all patients. No major complications had occurred in any patients after surgery. The foley catheters were removed 6.67 ± 0.7 (5-7) days after surgery. Conclusions:If performed by well-trained laparoscopic surgeons, laparoscopic hysterectomy could be the best option for appropriate patients. Nevertheless, patients should be well aware of the potential complications in endometriosis and caesarean cases before the procedure, and care should be paid during dissection. When a urogenital injury is suspected or detected the condition must be adequately identified and proper treatment must be performed to avoid postoperative complications and long-term morbidity.

Laparoscopic management of bladder injury during total laparoscopic hysterectomy

“…Laparoscopic bladder repair is more cost effective than open surgery and enables faster return to daily activities but, it warrants more advanced surgical experience and skills. [37] Main limitations of the present study are that it is a retrospective analysis and includes a limited number of cases.…”

Abordaje laparoscópico exitoso de lesión vesical intraperitoneal ocasionada durante una cirugía ginecológica. Reporte de caso

“…Since its introduction in the 1970s, the laparoscopic approach has proven to be one of the most significant advances in surgery (1), allowing for the completion of various procedures. For example, as stated by Aydin & Mercimek (7), in 1994, Parra reported the first laparoscopic repair of an intraperitoneal bladder perforation after iatrogenic bladder trauma.…”

“…Some of the risk factors for urinary tract injury during gynecological surgeries include a history of radiation or pelvic surgery, endometriosis, urinary tract anomalies, peritoneal adhesions, pelvic masses, obesity, and uterine fibroids, as well as the surgeon's lack of experience, specifically a low volume of laparoscopic gynecological surgical procedures performed (7).…”

“…Although not supported by evidence, performing bladder catheterization prior to peritoneal insufflation and trocar insertion is recommended as good clinical practice to avoid injury to a distended bladder (1,9). Preoperative prophylactic ureteral catheterization is debatable, as a beneficial effect on reducing the risk of ureteral injury during gynecological surgery has not been demonstrated consistently (7). Thus, to reduce the risk of urinary injury during gynecologic laparoscopic surgery, it is critical to understand and follow electrosurgery safety precautions, as bladder injuries may be difficult to detect because they can occur at a site distant from the surgeon's view and/or present as a late tissue rupture several days after the primary injury (1).…”

“…Intraperitoneal bladder injuries require surgical repair (5), which is traditionally performed by laparotomy; however, little information is available on minimally invasive treatments in this clinical setting. The laparoscopic approach has demonstrated clear benefits, such as decreased bleeding, postoperative pain, intra-abdominal adhesions, risk of incisional hernias, and length of hospital stay and disability; improved visualization of pelvic organs; and early return to daily activities (1,(5)(6)(7).…”