Uterine manipulator in total laparoscopic hysterectomy: safety and usefulness

Khalek, Yara Abdel; Bitar, Roger; Christoforou, Costas; Garzon, Simone; Tropea, Alessandro; Biondi, Antonio; Sleiman, Zaki

doi:10.1007/s13304-019-00681-w

Cited by 32 publications

(21 citation statements)

References 58 publications

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“…Insertion of ureteric stents before hysterectomy or routine cystoscopy during surgery is not cost‐effective 10,16–18 . A uterus manipulator is used in laparoscopic surgery by many, but the effect of such devices to reduce ureteric injuries is debated 19 . It is reasonable to recommend peroperative identification of the ureters during all hysterectomies, because the procedure is easy, quickly performed, and free of cost.…”

Section: Discussionmentioning

confidence: 99%

Ureteric injuries during hysterectomy—A Norwegian retrospective study of occurrence and claims for compensation over an 11‐year period

Ravlo

Moen

Bukholm³

et al. 2021

Acta Obstet Gynecol Scand

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Introduction Ureteric injury is a rare but serious, iatrogenic complication of hysterectomy. The risk depends on indication for surgery, predisposing risk factors, and peroperative conditions. Our aims were to evaluate and learn from compensation claims to The Norwegian System of Patient Injury Compensation (NPE) for ureteric injury occurring during hysterectomies to predict risk factors, time of identification, symptoms, and consequences, and to relate these cases to injuries registered in The Norwegian Patient Registry. Material and methods A retrospective study of ureteric injuries occurring during hysterectomies, reported to NPE and the Norwegian Patient Registry from 2009 through 2019. Results During the study period, 53 096 hysterectomies were registered in The Norwegian Patient Registry, of which ureteric injury was documented in 643 (1.2%). More ureteric injuries were registered in large hospital trusts than in small trusts (1.3% vs. 0.7%, p < 0.05). NPE received 69 claims due to ureteric injury occurring during hysterectomy, comprising 11% of all injuries in the study period. Compensation was approved for 15%. Women who claimed compensation were younger (48.1 ± 8.9 years vs. 55.1 ± 13.6 years, p < 0.01), more likely to have had a benign diagnosis (89.9% vs. 52.1%, p < 0.01), and more likely to have had the ureteric injury recognized after discharge (58.0% vs. 33.0%, p < 0.001) compared with non‐complainants. Identification of the ureters during the hysterectomy was documented in 30% of the NPE patient files. Additional information for the NPE cases included the following. The most common symptoms of unidentified injury were pain (77%), fever (12%), urinary leakage (13%), and anuria (8%). Re‐operation was necessary in 77% of the cases, and 10% of the women lost one kidney. Long‐term consequences after repair, such as loss of a kidney or persistent pain, were seen in 17%. No women died because of the injury. Conclusions The incidence of ureteric injury occurring during hysterectomy in Norway was 1.2%; 11% involved a claim for compensation, and 15% of these had their case approved. Most ureteric injuries were not recognized during the hysterectomy. Documentation of peroperative identification of the ureters during hysterectomy was often missing. Vigilance to pain as a postoperative symptom of peroperative unrecognized ureteric injury may result in earlier diagnosis and treatment.

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Section: Discussionmentioning

confidence: 99%

Ureteric injuries during hysterectomy—A Norwegian retrospective study of occurrence and claims for compensation over an 11‐year period

Ravlo

Moen

Bukholm³

et al. 2021

Acta Obstet Gynecol Scand

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“…Therefore, training is necessary for the second assistant who will hold and move the uterus during the procedure. [13] Perforation may also occur during insertion. In a case presented by Akdemir and Cirpan, [11] uterine perforation and intestinal penetration occurred.…”

Section: Discussionmentioning

confidence: 99%

“…This has been indi-cated as a disadvantage for CF in various studies. [4,13] Since the cervix is atrophic in patients at the post-menopausal stage, there may be difficulties in the insertion of CF.…”

Section: Discussionmentioning

confidence: 99%

“…It should be taken into consideration that the learning time of the assistant is also long. [13] Due to this situation, TLH techniques without using UM have been defined by various surgeons. Opening of the 5 th port and manipulation of the port by the assistant, [17] uterine rein technique [18] and Kamran's technique [19] are examples of such techniques.…”

Section: Discussionmentioning

confidence: 99%

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Complications Associated with the Use of 3 Different Uterine Manipulators (Clermont-Ferrand, VCare and RUMI II) in Total Laparoscopic Hysterectomy

Aslan¹

2021

Laparosc Endosc Surg Sci

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Introduction: In total laparoscopic hysterectomy (TLH), uterine manipulators (UM) are utilized to facilitate dissection by moving the uterus. However, some complications may occur during the utilization of a manipulator. The aim of this study is to compare the complications that occur during the utilization of three different manipulators. Materials and Methods:In this retrospectively designed study, 103 patients who underwent TLH due to benign indications were included in the study. All patients were operated by the same two surgeons using the same technique. The patients were divided into three groups according to the manipulators utilized. Group 1 (G1) included patients operated with Clermont-Ferrand UM, Group 2 (G2) included patients operated with RUMI II, and Group 3 (G3) included patients operated with VCare. UM-related complications, duration of operation, estimated amount of bleeding, duration of hospital stay, uterine weight, uterine length, number of myomas, and diameter of the largest myoma were recorded.Results: Uterine weight and mean blood loss were higher in G1 than in G3. There was no significant difference between the groups in terms of uterine perforation. Penetration of the manipulator into the mesorectum occurred in one patient in G1 with Douglas perforation. There were two cervical cup melts in G2 and 1 in G3. Cuff dehiscence occurred in one patient each in G2 and G3. Conclusion:Manipulation of the UM, which is an indispensable instrument of the TLH procedure today, by people with skill and experience and the surgeon's knowledge on the features and limits of the manipulator used will reduce the risk of UM-related complications.

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“…Despite these encouraging results, the UM use could increase the technical difficulties of the surgical procedure or lead to non-cancer-related operative complications ( 52 ). Uterine mobilization in the presence of android anatomical conformation of the pelvis of some women, or the case of very large uteri, could decrease with the positioning of the UM ( 53 ).…”

Section: Methodsmentioning

confidence: 99%

Role of uterine manipulator during laparoscopic endometrial cancer treatment

Capozzi¹,

Rosati²,

Uccella³

et al. 2020

Transl Cancer Res TCR

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Endometrial cancer (EC) is the most frequent gynecologic malignancy with 61,000 new cases diagnosed per year in the USA. Gynecologic Oncology Group (GOG) LAP2 randomized study demonstrated a superimposable 5-year overall survival between laparotomic and laparoscopic approaches in EC treatment. In this context the uterine manipulator (UM) represents a valuable tool in order to increase the ergonomics of surgical gesture during a laparoscopic total hysterectomy. Despite the proven safety of the minimally invasive approach in EC treatment, neither the indication whether to use or not, nor the recommendation concerning a specific type of UM are provided by international guidelines. This narrative review aims to collect all the main findings in the literature about UM use to investigate its safety in EC patients. Based on the analysis of the literature research, the main results were categorized into two manipulator-related problems: the iatrogenic LVSI, and the retrograde tumor spillage. LVSI is defined as the presence of tumor cells within an endothelium-lined space. An electronic search was performed using the following keywords: 'uterine manipulator', and 'endometrial cancer'. The electronic database search provided a total of 93 studies. Of whom, 12 case reports, 5 studies not in English language, and 65 works not fitting the review scope were excluded from the analysis. Eleven studies were considered eligible for the purpose of the study. The most recent studies have highlighted the safety of the uterine manipulator in the earlystage EC laparoscopic treatment. All types of manipulators are considered to be fairly safe but its application should be tailored according to tumor dimension and grade of myometrial infiltration.

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Uterine manipulator in total laparoscopic hysterectomy: safety and usefulness

Cited by 32 publications

References 58 publications

Ureteric injuries during hysterectomy—A Norwegian retrospective study of occurrence and claims for compensation over an 11‐year period

Ureteric injuries during hysterectomy—A Norwegian retrospective study of occurrence and claims for compensation over an 11‐year period

Complications Associated with the Use of 3 Different Uterine Manipulators (Clermont-Ferrand, VCare and RUMI II) in Total Laparoscopic Hysterectomy

Role of uterine manipulator during laparoscopic endometrial cancer treatment

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