2287 Cystoscopy with Laparoscope Lens of 5 MM after Laparoscopic Hysterectomy, Experience in a Third Level Hospital

Abstract

Study Objective Evaluate the detection of ureteral injuries with the use of laparoscopic lens of 5 mm and 30° for cystoscopy after total laparoscopic hysterectomy. Design Retrospective, descriptive, observational. Setting Third level hospital in the north of Mexico. Patients or Participants 135 patients scheduled for laparoscopic hysterectomy between march 2018 to march 2019, in a third level hospital in the north of Mexico. In four cases, laparoscopic surgery was converted to laparotomy due to bleeding, non-diagnosed ovarian malignancy, failure in the equipment, and patient's condition. Interventions No intervention. Measurements and Main Results Retrospective study of 131 patients who underwent a total laparoscopic hysterectomy, in which routinary diagnostic transoperative cystoscopy was made with a laparoscopic lens of 5 mm and 30°. The detection of 1 case of ureteral kinking was detected during the cystoscopies and one patient had an ureterovaginal fistula detected 7 days after de surgery. The results of cystoscopy after a laparoscopic hysterectomy has a sensibility of 50%, specificity of 100% and False Positive Ratio 0% and False Negatives Ratio 50% in identifying ureteral injuries. Conclusion The use of routinary cystoscopy during total laparoscopic hysterectomy has been debated previously. The detection rate in other studies reported that twice the injuries were detected during cystoscopy immediately after hysterectomy and delayed detection of ureteral injury decreased seven fold. Our study justifies the use of cystoscopy as a cost effective test, using only the 5 mm lens as the additional equipment required.