A new technique for dissecting the bladder laparoscopically

Abstract

To evaluate a new technique designed to facilitate bladder dissection during laparoscopic-assisted vaginal hysterectomy (LAVH). Minimal access surgery unit, James Cook University Hospital. A retrospective review of 130 LAVHs in which the bladder was dissected laparoscopically. A metal catheter was used to facilitate identification of the bladder edge, and a sponge forceps was inserted vaginally to mark the site for anterior colpotomy. Then monopolar scissors were used to open the vagina. The hysterectomy was then completed vaginally. In this series there were 14 (10.8%) recorded complications with two (1.5%) major complications (95% confidence interval 0.2–5.5%). There was one bladder trauma (0.7%; 95% confidence interval 0.02–4.2%), which was recognised immediately and repaired with laparoscopic intracorporeal knots. One patient required additional vault sutures 6 h postsurgery because of vaginal bleeding. The mean operating time was 98.7 min, and the recorded mean hospital stay was 2.7 days, with a range of 2–5 days. The recorded estimated intraoperative blood loss ranged from 75 to 300 ml, with a mean loss of 195 ml, and four patients required blood transfusion. Dissection of the bladder laparoscopically adds 5–10 min to the operative time but significantly facilitates identifying the appropriate plane. It is an easy technique to learn and teach. It is associated with minimal complications, with no increased incidence of bladder injury or dysfunction.