Laparoscopic management of intentional and unintentional cystotomies

Abstract

We evaluated the outcome of laparoscopic closure of intentional or unintentional bladder openings during operative laparoscopy. The unintentional cystotomies occurred in six women during ancillary suprapubic cannula insertion (1), sharp dissection of the bladder from the uterus in preparation for hysterectomy (2), development of the space of Retzius for bladder neck suspension (1), myomectomy (1), and resection of an ovarian remnant (1). In the remaining 13 women, bladder entry was required for treatment of endometriosis (3), and full-thickness partial cystectomy was necessary for deeply infiltrative endometriosis (7) or embedded ovarian remnants (2), or to repair a vesicovaginal fistula (2). The bladder defect was repaired laparoscopically in one layer using interrupted absorbable polyglycolic acid suture (17) or polydioxanone suture (2), followed by 7 to 14 days of transurethral drainage. The repair of the defects took approximately 5 to 30 minutes. Major complications were limited to one woman who developed a vesicovaginal fistula that required additional surgery. Minor complications were mild incisional erythema (1), urinary incontinence (1), and bladder spasms (1). In follow-up of 6 to 48 months, all patients had good outcomes. In selected women, certain bladder injuries can be repaired safely and effectively during operative laparoscopy.