Prevention of complications in laparoscopic hysterectomy: Experience with 1120 cases performed by a single surgeon

Abstract

Study objective The aim of this study is to describe a safe technique without any ureteral, bladder, and major vessel injuries in laparoscopic hysterectomy with a CO 2 laser technique. Design Prospective study (Canadian Task Force classification II-3). Setting Centre Hospitalier Interrégional Edith Cavell, Department of Obstetrics and Gynecology, Endoscopic Laser Surgery Center, Bruxelles, Belgium; and Kadir Has University, Metropolitan Florence Nightingale Hospital, Istanbul, Turkey. Patients One thousand one hundred twenty women with benign diseases. Interventions Laparoscopic-assisted vaginal hysterectomy (LAVH) or laparoscopic hysterectomy (LH). Measurements and main results Between 1992 and 2004, in 1120 women with benign diseases, consecutive LAVH or LH was planned. During laparoscopic hysterectomy, at all stages, bipolar forceps was used for hemostasis, and a CO 2 laser was used for vaporization and excision. The total operating time was 35 to 180 minutes, with a median of 52 minutes (range 35–163) for LAVH (n = 542) and 55 minutes (range 42–180) for LH (n = 552). Operations were successfully completed laparoscopically in 98.8% of the patients. The mean hospital stay was 2 days. The overall major complication rate was 1%. No ureteral, bladder, or major vascular injury occurred. Conclusion The technique we used in our study is safe and effective in the prevention of ureteral, vesical, and vascular injuries during LAVH and LH; moreover, the use of bipolar coagulation and a CO 2 laser in endoscopic surgery results in a shorter duration of operation. This technique provides all the advantages of both laparoscopic and vaginal surgery.