Complications Of Total Laparoscopic Hysterectomy Research Articles

Complications of Total Laparoscopic Hysterectomy in a Tertiary Care Center.

Introduction Laparoscopic hysterectomy is a standard practice in developed countries and corporate setups in India but is a relatively new practice in government institutions; surgical audits are rarely done in our institutions. This study aims to determine the complications of total laparoscopic hysterectomy (TLH) in a tertiary care center in India. Methods This was a retrospective record review of patients admitted to the Obstetrics and Gynecology department of Veer Surendra Sai Institute of Medical Sciences and Research (VIMSAR), Odisha, India. Data were collected from case sheets of patients who underwent TLH, operated on between January 2018 and May 2022. Demographic and clinical data were extracted andanalyzed. Results Of the 223 consecutive patients, 12 (5.3%) were converted to laparotomy. The mean age of patients was 44.34 years (±5.457), with a mean BMI of 24.24 kg/m2 (±2.181). The mean surgical duration was 1.895 hr (±0.487), with a mean blood loss of 140 ml and an average hospital stay of 3.25 (±0.821) days. Duration of surgery, blood loss, and hospital stay decreased with the surgeon's increasing experience. Reoperation was not needed in any case. Complications were recorded in about 18 (8.07%) cases. Also, major complications were less. Conclusion Total laparoscopic hysterectomy is a less invasive and safe alternative to total abdominal hysterectomy, offering the benefits of minimally invasive surgery, and is also ideal for candidates unsuitable for vaginal hysterectomy.

Complications of total laparoscopic hysterectomy: A retrospective study of cases performed by a single surgeon.

In this study, we evaluated the complications of total laparoscopic hysterectomy (TLH) and analysed the trend of complications, intraoperative and post-operative, over a period of time. It was a retrospective study conducted in the private care setting. All women who underwent hysterectomy for benign conditions from a 1 January 2003 to 31 December 2017, (15 years) were included in this study. A total of 3272 patients were operated during this period. All surgeries were performed by a single surgeon. Intraoperative complications that occurred during surgery during the study period were 3 cases (0.09%) had bladder injury, 3 cases (0.09%) had bowel injury, 1 case (0.03%) had internal iliac vessel bleeding and 1 case(0.03%) needed conversion to vaginal hysterectomy due to cautery failure and post operative complications were 90 cases (2.75%) had vault bleeding, 2 cases (0.06%) had intestinal obstruction, 5 cases (0.15%) had paralytic ileus, 1 case (0.03%) had vesicovaginal fistula, 1 case(0.03%) had ureterovaginal fistula and 1 case (0.03%) had peritonitis. TLH is a very effective, patient-friendly and safe technique in the hands of experienced surgeons giving good quality of life to patients postoperatively.

Surgical morbidity of total laparoscopic hysterectomy for benign disease: Predictors of major postoperative complications

ObjectiveTo estimate rate of perioperative complications and to define risk factors of 30-day major (Clavien-Dindo ≥ 2) postoperative complications of total laparoscopic hysterectomy (TLH) for benign disease. Study designAn uncontrolled single-center single-arm retrospective study. Data of consecutive patients who have undergone TLH for pathologically confirmed benign disease between January 2000 and December 2019 have been analyzed. Perioperative surgical outcomes, occurrence of postoperative complications, readmissions, and reoperations within 30 days from surgery were registered. Univariate and multivariable analyses were performed to determine the factors associated with major (Clavien-Dindo ≥ 2) postoperative complications. ResultsOver the study period 3090 patients were included in the study. Conversion to open surgery occurred in 54 (1.7%) cases. Mean operative time for TLH was 87.7 (±1.7) minutes while mean estimated blood loss was 119.5 (+7.4) mL. Overall, postoperative complications were registered in 430 (13.9%) patients, and major events were observed in 208 (6.7%) of the cases. Same-hospital readmissions and reoperations within 30-day from surgery occurred in 78 (2.5%) and 28 (0.9%) patients, respectively. At multivariable analysis, endometriosis (odds ratio: 3.51, 95%CI:1.54–8.30, p = 0.02), the need for conversion to open surgery (odds ratio: 1.26, 98%CI:1.03–12.64, p < 0.001), and the occurrence of any intraoperative complication (odds ratio: 3.10, 95%CI: 1.45–21.61, p < 0.001) were found as independent risk factors for major postoperative complications. ConclusionsTotal hysterectomy performed via laparoscopy is associated with acceptable major postoperative complications rate. A huge effort should be made to minimize the occurrence of intraoperative complications and the need for conversion to open surgery. Patients undergoing TLH for endometriosis should be counselled about the increased risk of major postoperative events.

Peri-operative complications of Total laparoscopic hysterectomy for benign gynecological diseases in Fukuoka university

Peri-operative complications of Total laparoscopic hysterectomy for benign gynecological diseases in Fukuoka university

Outcomes and complications of total laparoscopic hysterectomy after conization

Objective: High-grade squamous intraepithelial lesion (HSIL)/cervical intraepithelial neoplasia (CIN) 3, and stage IA1 cervical cancer are often diagnosed after cervical conization. Additional resection is required in some cases, and total laparoscopic hysterectomy (TLH) after conization requires attention due to the postoperative changes around the cervix. Methods: This single-center retrospective study investigated the perioperative outcomes and complications of TLH with or without conization. Patients diagnosed with CIN or stage IA1 cervical cancer were grouped according to whether conization was performed before TLH. The perioperative outcomes, complications, and oncological outcomes were compared for 32 patients who underwent TLH after conization (cone-TLH group) and 18 patients who underwent TLH alone (TLH group). Results: The mean interval between conization and TLH was 14.8 ± 5.2 weeks. There were no significant differences between the cone-TLH and TLH groups in terms of surgical time (186.3 ± 48.1 min vs. 179.8 ± 34.6 min, P = 0.61), blood loss (100 [5-500] mL vs. 100 [5-560] mL, P = 0.79), length of hospital stay (4.7 ± 1.4 days vs. 4.6 ± 1.0 days, P = 0.86), or recurrence rate. One patient in the cone-TLH group experienced a ureter injury. Conclusions: Although the outcomes were comparable between TLH alone and TLH after conization, care is needed to avoid ureter complications.

Impact of High Body Mass Index on Outcomes of Laparoscopic Hysterectomy

Abstract Objective: The objective of this study was to investigate the association between obesity and intra/post–operative complications of total laparoscopic hysterectomy (TLH). Materials and Met...

Investigation of the Causes and Prevention of Complications of Total Laparoscopic Hysterectomy at our Hospital – The Efficacy of the Surgical Manual Prepared by Collaboration Among Several Departments –

Investigation of the Causes and Prevention of Complications of Total Laparoscopic Hysterectomy at our Hospital – The Efficacy of the Surgical Manual Prepared by Collaboration Among Several Departments –

Evaluation of the surgical outcome and complications of total laparoscopic hysterectomy in patients with enlarged uteruses

ObjectiveThe aim of this study was to investigate whether uterine weight has a deleterious effect on the operation time, complication rates, length of hospital stay and incidence of intraoperative haemorrhage during total laparoscopic hysterectomy operation. MethodsA total of 282 patients who underwent total laparoscopic hysterectomy for benign gynaecologic indications were retrospectively analyzed. The median operation time of 70 min was accepted as an index number, and a cut-off point of ≥300 g was calculated for uterine weight by using reciever operator characteristics (ROC) curve analysis. ResultsThere was no statistically significant relationship between the uterine weight and haemoglobin drop rate (1.27 ± 0.89 vs 1.21 ± 0.88, p = 0.905), complication rate (10.83% vs 9.26%, p = 0.062) and length of hospital stay (3.27 ± 1.23 vs 3.37 ± 1.35 days, p = 0.505) based on this cut. Lee-Huang point was preferred for abdominal entry in cases with uteruses reached the level of umbilicus −2 cm in physical examination. ConclusionsUterine weight was not effected the complication rate, estimated blood loss and length of hospital stay in total laparoscopic hysterectomy operation. A cut-off value of 300 g could be used for an increased operation time.

Impact of endometriosis on surgical outcomes and complications of total laparoscopic hysterectomy.

Total laparoscopic hysterectomy (TLH) in the case of endometriosis may be extremely challenging. Our aim has been to analyze perioperative details and complications of TLH in women with vs. women without endometriosis. Consecutive women who underwent TLH for endometriosis (endometriosis group) were compared with consecutive patients who had TLH for other conditions (controls) in terms of perioperative outcomes. Patients in the endometriosis group were analyzed, according to the severity of the disease. One-hundred and twelve women in the endometriosis group, 29 (25.9%) with minimal-mild, and 83 (74.1%) with moderate-severe stage disease (rAFS score), respectively, were compared with 572 controls. Conversion rate was 0.8 vs. 0.5% (P=0.51), and median operative time was 75 vs. 55min (pxxx=x) in the endometriosis group vs. Intraoperative complications were similar between groups (P=0.56). Postoperative complications occurred in 10 (12.3%) women in the endometriosis group vs. 12 (3.3%) among the controls (P=0.002). The severity of complications according to Clavien-Dindo classification system was higher in the endometriosis group (Clavien-Dindo >2: 7.5 vs. 1.9%). The risk of organ lesions, urinary lesions, postoperative complications, and severe adverse events was significantly higher in women with moderate-severe endometriosis vs. No differences between patients with minimal-mild endometriosis and controls were found. TLH in the case of endometriosis is associated with longer operative time and an almost fourfold increase in the risk and severity of complications compared with controls. In particular, the adjunctive risk of adverse events is specific for moderate/severe-stage disease but not for minimal/mild endometriosis.

Surgical outcome and complications of total laparoscopic hysterectomy for very large myomatous uteri in relation to uterine weight: a prospective study in a continuous series of 461 procedures.

To analyze whether a large uterine size was associated with increased rate of intraoperative and postoperative surgical complications in patients who underwent total laparoscopic hysterectomy (TLH) for myomatous uteri. We examined prospectively data from 461 consecutive TLHs performed by a single surgeon between August 2004 and August 2014 at the Department of Obstetrics and Gynecology, Sirai Hospital, Carbonia, and at the Department of Gynecologic Oncology, Businco Hospital, Cagliari, Italy. Demographic and surgical data were stratified by uterine weight (range 90-5500g) into four groups: <300g; from 300 to 500g; from 500 to 800g; and >800g. Outcomes examined included blood loss, operative time, intraoperative and postoperative complications, and duration of hospital stay. A linear regression analysis was performed to identify whether uterine weight was an independent predictor affecting these outcomes. In addition, BMI, previous surgery with adhesiolysis, and endometriosis were tested as a predictor of surgical complications and outcomes. No significant difference was found in intraoperative and postoperative complications, as well as hospital stay, by uterine weight. Increased uterine size was significantly associated with longer operative time and increased blood loss. Beside uterine weight, prior surgery was predictive of postoperative complications. In contrast, higher BMI was not associated with increased complication rate. Independent predictors of longer operative time included previous surgery, endometriosis, and BMI. Our results showed that in experienced hands, TLH is feasible and safe also in presence of very large uteri. TLH results in a few complications and short hospital stay regardless of uterine weight.

Total laparoscopic hysterectomy in 1253 patients using an early ureteral identification technique

The aim of this study was to determine the incidence of perioperative complications and evaluate risk factors for the major complications of total laparoscopic hysterectomy (TLH) using an early ureteral identification technique. We describe the technique we standardized and used for TLH, without exclusion criteria. A retrospective study was carried out at Kurashiki Medical Center, Japan, based on 1253 TLH procedures performed from January 2005 to March 2009. We reviewed records to identify the major perioperative complications, including bladder, ureteral, and intestinal injuries, and incidences of reoperation. Risk factors for major complications were analyzed using multivariate logistic regression models. A total of 24 patients encountered major complications (1.91%). Complications included 10 intraoperative urologic injuries, five cases of postoperative hydronephrosis, five cases of vaginal dehiscence, one bowel injury, one postoperative hemorrhage, one bowel obstruction, and one ureterovaginal fistula. All 11 cases of intraoperative visceral injury were recognized during the surgery and repaired during the same laparoscopic surgical procedure. Of the risk factors analyzed, a history of abdominal surgery was the only one associated with the occurrence of major complications, with an odds ratio of 2.48 (95% confidence interval 1.23-6.49). While complications are inevitable, even in the hands of the most skilled surgeon, they can be minimized without conversion to laparotomy by a sufficiently developed suturing technique and a precise knowledge of pelvic anatomy. The presented data indicate that our method allows for safe TLH and minimization of ureteral injury, without the use of stringent exclusion criteria.

Total laparoscopic hysterectomy (TLH) versus coagulation of uterine arteries (CUA) at their origin plus total laparoscopic hysterectomy (TLH) for the management of myoma and adenomyosis

We tried to evaluate the relative feasibility, surgical duration and complications of total laparoscopic hysterectomy (TLH) versus coagulation of uterine arteries at their origin (CUA) plus total laparoscopic hysterectomy for the management of myoma and adenomyosis, and to compare the estimated blood loss for both procedures. A total of 123 patients underwent TLH or CUA plus TLH for the treatment of symptomatic myoma and adenomyosis. Sixty‐four women underwent TLH, whilst 68 women underwent coagulation of uterine arteries at their origin plus TLH. The mean weight and volume of the uterus as determined following TLH was 288.1±102.4gm (range 182.1∼396.2gm.) and 451±340.6cm3 (range 107.4 ∼ 792), respectively. The mean weight of the uterus following CUA plus TLH was 269.1±151.7gm (range 215.8∼430.1) whilst the mean uterine volume was 472.7±377.8cm3 (range 93.7 ∼ 851.2). No significant differences with respect to surgical duration (95 vs. 96.5 minutes TLH vs. CUA + TLH; p>0.05), blood loss (177.2±80.1ml for TLH and 154.9±30.21ml for CUA+TLH; p>0.05) and mean±SD preoperative (12.05±1.70gm/dl for TLH and 12.14±1.38gm/dl for CUA+TLH; p>0.05) and post‐operative hemoglobin level (11±1.03 for TLH and 11±1.49 for CUA + TLH; p>0.05) were observed between the two study groups. The blood loss for TLH is comparable to that for the CUA plus TLH procedure.

Surgical morbidity associated with total laparoscopic hysterectomy in women with prior diagnostic excision of the cervix

To evaluate the feasibility, safety, and complications of total laparoscopic hysterectomy (TLH) in women undergoing prior diagnostic excision of the cervix. A retrospective study (Canadian Task Force classification II-2) was conducted in a tertiary care university hospital. The medical records of women undergoing TLH between June 2003 and September 2004 were reviewed. Twenty-six women with stage IA1 cervical cancer (19) and persistent high grade cervical neoplasia (7) underwent TLH after diagnostic cervical excision. The operation was successfully performed in all cases without conversion to laparotomy. The mean age of the patients was 47.0 +/- 8.64 years (95% CI 43.5-50.5). 19 patients had previous loop electrosurgical excision procedure (LEEP), one had cold knife conization. Six patients underwent repeated LEEP for positive endocervical margin. The mean operating time was 253.0 +/- 66.7 min (95% CI 226.0-279.9). The median blood loss was 300 mL (range 50-1000 mL). Only one patient needed 1 unit of blood transfusion. The median post-operative hospital stay was 3 days (range 2-6 days). All hysterectomy specimens had negative surgical margins. Two patients had major complications, one with bladder injury requiring laparoscopic repair. The remaining one had ureteral injury detected 9 days after the operation requiring subsequent ureteroneocystostomy. Both complications occurred in the first four cases of this series. No significant morbidity was noted in 2 years of follow-up. TLH appears to be feasible and safe in patients with prior diagnostic excision of the cervix. Careful separation of the bladder from the cervix and identification of both ureters are recommended to minimize morbidity associated with this operation.

The Learning Curve of Total Laparoscopic Hysterectomy: Comparative Analysis of 1647 Cases

Study Objective To compare the frequency of complications of total laparoscopic hysterectomy performed in the first and more recent years of our experience, and based on that, offer ways to prevent them. Design Retrospective, comparative study (Canadian Task Force classification II-2). Setting University tertiary referral center for endoscopic surgery. Patients During 1989–1995 and 1996–1999, 695 and 952 women, respectively, with benign pathology. Intervention Total laparoscopic hysterectomy. Measurements and Main Results differences in patient characteristics were found between 1989–1995 and 1996–1999. Substantial decreases in major complication rates were noted, 5.6% and 1.3%, respectively. No major vessel injury occurred. Excessive hemorrhage (1.9%) and need for blood transfusion (2.2%) during the first period were statistically higher than in the second period (both 0.1%, p <0.005). Urinary complications (2.2%) including 10 bladder lacerations, 4 ureter injuries, and 1 vesicovaginal fistula occurred more frequently in the first period than in the second period (0.9%), when 6 bladder and 2 ureter lacerations and 1 vesicovaginal fistula occurred (p <0.005). One bowel injury and one bowel obstruction occurred in the first period, but no bowel complications in the second. Between periods, 33 (4.7%) and 8 (1.4%) conversions to laparotomy were necessary. During the first period there were nine reoperations; of six laparotomies, four were due to urinary injuries, one due to heavy vaginal bleeding, and one due to a vesicovaginal fistula; three diagnostic laparoscopies were required due to postoperative abdominal pain. Three reoperations during the second period were two laparoscopies due to heavy vaginal bleeding and one laparotomy due to a vesicovaginal fistula (p <0.005). Statistically significant differences in median (range) uterine weight 179.5 g (22–904 g) and 292.0 g (40–980 g) and operating times 115 minutes (40–270 min) and 90 minutes (40–180 min), respectively, were recorded (p <0.005). Conclusion Laparoscopic hysterectomy was safe, effective, and reproducible after training, and with current technique, had a low rate of complications.

Laparoscopic hysterectomy

We describe the use of laparoscopic techniques in hysterectomy, and the epidemiology of hysterectomy. We review the advantages and complications of total laparoscopic hysterectomy and subtotal laparoscopic hysterectomy. Finally, we discuss long-term outcomes and the cost of these techniques.