Total laparoscopic hysterectomy in 1253 patients using an early ureteral identification technique
Journal of Obstetrics and Gynaecology Research, 05/18/2012Kobayashi E et al.
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 the method allows for safe TLH and minimization of ureteral injury, without the use of stringent 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.
They 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).
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