7 Avoidance of complications of laparoscopic hysterectomy

Choice of route for hysterectomy – evaluation of procedures performed in the gynaecological department of the Tuchola District Hospital, from 2005 to 2008

“…All reports show similar complication rates: the highest for abdominal, the smallest for vaginal hysterectomy [14][15][16][17]. Complications of laparoscopic hysterectomy include injuries to the urinary bladder, intestine and blood vessels and occur more often in total hysterectomy, mostly during the learning curve period and when advanced endometriosis or intraperitoneal adhesions are present [18][19][20][21]. In the material presented above, we have noted two cases of major complications [22,23] due to the thermal injury to the ureter from the so-called delayed electric current effect [24][25][26][27][28], one diagnosed on the 14 th postoperative day as a uretero-vaginal fistula and the other on the 21 st day as leak of urine into the peritoneal cavity from the necrotic ureter.…”

Safety aspects of laparoscopic hysterectomy

“…Stapling devices offer speed but are expensive and are also associated with ureteral injuries (61). The use of ureteral catheters has been recommended to prevent ureteral injuries (42) but they have also been associated with significant morbidity (62). Hence, one way to decrease ureteral injuries would be to cut the uterine vessels vaginally (63), especially during the learning phase.…”

“…Two main types of vascular structure are at risk during laparoscopic hysterectomy: those lying in the abdominal wall and those lying retroperitoneally in the pelvic side wall and posterior abdominal wall. The injuries may occur during the entry phase of laparoscopy or during the procedure with instruments or diathermy (42). The incidences vary considerably depending on what kind of bleeding complications are counted.…”