Adelaide laparoscopic hysterectomy audit (1991–1998): realistic complication rates!

Abstract

Objective To review complications of laparoscopic hysterectomy occurring in a citywide population of approximately 1 million people. Design All laparoscopic hysterectomy cases were analysed retrospectively independently of the surgeons involved. Setting All private and public hospitals (n = 19) in metropolitan Adelaide, South Australia. Subjects 1904 patients over the period 1991–98. Interventions The majority of cases involved a combined laparoscopic and vaginal approach with a proportion of total laparoscopic hysterectomies (n = 33). Surgical techniques involved both staples and diathermy. Main outcome measures Rates of major complications such as haemorrhage, haematoma formation, laparotomy and urinary tract injury. Results Significant haemorrhage occurred in 3.7% (n = 70) of cases with a haematoma incidence of 3.2% (n = 60). Laparotomy rates reduced from 5% (1991–93) to 1.7% (1996–98) with an overall incidence of 3.4% (n = 64). Overall urinary tract injury rates remained constant over the survey period, i.e. 3.3% (1991–93) vs. 3.1% (1996–98). However there was a significant reduction in ureteral damage but this was countered by an increasing cystotomy rate. Conclusions Laparotomy rates were comparable to those in published data but reduced significantly over the audit period. The incidence of haematoma formation was significantly greater than that in published data, but reduced over the period 1991–98. Urinary tract damage and haemorrhage exceeded expectations. This audit once again has suggested that the true rate of major complications with laparoscopic hysterectomy is higher than the literature suggests.

Retrospective study of the success rates and complications associated with total laparoscopic hysterectomy

“…Our rates of ureteric (0.2%) and bladder (0.2%) injury are comparable to other studies reporting 0.2–0.4% ureteric and 1.0–1.8% bladder injuries 4,21,22 . Prior cesarean section, prior pelvic surgery and endometriosis have been cited as the main determinants of intra‐ and postoperative complications 23 .…”

Vaginal Hysterectomy Versus Two-dimensional and Three-Dimensional Total Laparoscopic Hysterectomy in Women With Benign Uterine Diseases

“…[7,[29][30][31][32][33] No urinary tract damage was observed in the VH group; however, in the 2D TLH group, two patients reported ureter injury and one patient revealed vesicovaginal fistula; in the 3D TLH group, ureter injury developed in one patient in our study. We found urinary injury ratios for 2D and 3D TLH groups (2.9% and 2.4%, respectively) to be higher than the 0.2%-0.4% values for TLH as mentioned in other studies; [34,35] however, we did not observe any significant difference between the 2D and 3D TLH groups in terms of the urinary injury rates. Urinary bladder injury rates for 2D and 3D TLH groups (1.4% and 0%, respectively) in our study were found to be similar with the reported values (1.0% and 1.8%, respectively) in other studies.…”

Learning Laparoscopic-Assisted Hysterectomy

“…Estimated blood loss remained fairly constant and dropped from 274 mL to 213 mL whereas the rate of hemorrhage increased from 3.5% to 4.7%. 16 This difference could be explained by the circumstances: the Adelaide audit was undertaken when the technique was fairly new and spread rapidly. In our study, we found a significant reduction of hemoglobin drop after 30 cases as a sign of the learning effect.…”