Iatrogenic uterine perforation and bowel penetration using a Hohlmanipulator: A case report

Akdemir, Ali; Çırpan, Teksin

doi:10.1016/j.ijscr.2013.10.005

Cited by 18 publications

(17 citation statements)

References 10 publications

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“…However, assembly is stated as difficult [7]. Most publications were found regarding this manipulator: three prospective studies, one retrospective study, a product survey and one case report [4,7,[12][13][14][15][16]. One retrospective study and one prospective cohort study were performed by Mueller et al [4,14], including 44 and 567 patients, respectively.…”

Section: Resultsmentioning

confidence: 99%

“…Another prospective cohort was published of 1432 patients undergoing total intrafascial laparoscopic hysterectomy (TAIL) using a Hohl manipulator, experiencing 1 ureter and 8 bladder injuries [15]. Finally, a case report exists describing a uterine perforation and bowel perforation in a patient were a Hohl manipulator was used [12]. No reports on this manipulator were found in the MAUDE database.…”

Section: Resultsmentioning

confidence: 99%

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Efficacy and safety of uterine manipulators in laparoscopic surgery: a review

Haak

Alleblas

Nieboer

et al. 2015

Arch Gynecol Obstet

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Purpose This review aims to objectively assess the efficacy and safety of uterine manipulators as reported in scientific literature. Furthermore, it evaluates as to which manipulator best suits which surgical procedure. Methods PubMed, Embase, Web of Science, COCHRANE, CINAHL, Academic Search Premier, Science Direct and the MAUDE database were searched. Technical information was retrieved from the manufacturers. Results 25 articles covering 10 uterine manipulators were found. Studies regarding implementation and use of manipulators are scarce; only two surveys were found comparing different manipulators. Moreover, clinical evidence proving the efficacy of manipulators with respect to prevention of complications, inherent to laparoscopic surgery, does not exist. Conclusion The use of uterine manipulators is well established and it is clear that uterine manipulators offer the easiest way to handle the uterus during surgery. However, detailed information regarding efficacy and safety is scarce. Clinical evidence substantiating the assumed mechanism of prevention of ureter injuries was not found. Our review did not find the optimal manipulator. Some are more versatile than others and not all instruments are appropriate for all types of surgery. Therefore, gynecologists should choose the manipulator that best suits the type of surgery that is performed.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Efficacy and safety of uterine manipulators in laparoscopic surgery: a review

Haak

Alleblas

Nieboer

et al. 2015

Arch Gynecol Obstet

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“…During the insertion of any uterine manipulator (with or without balloon) and its use (especially in the atrophic uterus), the manipulator's shank may weaken the myometrium, iatrogenically leading to uterine rupture and opening of the tumor to the peritoneal cavity and surgical field. 30,31 The uterine rupture is rarely reflected in surgical reports, and it has not been considered in previous analyses. Machida et al 32 reported a 0.4% to 1% perforation rate with a balloon manipulator; thus, other factors could be involved.…”

Section: Discussionmentioning

confidence: 99%

Impact of uterine manipulator on oncological outcome in endometrial cancer surgery

Padilla-Iserte

Lago

Tauste

et al. 2021

American Journal of Obstetrics and Gynecology

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BACKGROUND: There are limited data available to indicate whether oncological outcomes might be influenced by the uterine manipulator, which is used at the time of hysterectomy for minimally invasive surgery in patients with endometrial cancer. The current evidence derives from retrospective studies with limited sample sizes. Without substantial evidence to support its use, surgeons are required to make decisions about its use based only on their personal choice and surgical experience. OBJECTIVE: To evaluate the use of the uterine manipulator on oncological outcomes after minimally invasive surgery, for apparent early-stage endometrial cancer. STUDY DESIGN: We performed a retrospective multicentric study to assess the oncological safety of uterine manipulator use in patients with apparent early-stage endometrial cancer, treated with minimally invasive surgery. The type of manipulator, surgical staging, histology, lymphovascular space invasion, International Federation of Gynecology and Obstetrics stage, adjuvant treatment, recurrence, and pattern of recurrence were evaluated. The primary objective was to determine the relapse rate. The secondary objective was to determine recurrence-free survival, overall survival, and the pattern of recurrence. RESULTS: A total of 2661 women from 15 centers were included; 1756 patients underwent hysterectomy with a uterine manipulator and 905 without it. Both groups were balanced with respect to histology, tumor grade, myometrial invasion, International Federation of Gynecology and Obstetrics stage, and adjuvant therapy. The rate of recurrence was 11.69% in the uterine manipulator group and 7.4% in the nomanipulator group (P<.001). The use of the uterine manipulator was associated with a higher risk of recurrence (hazard ratio, 2.31; 95% confidence interval, 1.27e4.20; P¼.006). The use of uterine manipulator in uterus-confined endometrial cancer (International Federation of Gynecology and Obstetrics [FIGO] IeII) was associated with lower disease-free survival (hazard ratio, 1.74; 95% confidence interval, 0.57e0.97; P¼.027) and higher risk of death (hazard ratio, 1.74; 95% confidence interval, 1.07e2.83; P¼.026). No differences were found regarding the pattern of recurrence between both groups (chi-square statistic, 1.74; P¼.63). CONCLUSION: In this study, the use of a uterine manipulator was associated with a worse oncological outcome in patients with uterusconfined endometrial cancer (International Federation of Gynecology and Obstetrics IeII) who underwent minimally invasive surgery. Prospective trials are essential to confirm these results.

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“…34 Akdemir and Cirpan discussed how although the Hohl manipulators were easy to use and decreased the rate of VCD, complications arose mainly from improper use of the manipulator. 35 Such complications were uterine perforation and bowel injury, they concluded that improper use of manipulator may overshadow it's advantages. 35 Van den Haak et al 36 highlighted the use of uterine manipulators for prevention of ureter injuries during TH, however there is still lack of data regarding how this prevention occurs.…”

Section: Comparison Of Type Of Uterine Manipulator Used (Hohl Vs Vcare®)mentioning

confidence: 99%

“…35 Such complications were uterine perforation and bowel injury, they concluded that improper use of manipulator may overshadow it's advantages. 35 Van den Haak et al 36 highlighted the use of uterine manipulators for prevention of ureter injuries during TH, however there is still lack of data regarding how this prevention occurs. 36 Ultimately, Van den Haak concluded use of uterine manipulators in TH is unlikely to negatively impact the outcome of TH, but was inconclusive in the direct benefit on the rate of VCD.…”

Section: Comparison Of Type Of Uterine Manipulator Used (Hohl Vs Vcare®)mentioning

confidence: 99%

Colpotomy in da vinci single-site hysterectomy: a case report and literature review

Guan¹,

Rezai²,

Hughes³

et al. 2019

OGIJ

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Background: Vaginal cuff dehiscence (VCD) occurs after total hysterectomy with colpotomy when the surgical closure fails. Vaginal cuff dehiscence is defined as any separation of the edges of the cuff and vaginal evisceration is defined as the prolapse of intraperitoneal contents typically the small bowel. The rate of all vaginal cuff dehiscence (VCD) has been reported from 0.1% to 4.6% and with robotic assisted laparoscopy hysterectomies (RA-LH) as high as 7.5%. True estimated rates, however, of vaginal dehiscence are difficult to determine as most of the literature consists of case reports which have an inherent reporting bias. Vaginal dehiscence is rare compared to other surgical complications but due to its devastating nature warrants discussion. Objective: The objective of this review was to compare a number of variables possibly associated with the VCD after total hysterectomy (TH). Variables compared were surgical hysterectomy approach (open, laparoscopic, vaginal and robotic), type of suture used to close the vaginal cuff (barbed or traditional), approach to colpotomy (open, laparoscopic, vaginal and robotic) and type of uterine manipulator used. Case: A 50-year-old woman Gravida 0,Para 0, with a history of chronic pelvic pain and pelvic pressure, menorrhagia and anemia due to abnormal uterine bleeding secondary to leiomyoma (AUB-L) unresponsive to medical management therapy and symptoms affecting her daily activities presented to our clinic and requested laparoscopic hysterectomy. Patient underwent Da Vinci SILS TLH (robot-assisted total hysterectomy) with bilateral salpingectomy. Hysterectomy was modified by performing colpotomy prior to uterine artery cauterization and cardinal ligament transection. Patient had uncomplicated hospital and recovery course and was discharged on postoperative day 1. Upon return to clinic on postoperative week 3 for postoperative followup, patient did not have any complaint and reported resolutions of symptoms. Conclusion: The largest amount of evidence remains that the rate of VCD is associated with robotic and laparoscopic closure of colpotomy. Some authors have made local policy changes to improve care by only closing colpotomy vaginally and have met with success. Other institutions have begun using lower power during electrocautery in order to reduce tissue damage. Barbed sutures showing improved operative times and being well tolerated have been studied in the hopes of reducing VCD with one large study showing statistically significant results.

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Iatrogenic uterine perforation and bowel penetration using a Hohlmanipulator: A case report

Cited by 18 publications

References 10 publications

Efficacy and safety of uterine manipulators in laparoscopic surgery: a review

Efficacy and safety of uterine manipulators in laparoscopic surgery: a review

Impact of uterine manipulator on oncological outcome in endometrial cancer surgery

Colpotomy in da vinci single-site hysterectomy: a case report and literature review

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