Laparoscopic hysterectomy and ureteric injury: a comparison of the initial 275 cases and the last 1,000 cases using staples

Abstract

We retrospectively analysed our first 1,275 laparoscopic hysterectomies for ureteric injuries. All patients scheduled for hysterectomy in two private gynaecological practices in Sydney and Adelaide over the past decade were offered laparoscopic hysterectomy using a linear cutter stapling device for securing uterine vascular pedicles. The stapling of the uterine vascular pedicles resulted in the injury of four ureters in the first 275 cases (1.45%), whereas in the subsequent 1,000 cases there was only one such injury (0.1%). In light of our data and the reviewed literature, we conclude regarding ureteric injury at laparoscopic hysterectomy that: in the early days it was probably more the result of surgical inexperience and technique development rather than instrument failure; in experienced hands and with a perfected technique the rate is probably no higher than for abdominal hysterectomy; in experienced hands the rate is probably similar whether stapling or bipolar diathermy is used to secure the uterine vascular pedicles.

Total laparoscopic hysterectomy: a retrospective study of 5 years

“…16,21 But there are studies now which state that in experienced hands and with a perfect technique TLH is not associated with any increase in major complications and even ureteric injuries are not more. 22,23 Effect of AH and TLH on post-operative vaginal length was compared which showed that it was shorter following AH and patients who have undergone TLH have better outcome related to certain sexual function parameters. 24,25 Conversion rate in present study was 1.69% for laparotomy and 1.69% for vaginal hysterectomy.…”

Evidence‐based implementation and increase in the rate of laparoscopic hysterectomy

“…However, large numbers would be required to show a difference given the rarity of this complication. Other large observational studies have shown no increase in ureteric injury for TLH compared to AH for the latter half of the data collection, which they attributed to surgeons completing the learning curve …”

Do new vessel sealing devices and harmonic ace increase ureteric injury in total laparoscopic hysterectomy?

“…The general incidence of ureteric injury, irrespective of the pathology, in abdominal hysterectomy is 1.3–2.2%, in vaginal hysterectomy is 0.03%, and in conventional laparoscopic hysterectomy, it is 1.37%. [ 1 – 3 ]…”