Laparoscopic Hysterectomy - Complications Of The Technique

In a total laparoscopic hysterectomy (TLH) the uterine vessels, uterosacral and cardinal ligaments are laparoscopically divided, and the vaginal vault is laparoscopically sutured which requires good surgical skills. The aim of this study was to evaluate our surgical technique of laparoscopic hysterectomy by analysing the complications of the procedure. This was a retrospective observational study at the County Emergency Hospital Timisoara including the patients operated with laparoscopic hysterectomy between 2016 January and 2017 December. Inclusion criteria were benign uterine pathology and the attempt to perform a laparoscopic hysterectomy. There were 148 patients eligible for this study. Conversions to open surgery happened in 10 cases, reasons for conversion were: bleeding from the uterine artery in 2, profuse bleeding in 4, large myoma situated in the lower uterine segment obstructing the access to the uterine arteries in 3 cases, recognized ureteral damage in 1 case.There were 6 reoperations in our study: 3 for ureter damage, one for bleeding, one for bowel obstruction because of the adhesions with the vaginal stump, and one because of postoperative peritonitis due to bowel damage. Ureter damage required one trans-urethral stent placement and two reimplantation of the ureter in the bladder. Wound infections occurred only in cases with Pfannenstiel incision for specimen extraction. Pelvic abscesses were managed by drainage under ultrasound guidance and antibiotics. No deaths were recorded.Laparoscopic hysterectomy is a safe procedure, extra-care should be taken related to the ureters, bladder and the specimen extraction site should be the vagina if possible.