Cystoscopy with a 5-mm laparoscope and suction irrigator

Area of Science:

• Gynecology
• Urology
• Surgical Innovation

Background:

• Total laparoscopic hysterectomy (TLH) is a minimally invasive procedure.
• Intraoperative assessment of urinary tract integrity is crucial during TLH.
• The utility of routine cystoscopy during TLH remains debated.

Purpose of the Study:

• To evaluate the safety and usefulness of intraoperative cystoscopy during total laparoscopic hysterectomy (TLH).
• To determine if cystoscopy can accurately detect urologic injuries during TLH.
• To assess the impact of cystoscopy on operative time and blood loss.

Main Methods:

• Retrospective analysis of 744 patients undergoing TLH over 10 years.
• Comparison between patients who underwent cystoscopy (n=344) and those who did not.
• Cystoscopy performed using a 5-mm laparoscope and saline suction irrigator.

Main Results:

• Cystoscopy added 13 minutes to operative time and increased blood loss by 30 dL.
• No significant difference in hospital stay or overall complications.
• Accurately confirmed cystotomy closure in 12 patients and identified 3 ureteral injuries.
• Failed to identify 3 patients who developed ureteral fistulas post-operatively.
• One complication was attributed to the cystoscopy procedure.

Conclusions:

• Intraoperative cystoscopy during TLH is well-tolerated and reassures immediate urologic integrity.
• Cystoscopy is not effective in identifying patients at risk for delayed ureteral fistula formation.
• The routine use of cystoscopy during TLH may not be beneficial for predicting long-term urologic complications.