Adelaide Laparoscopic Hysterectomy Audit

After anecdotal reports of significant complications with laparoscopic hysterectomy, the Royal Australian College of Obstetricians and Gynaecologists, South Australian branch, instituted the Adelaide laparoscopic hysterectomy audit. All 760 cases performed in the city of Adelaide (population 1 million) from commencement in 1991 to 1994 were analyzed with specific attention to major complications such as hemorrhage, hematoma, laparotomy rates, and urinary tract injuries. Potential bias was carefully avoided by auditing independent of the surgeons involved. Eighty-nine percent of cases were performed with disposable endoscopic surgical staples. Surgical technique was a combined laparoscopic and vaginal approach. Mean operating time was 129 minutes, mean estimated blood loss was 263 ml, and average hospital stay was 4.9 days. Significant hemorrhagic complications occurred in 3% of women. Hematoma formation requiring reintervention was reported at 3.3%, with an overall laparotomy rate of 5.3%. Urinary tract injury overall totaled 2.4%, consisting of bladder laceration 0.9%, ureteric laceration 0.5%, and late diagnosis 1.1%. Hemorrhage, hematoma, and laparotomy rates were higher than published data suggest but compared favorably with appropriate abdominal and vaginal hysterectomy complication series. However, urinary tract injuries were significantly elevated in comparison with published data, raising the questions of learning curve and experience as factors.