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[Total hysterectomy for benign pathologies. Laparoscopic surgery does not seem to increase the risk of complications]
C Chapron1, J B Dubuisson, Y Ansquer
1Service de Chirurgie Gynécologique, Clinique Universitaire Baudelocque, CHU Cochin-Port-Royal, Paris.
Objective:
To assess the risk of complications of total laparoscopic hysterectomy (TLH).
Setting:
University Hospital, Surgical Gynecological team.
Design:
Retrospective study of 313 patients. For all the patients a total laparoscopic hysterectomy was performed. Every part of the operation was carried out via laparoscopy, from the adnexal phase (conservative or radical) to the colpotomy. All hemostasis was carried out by electrosurgery (bipolar coagulation). All the instruments are reusable.
Results:
The rate of conversion to laparotomy was 6.7% (21 patients). For the patients who underwent a TLH (292 cases; 92.3%) the overall complication rate was 9.95% (29 patients). The rate of patients presented a complication which required a further operation was 1.4% (4 patients). The rate of patients presented a complication which required a re-hospitalization was 2.0% (6 patients). The rate of major urinary injury was 2.5% (6 cases): bladder injury (4 patients; 1.35%); vesico-vaginal fistula (1 case; 0.35%); ureteral complication (1 case; 0.35%). The rate of postoperative febrile morbidity was 5.8% (17 patients).
Conclusions:
These encouraging results mean that, provided the surgeons are experienced in laparoscopic surgery, total laparoscopic hysterectomy technique would appear not to have a higher rate of complications than hysterectomy via laparotomy or the vaginal route.