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Complications of gynecologic laparoscopy
Abstracts
and ligation of uterine vessels and transection of uterosacral ligaments 20%, and dissection of uterine cervix from vaginal fomices, removal of the uterus from the abdominal cavity, and placing sutures on the vaginal cuff, 30%. Blood loss did not exceed 100 ml. No intraoperative or postoperative complications occurred. Conclusions. Our initial experience with laparoscopic hysterectomy showed several advantages, including minimal invasiveness and trauma, lower blood loss, good visualization, and opportunity for education. On the other hand, it requires laparoscopic equipment and instruments and a large operating team, and risks associated with anesthesia are significantly higher than with other approaches, especially in women over age 50 years with hypertension and cerebral disorders.
Three complications occurred, for a total complication rate of 1.7/1000 procedures. One was incidental cystotomy during LAVH, which was repaired during the procedure with no major morbidity. The other two occurred during sterilization; one involved minor bleeding at the fallopian tube that was controlled with coagulation, and the other was fundal perforation, which was coagulated with good hemostasis. No complications occurred during diagnostic laparoscopy. Conclusion. Diagnostic procedures had the lowest complication rates. Sterilization and operative laparoscopic procedures were associated with highest complication rates. 85. Experience with Radical LAVH CL Lee, KG Huang, CH Lai, YK Soong. Chang Gung University and Memorial Hospital, Taipei, Taiwan.
83. Pregnancy and Laparoscopic Surgery E Lachman, A Schienfeld, E Foss, G Gino, R Boldes, S Levin, M Burstein, M Stark. Misgav Ladach Hospital, Jerusalem, Israel.
Objective. To evaluate radical LAVH, a relatively conservative treatment for early cervical cancer. Measurements and Main Results. From January 1994 to June 1997 we performed radical LAVH in 54 women. Indications for surgery, including cervical carcinoma stages la and 2a, were the same as for radical abdominal hysterectomy. Procedures were performed under general endotracheal anesthesia with videolaparoscopy. Results were comparable with traditional approaches. Conclusion. As surgeons gain more experience with it, radical LAVH may eventually play an important role in gynecologic oncology.
Objective. To evaluate the success of laparoscopic techniques during pregnancy. Measurements and Main Results. In a search of the English literature we found that the most common 518 laparoscopic procedures performed during pregnancy were cholecystectomy (45 %), surgery of adnexa (34%), and appendectomy (15%; other operations 6%). Surgery was performed 33% of the time during the first, 56% during the second, and 11% during the last trimester. In the past year, we added three cases to this list: cholecystectomy in the second trimester, adnexal tumor in the second trimester, and evaluation of abdominal pain in the first trimester. Conclusion. Laparoscopy in pregnancy appears to be safe when performed by experienced practitioners. Further studies addressing safety are warranted before definitive conclusions are made.
86. Minilaparoscopy to Reduce Complications from Cannula Insertion in Patients with Previous Pelvic or Abdominal Surgery PI Lee. Samsung Cheil Hospital, Sung Kyun Kwan University College of Medicine, Seoul, Korea.
Objective. To evaluate the efficacy of minilaparoscopy for visualization and adhesiolysis of intraabdominal adhesions for safe insertion of a primary umbilical cannula in women who had previous pelvic or abdominal surgery (prospective observational study). Measurements and Main Results. Twenty consecutive women who had previous pelvic and/or abdominal surgery, excluding tubal ligation and simple appendectomy, underwent minilaparoscopy through Palmer's point for visualization and adhesiolysis before insertion of an umbilical cannula. Eleven women had Pfannenstiel scars and nine had vertical midline scars from previous pelvic surgery (20), ruptured appendix
84. Complications of Gynecologic Laparoscopy KT Laremont, KA Justin, JH Dorsey. Institute for Conservative and Minimally Invasive Surgery, Greater Baltimore Medical Center, Baltimore, Maryland.
Objective. To evaluate the frequency of laparoscopic complications at a large Baltimore gynecologic surgery center. Measurements and Main Results. From July 1, 1996, to June 30, 1997, 1748 diagnostic, operative, and sterilization laparoscopic procedures were performed.
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and ligation of uterine vessels and transection of uterosacral ligaments 20%, and dissection of uterine cervix from vaginal fomices, removal of the uterus from the abdominal cavity, and placing sutures on the vaginal cuff, 30%. Blood loss did not exceed 100 ml. No intraoperative or postoperative complications occurred. Conclusions. Our initial experience with laparoscopic hysterectomy showed several advantages, including minimal invasiveness and trauma, lower blood loss, good visualization, and opportunity for education. On the other hand, it requires laparoscopic equipment and instruments and a large operating team, and risks associated with anesthesia are significantly higher than with other approaches, especially in women over age 50 years with hypertension and cerebral disorders.
Three complications occurred, for a total complication rate of 1.7/1000 procedures. One was incidental cystotomy during LAVH, which was repaired during the procedure with no major morbidity. The other two occurred during sterilization; one involved minor bleeding at the fallopian tube that was controlled with coagulation, and the other was fundal perforation, which was coagulated with good hemostasis. No complications occurred during diagnostic laparoscopy. Conclusion. Diagnostic procedures had the lowest complication rates. Sterilization and operative laparoscopic procedures were associated with highest complication rates. 85. Experience with Radical LAVH CL Lee, KG Huang, CH Lai, YK Soong. Chang Gung University and Memorial Hospital, Taipei, Taiwan.
83. Pregnancy and Laparoscopic Surgery E Lachman, A Schienfeld, E Foss, G Gino, R Boldes, S Levin, M Burstein, M Stark. Misgav Ladach Hospital, Jerusalem, Israel.
Objective. To evaluate radical LAVH, a relatively conservative treatment for early cervical cancer. Measurements and Main Results. From January 1994 to June 1997 we performed radical LAVH in 54 women. Indications for surgery, including cervical carcinoma stages la and 2a, were the same as for radical abdominal hysterectomy. Procedures were performed under general endotracheal anesthesia with videolaparoscopy. Results were comparable with traditional approaches. Conclusion. As surgeons gain more experience with it, radical LAVH may eventually play an important role in gynecologic oncology.
Objective. To evaluate the success of laparoscopic techniques during pregnancy. Measurements and Main Results. In a search of the English literature we found that the most common 518 laparoscopic procedures performed during pregnancy were cholecystectomy (45 %), surgery of adnexa (34%), and appendectomy (15%; other operations 6%). Surgery was performed 33% of the time during the first, 56% during the second, and 11% during the last trimester. In the past year, we added three cases to this list: cholecystectomy in the second trimester, adnexal tumor in the second trimester, and evaluation of abdominal pain in the first trimester. Conclusion. Laparoscopy in pregnancy appears to be safe when performed by experienced practitioners. Further studies addressing safety are warranted before definitive conclusions are made.
86. Minilaparoscopy to Reduce Complications from Cannula Insertion in Patients with Previous Pelvic or Abdominal Surgery PI Lee. Samsung Cheil Hospital, Sung Kyun Kwan University College of Medicine, Seoul, Korea.
Objective. To evaluate the efficacy of minilaparoscopy for visualization and adhesiolysis of intraabdominal adhesions for safe insertion of a primary umbilical cannula in women who had previous pelvic or abdominal surgery (prospective observational study). Measurements and Main Results. Twenty consecutive women who had previous pelvic and/or abdominal surgery, excluding tubal ligation and simple appendectomy, underwent minilaparoscopy through Palmer's point for visualization and adhesiolysis before insertion of an umbilical cannula. Eleven women had Pfannenstiel scars and nine had vertical midline scars from previous pelvic surgery (20), ruptured appendix
84. Complications of Gynecologic Laparoscopy KT Laremont, KA Justin, JH Dorsey. Institute for Conservative and Minimally Invasive Surgery, Greater Baltimore Medical Center, Baltimore, Maryland.
Objective. To evaluate the frequency of laparoscopic complications at a large Baltimore gynecologic surgery center. Measurements and Main Results. From July 1, 1996, to June 30, 1997, 1748 diagnostic, operative, and sterilization laparoscopic procedures were performed.
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