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What is a complication in total laparoscopic hysterectomy?
August 2004, Vol. 11, No. 3 Supplement TheJournalof the American Association of Gynecologic Laparoscopists
section was performed in 3 out of 5 patients; two women delivered vaginally. Corzclusiorz. Our experience suggests that laparoscopic procedures performed either in the first or in the second trimester of pregnancy are safe and effective for both mother and fetus. However, such conclusion is contingent upon the skill and the experience of the surgical team as well as the adequacy of laparoscopic and anesthesiologic techniques.
99. What is a Complication in Total Laparoscopic Hysterectomy? IK Orbuch, H Reich. Study Objective. To define what is a complication in total laparoscopic hysterectomy (TLH). Desigrz. Retrospective review. Sett#zg. University medical center. Patierzts. Seventy-six patients (76 women). Irzterverztiorz. Total laparoscopic hysterectomy. Measuremerzts arzd Ma#z Results. Total laparoscopic hysterectomy was performed for uterine leiomyoma in 66% of the patients. 41% of patients (30 patients) underwent prior laparotomy. Uterus ranged in weight from 53-2783 g (average 498.3 g). Mean EBL was 230 cc's. One patient developed a 9 cm infected hematoma on postoperative day 10. One patient required conversion to laparotomy secondary to large blood loss. One enterotomy and one rectal perforation were noted intraoperative, both successfully repaired intraoperative. Ureteral obstruction was discovered intraop in three patients with subsequent successful intraoperative repair. One cystotomy was noted intraoperative with intraoperative repair. Two cuff collections were noted postoperative successfully treated with antibiotics. Corzclusiorz. Major complications should be defined as problems that remain unrecognized resulting in postoperative sequela or compromising the patient. We include one pelvic abscess and one conversion to laparotomy as complications (2.7%). If we included problems that occurred and were fixed during these surgeries (i.e. enterotomy, ureter obstruction, and cystotomy), our rate would be 11.8%. If they are recognized, most complications during TLH can be corrected by laparoscopic surgery. Bladder and ureters can be assessed by including cystoscopy in the procedure. Rectum and rectosigmoid can be assessed by filling with blue dye and underwater exam. Bleeding can be evaluated by looking underwater at low pressure while irrigating. Thus, early recognition of intraoperative problems can lead to reparation and restoration of normal function and anatomy minimizing sequela.
100. A Prospective Randomized Trial of Closing Laparoscopic Trocar Wounds by Transcutaneous versus Subcuticular Suture or Adhesive Papertape 0 Buchweitz, P WOlfing, L Kiesel. University of MOnster, MOnster, Nordrhein Westfalen, Germany. Study Objective. Several methods for closure of trocar wounds are known in laparoscopic surgery. The choice of technique (mostly transcutaneous or subcuticular suture or
adhesive papertape) is often based on the surgeon's personal experience. The objective of this trial was to assess the impact of these closure methods on potential complications of wound healing, cosmetic outcome, and patient satisfaction. Desigrz. Prospective randomized analysis. Sett#zg. University hospital. Patierzts. Sixty consecutive patients undergoing operative laparoscopy. Irzterverztiorz. 5-mm port site incisions were closed with either subcuticular or transcutaneous absorbable sutures (4-0 polyglactin 910) or with adhesive papertape. Measuremerzts arzd Ma#z Results. Postoperative complications, pain, and patient satisfaction with scars were evaluated at 3-month follow-up postoperatively using a questionnaire. Each patient served as her own control. Dissatisfying results were reported significantly more frequently after subcuticular sutures (p <.05). Assessment of patient satisfaction with cosmetic outcome on a visualanalog scale revealed significantly better results after transcutaneous skin closure than with other approaches (p <.05). Adverse wound healing (e.g. infection, dehiscence) were observed most frequently in the subcuticular suture group. In addition, the rate of painful scars was highest with this technique. Corzclusiorz. The transcutaneous closure with absorbable suture material seems to be the most suitable technique for closure of laparoscopic port site incisions.
101. A 7-Year Operative Laparoscopy Experience in Private Practice T Brown, ML Moore, M Cohen. Advanced Women's Health Institute, Denver, Colorado. Study Objective. To review the learning curve and complication rate in gynecologic endoscopic procedures performed in a private practice setting. Desigrz. Prospective observational study. Sett#zg. Private practice. Patierzts. One thousand one hundred seventy-four women underwent consecutive surgeries, all laparoscopic, with the exception of two open abdominal cases. Irzterverztiorz. Operative laparoscopy. Measummerzts arzd Ma#z Results. An audit of all operative laparoscopy cases in the Advanced Women's Health Institute prospective surgical database (February 1997 through March 2004) was conducted. Data collected included operation type, operating time, estimated blood loss, uterine size, tissue weight, intraoperative complications, and postoperative complications. Operations included 253 laparoscopic supracervical hysterectomy (LSH) (21.5%); 166 LSH with adnexectomy (14.2%); 279 laparoscopic myomectomies (23.8 %); 216 laparoscopic myomectomies with ablation of endometrium (18.4%); 86 cases of pelvic reconstruction (7.3%); 67 cases of endometriosis (5.7%); 31 laparoscopic oophorectomies (2.6%); 21 tubal surgeries (1.8%); 17 classic intrafascial supracervical hysterectomy (CISH) (1.4%); 14 ovarian cystectomies (1.2%); 12 cases of lysis of adhesions (1.0%); 6 uterosacral plications (0.6%);
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section was performed in 3 out of 5 patients; two women delivered vaginally. Corzclusiorz. Our experience suggests that laparoscopic procedures performed either in the first or in the second trimester of pregnancy are safe and effective for both mother and fetus. However, such conclusion is contingent upon the skill and the experience of the surgical team as well as the adequacy of laparoscopic and anesthesiologic techniques.
99. What is a Complication in Total Laparoscopic Hysterectomy? IK Orbuch, H Reich. Study Objective. To define what is a complication in total laparoscopic hysterectomy (TLH). Desigrz. Retrospective review. Sett#zg. University medical center. Patierzts. Seventy-six patients (76 women). Irzterverztiorz. Total laparoscopic hysterectomy. Measuremerzts arzd Ma#z Results. Total laparoscopic hysterectomy was performed for uterine leiomyoma in 66% of the patients. 41% of patients (30 patients) underwent prior laparotomy. Uterus ranged in weight from 53-2783 g (average 498.3 g). Mean EBL was 230 cc's. One patient developed a 9 cm infected hematoma on postoperative day 10. One patient required conversion to laparotomy secondary to large blood loss. One enterotomy and one rectal perforation were noted intraoperative, both successfully repaired intraoperative. Ureteral obstruction was discovered intraop in three patients with subsequent successful intraoperative repair. One cystotomy was noted intraoperative with intraoperative repair. Two cuff collections were noted postoperative successfully treated with antibiotics. Corzclusiorz. Major complications should be defined as problems that remain unrecognized resulting in postoperative sequela or compromising the patient. We include one pelvic abscess and one conversion to laparotomy as complications (2.7%). If we included problems that occurred and were fixed during these surgeries (i.e. enterotomy, ureter obstruction, and cystotomy), our rate would be 11.8%. If they are recognized, most complications during TLH can be corrected by laparoscopic surgery. Bladder and ureters can be assessed by including cystoscopy in the procedure. Rectum and rectosigmoid can be assessed by filling with blue dye and underwater exam. Bleeding can be evaluated by looking underwater at low pressure while irrigating. Thus, early recognition of intraoperative problems can lead to reparation and restoration of normal function and anatomy minimizing sequela.
100. A Prospective Randomized Trial of Closing Laparoscopic Trocar Wounds by Transcutaneous versus Subcuticular Suture or Adhesive Papertape 0 Buchweitz, P WOlfing, L Kiesel. University of MOnster, MOnster, Nordrhein Westfalen, Germany. Study Objective. Several methods for closure of trocar wounds are known in laparoscopic surgery. The choice of technique (mostly transcutaneous or subcuticular suture or
adhesive papertape) is often based on the surgeon's personal experience. The objective of this trial was to assess the impact of these closure methods on potential complications of wound healing, cosmetic outcome, and patient satisfaction. Desigrz. Prospective randomized analysis. Sett#zg. University hospital. Patierzts. Sixty consecutive patients undergoing operative laparoscopy. Irzterverztiorz. 5-mm port site incisions were closed with either subcuticular or transcutaneous absorbable sutures (4-0 polyglactin 910) or with adhesive papertape. Measuremerzts arzd Ma#z Results. Postoperative complications, pain, and patient satisfaction with scars were evaluated at 3-month follow-up postoperatively using a questionnaire. Each patient served as her own control. Dissatisfying results were reported significantly more frequently after subcuticular sutures (p <.05). Assessment of patient satisfaction with cosmetic outcome on a visualanalog scale revealed significantly better results after transcutaneous skin closure than with other approaches (p <.05). Adverse wound healing (e.g. infection, dehiscence) were observed most frequently in the subcuticular suture group. In addition, the rate of painful scars was highest with this technique. Corzclusiorz. The transcutaneous closure with absorbable suture material seems to be the most suitable technique for closure of laparoscopic port site incisions.
101. A 7-Year Operative Laparoscopy Experience in Private Practice T Brown, ML Moore, M Cohen. Advanced Women's Health Institute, Denver, Colorado. Study Objective. To review the learning curve and complication rate in gynecologic endoscopic procedures performed in a private practice setting. Desigrz. Prospective observational study. Sett#zg. Private practice. Patierzts. One thousand one hundred seventy-four women underwent consecutive surgeries, all laparoscopic, with the exception of two open abdominal cases. Irzterverztiorz. Operative laparoscopy. Measummerzts arzd Ma#z Results. An audit of all operative laparoscopy cases in the Advanced Women's Health Institute prospective surgical database (February 1997 through March 2004) was conducted. Data collected included operation type, operating time, estimated blood loss, uterine size, tissue weight, intraoperative complications, and postoperative complications. Operations included 253 laparoscopic supracervical hysterectomy (LSH) (21.5%); 166 LSH with adnexectomy (14.2%); 279 laparoscopic myomectomies (23.8 %); 216 laparoscopic myomectomies with ablation of endometrium (18.4%); 86 cases of pelvic reconstruction (7.3%); 67 cases of endometriosis (5.7%); 31 laparoscopic oophorectomies (2.6%); 21 tubal surgeries (1.8%); 17 classic intrafascial supracervical hysterectomy (CISH) (1.4%); 14 ovarian cystectomies (1.2%); 12 cases of lysis of adhesions (1.0%); 6 uterosacral plications (0.6%);
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