Incidence and risk factors of bladder injuries during laparoscopic hysterectomy indicated for benign uterine pathologies: a 14.5 years experience in a continuous series of 1501 procedures

BACKGROUND Laparoscopic hysterectomy is indicated as an alternative to laparotomy when the vaginal route is potentially difficult because of an immobile uterus and a poor vaginal accessibility. The aim of this study was to evaluate the rate, the risk factors for bladder injuries in a series of 1501...

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Bibliographic Details
Published in:Human reproduction (Oxford) 2009-04, Vol.24 (4), p.842-849
Main Authors: Lafay Pillet, Marie-Christine, Leonard, Franck, Chopin, Nicolas, Malaret, Jean-Marie, Borghese, Bruno, Foulot, Hervé, Fotso, Adolphe, Chapron, Charles
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Biological and medical sciences
bladder injuries
Cesarean Section - adverse effects
complications
Female
Gynecology. Andrology. Obstetrics
Humans
Hysterectomy - adverse effects
Hysterectomy - methods
laparoscopic hysterectomy
Laparoscopy - adverse effects
Laparoscopy - methods
Medical sciences
Middle Aged
operative laparoscopy
Postoperative Complications - etiology
Pregnancy
Prospective Studies
Reoperation - adverse effects
Retrospective Studies
Risk Factors
total hysterectomy
Urinary Bladder - injuries
Uterine Diseases - surgery
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Summary:BACKGROUND Laparoscopic hysterectomy is indicated as an alternative to laparotomy when the vaginal route is potentially difficult because of an immobile uterus and a poor vaginal accessibility. The aim of this study was to evaluate the rate, the risk factors for bladder injuries in a series of 1501 laparoscopic hysterectomies indicated for benign uterine pathologies. METHODS This study was conducted retrospectively from January 1993 to 2000 and prospectively from 2001 to July 2007.The indications, patients’ characteristics and complications were recorded. The overall rate of bladder injuries, the comparison of means (t test) and percentages (exact χ2 test) between the cases and the population with no injury, the odd ratios (OR) and multivariate analysis were performed using the statistical package for the social sciences software. RESULTS The rate of bladder injuries was 1% (15 patients). Risks factors were previous Caesarian section [OR: 4.33, 95% confidence interval (CI): 1.53–12.30] and previous laparotomy (OR: 4.69, 95% CI: 1.59–13.8). The rate of injury decreases with the surgeons' experience and reaches a plateau of 0.4% after 100 hysterectomies performed. CONCLUSIONS The rate of bladder injury during total laparoscopic hysterectomy is low and decreases with the surgeon's experience. Bladder injury is not linked to an increase of post-operative morbidity when recognized and repaired during the same laparoscopic procedure. The comparison with other routes of hysterectomies should take into account these risk factors.
ISSN:0268-1161
1460-2350
DOI:10.1093/humrep/den467