Blog dedicated to the continuous education in Gynecology and Endocrinology

 

A SERIES OF 3190 LAPAROSCOPIC HYSTERECTOMIES FOR BENIGN DISEASE FROM 1990 TO 2006: EVALUATION OF COMPLICATIONS COMPARED WITH VAGINAL AND ABDOMINAL PROCEDURES.

BJOG. 2009 Mar;116(4):492-500.

Donnez O, Jadoul P, Squifflet J, Donnez J.

OBJECTIVE: The aim of this study was to evaluate the complication rate after laparoscopic total hysterectomy and laparoscopic subtotal hysterectomy (LASH) in case of benign disease. DESIGN: All complications were prospectively recorded at the time of surgery and analysed retrospectively. SETTING: University hospital. POPULATION: Among 4505 hysterectomies performed by the same team using the same techniques between 1990 and 2006, 3190 were performed by laparoscopy, 906 by the vaginal route and 409 by laparotomy. METHODS: Laparoscopic hysterectomies, defined as laparoscopic subtotal hysterectomy (LASH) and total laparoscopic hysterectomy [laparoscopy-assisted vaginal hysterectomy (LAVH) switched to total laparoscopic hysterectomy (TLH) in 2000], were compared with vaginal and abdominal hysterectomies. MAIN OUTCOME MEASURES AND RESULTS: Since the early 1990s, the number of laparoscopic procedures has continued to grow, while the number of abdominal and vaginal procedures has decreased. Both minor complications (fever >38.5 degrees C after 2 days, bladder incision of <2 cm and iatrogenic adenomyosis) and major complications (haemorrhage, vesicoperitoneal fistula, ureteral injury, rectal perforation or fistula) have been observed during the surgical procedure itself and postoperatively. In the LASH group (n = 1613), the minor complication rate was 0.99% (n = 16) and the major complication rate 0.37% (n = 6). In the total laparoscopic hysterectomy (LAVH/TLH) group (n = 1577), the minor complication rate was 1.14% (n = 18) and the major complication rate 0.51% (n = 8). In the vaginal hysterectomy group (n = 906), minor and major complication rates were 0.77% (n = 7) and 0.33% (n = 3), respectively. In the abdominal hysterectomy group (n = 409), minor and major complication rates were 0.73% (n = 3) and 0.49% (n = 2), respectively. CONCLUSION: The results from our series of 4505 women clearly show that, in experienced hands, laparoscopic hysterectomy is not associated with any increase in major complication rates.

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RANDOMISED TRIAL OF LAPAROSCOPIC BURCH COLPOSUSPENSION VERSUS TENSION-FREE VAGINAL TAPE: LONG-TERM FOLLOW UP.

1) BJOG. 2008 Feb;115(2):219-25; discussion 225.

Jelovsek JE, Barber MD, Karram MM, Walters MD, Paraiso MF.

OBJECTIVE: To compare the long-term efficacy of laparoscopic Burch colposuspension with tension-free vaginal tape (TVT) for the treatment of urodynamic stress urinary incontinence (SUI). DESIGN: Long-term follow up from a prospective randomised trial. SETTING: Academic tertiary referral centre. SAMPLE: Seventy-two women with urodynamic SUI from two institutions. more

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PREVENTION OF ADHESIONS IN GYNAECOLOGICAL ENDOSCOPY.

3) Hum Reprod Update. 2007 July-August;13(4):379-394.
Nappi C, Di Spiezio Sardo A, Greco E, Guida M, Bettocchi S, Bifulco G.

Adhesions resulting from gynaecological endoscopic procedures are a major clinical, social and economic concern, as they may result in pelvic pain, infertility, bowel obstruction and additional surgery to resolve such adhesion-related complications. more

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DETECTION OF PERITONEAL ENDOMETRIOTIC LESIONS BY AUTOFLUORESCENCE LAPAROSCOPY

1) Am J Obstet Gynecol. 2006 Oct;195(4):949-54
Buchweitz O, Staebler A, Tio J, Kiesel L.

OBJECTIVE: This study was undertaken to evaluate the feasibility of autofluorescence laparoscopy in the diagnosis of endometriotic lesions. STUDY DESIGN: Prospective analysis of 83 consecutive patients undergoing laparoscopy for suspected endometriosis under white light illumination and autofluorescence diagnosis. more

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