Prevention of complications in laparoscopic hysterectomy: experience with 1120 cases performed by a single surgeon

STUDY OBJECTIVE: The aim of this study is to describe a safe technique without any ureteral, bladder, and major vessel injuries in laparoscopic hysterectomy with a CO2 laser technique. DESIGN: Prospective study (Canadian Task Force classification II-3). SETTING: Centre Hospitalier Interrégional Edith Cavell, Department of Obstetrics and Gynecology, Endoscopic Laser Surgery Center, Bruxelles, Belgium; and Kadir Has University, Metropolitan Florence Nightingale Hospital, Istanbul, Turkey. PATIENTS: One thousand one hundred twenty women with benign diseases. INTERVENTIONS: Laparoscopic-assisted vaginal hysterectomy (LAVH) or laparoscopic hysterectomy (LH). MEASUREMENTS AND MAIN RESULTS: Between 1992 and 2004, in 1120 women with benign diseases, consecutive LAVH or LH was planned. During laparoscopic hysterectomy, at all stages, bipolar forceps was used for hemostasis, and a CO2 laser was used for vaporization and excision. The total operating time was 35 to 180 minutes, with a median of 52 minutes (range 35-163) for LAVH (n = 542) and 55 minutes (range 42-180) for LH (n = 552). Operations were successfully completed laparoscopically in 98.8% of the patients. The mean hospital stay was 2 days. The overall major complication rate was 1%. No ureteral, bladder, or major vascular injury occurred. CONCLUSION: The technique we used in our study is safe and effective in the prevention of ureteral, vesical, and vascular injuries during LAVH and LH; moreover, the use of bipolar coagulation and a CO2 laser in endoscopic surgery results in a shorter duration of operation. This technique provides all the advantages of both laparoscopic and vaginal surgery.