Incidence of Urinary Tract Injury and Utility of Routine Cystoscopy during Total Laparoscopic Hysterectomy for Endometrial Cancer (original) (raw)
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American Journal of Obstetrics and Gynecology, 2005
Objective: To evaluate the incidence of urinary tract injury due to hysterectomy for benign disease. Study design: Patients were enrolled prospectively from 3 sites. All patients undergoing abdominal, vaginal, or laparoscopic hysterectomy for benign disease underwent diagnostic cystourethroscopy. Results: Four hundred seventy-one patients participated. Ninety-six percent (24/25) of urinary tract injuries were detected intraoperatively. There were 8 cases of ureteral injury (1.7%) and 17 cases of bladder injury (3.6%). Ureteral injury was associated with concurrent prolapse surgery (7.3% vs 1.2%; P = .025). Bladder injury was associated with concurrent anti-incontinence procedures (12.5% vs 3.1%; P = .049). Abdominal hysterectomy was associated with a higher incidence of ureteral injury (2.2% vs 1.2%) but this was not significant. Only 12.5% of ureteral injuries and 35.3% of bladder injuries were detected before cystoscopy. Conclusion: The incidence of urinary tract injury during hysterectomy is 4.8%. Surgery for prolapse or incontinence increases the risk. Routine use of cystoscopy during hysterectomy should be considered. Ó 2005 Elsevier Inc. All rights reserved.
Medicina
Background and Objectives: Minimally invasive surgery (MIS) has recently increased its application in the treatment of gynecological malignancies. Despite technological and surgical advances, urologic complications (UC) are still the main concern in gynecology surgery. Current literature reports a wide range of urinary tract injuries, and consistent scientific evidence is still lacking or dated. This study aims to report a large single-center experience of urinary complications during laparoscopic hysterectomy for gynecologic oncologic disease. Materials and Methods: All patients who underwent laparoscopic hysterectomy for gynecologic malignancy at the Department of Medicine and Surgery of the University Hospital of Parma from 2017 to 2021 were retrospectively included. Women with endometrial cancer, cervical cancer, ovarian cancer, uterine sarcoma, or borderline ovarian tumors were included. Patients undergoing robotic surgery with incomplete anatomopathological data or patients lo...
Incidence of lower urinary tract injury at the time of total laparoscopic hysterectomy
JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons
To determine the incidence of and risk factors for injury to the lower urinary tract during total laparoscopic hysterectomy. All patients who underwent total laparoscopic hysterectomy for benign disease from January 1, 2002 to December 31, 2005, at an academic medical center are included. Subjects undergoing laparoscopic-assisted vaginal hysterectomy, supracervical hysterectomy, or hysterectomy for malignancy were excluded. Intraoperative cystoscopy with intravenous indigo carmine was routinely performed. Relevant data were abstracted to determine the incidence of lower urinary tract injury, predictors of injury, and postoperative complications. Total laparoscopic hysterectomy was performed in 126 consecutive subjects. Two (1.6%) cystotomies were noted and repaired before cystoscopy was performed. Two (1.6%) additional cystotomies were detected during cystoscopy. Absent ureteral spill of indigo carmine was detected in 2 subjects: 1 (0.8%) with previously unknown renal disease and 1 ...
Cystoscopy after total or subtotal laparoscopic hysterectomy: the value of a routine procedure
Gynecological Surgery, 2006
Ureteral injury during hysterectomy is one of the most troubling complications gynecologists need to be aware of. In various studies, such injury occurred in laparotomy, laparoscopy, and vaginal hysterectomy. The objective of our study was to assess the necessity, efficiency, and cost-effectiveness of cystoscopy at the end of total or subtotal laparoscopic hysterectomy (TLH/ STLH). This is a retrospective analysis of 7 years' experience in a university-affiliated hospital. All hysterectomies were performed on an overnight basis by experienced surgeons. Out of 338 patients, 106 patients underwent TLH, and 232 underwent STLH. Four cases (1.18%) of ureter injury were noted (one after TLH and three after STLH). Diagnosis was clinically made by postoperative vaginal sonography and was confirmed by intravenous pyelography. A cystoscopy was performed after intravenous indigo carmine injection. The study period consisted of two phases. In the first phase, we used bipolar cautery to occlude the uterine artery; consequently, a nearby thermal injury could be misdiagnosed. In the second phase we clipped the uterine artery with a new hemoclip called Hem-o-lok (Weck Closure Systems, USA), which forced an exact uterine artery closure. As a result, in the second phase no cases of ureteral injury were noted. In view of the fact that the equipment for cystoscopy is used during surgery for TLH/STLH and is sterile and available, the only additional cost of the cystoscopy is an ampule of indigo carmine. Therefore, we conclude that cystoscopy at the end of surgery for TLH/STLH is an important evaluation and provides the following significant advantages: In patients presenting with postoperative flank pain, cystoscopy may prevent the need for further evaluation and expensive testing, and cystoscopy increases the surgeon's and the patient's confidence in the integrity of the urinary tract during the recovery period.
The value of intra-operative cystoscopy at the time of laparoscopic hysterectomy
The aim of this study was to determine the usefulness of routine intra-operative cystoscopy in documenting ureteral injury during total laparoscopic hysterectomy with vault suspension and to document the incidence of this complication in a large series. The charts of 118 patients who underwent laparoscopic hysterectomy with vault suspension from January 1992 to January 1998 were retrospectively reviewed. The patients underwent intra-operative cystoscopic evaluation to verify ureteral permeability and bladder integrity. Intra-operative ureteral obstruction occurred in four patients (3.4%). All complications were immediately fixed and there were no postoperative ureteral problems. No late ureteral complications were observed. Intra-operative cystoscopy allows for early recognition and treatment of obstructive ureteral injuries and may reduce the rate of late postoperative complications during advanced laparoscopic procedures.
Universal Cystoscopy After Benign Hysterectomy
Obstetrics & Gynecology, 2016
Objective-To evaluate the association between a universal cystoscopy policy at the time of benign hysterectomy and the detection of urologic injuries. Methods-This is a retrospective cohort study at a tertiary care academic center where a policy of universal cystoscopy at the time of benign hysterectomy was instituted on October 1, 2008. Benign hysterectomies performed from March 3, 2006-September 25, 2013 were included and dichotomized into preuniversal and postuniversal cystoscopy groups. Medical records were reviewed for baseline and perioperative characteristics, cystoscopy use, and urologic injuries related to hysterectomy. Urologic injuries were identified by using a search engine and a departmental quality improvement database. Results-Two thousand nine hundred eighteen hysterectomies were identified during the study time period, 96 of which were excluded for indications of abdomino-pelvic cancers and peripartum indications. Therefore, 973 women were in the preuniversal cystoscopy group and 1,849 were in the postuniversal cystoscopy group. Thirty-six percent (347/973, 95% CI 32.8-38.8%) and 86.1% (1,592/1,849, 95% CI 84.5-87.7%) of cases underwent cystoscopy prepolicy and postpolicy, respectively. The urologic injury rates were 2.6% (25/973, 95% CI 1.6-3.6%) and 1.8% (34/1,849, 95% CI 1.2-2.5%) in the prepolicy and postpolicy groups, respectively. Delayed urologic injuries decreased significantly (0.7% [7/973], 95% CI 0.3-1.2% vs. 0.1% [2/1,849], 95% CI 0.0-0.3%). Of the nine delayed injuries, four had normal intraoperative cystoscopy findings and five had no cystoscopy performed. Conclusion-The practice of universal cystoscopy at the time of hysterectomy for benign indications is associated with decreased delayed postoperative urologic complications.
Journal of SAFOMS, 2018
Objective: • To determine the incidence of urinary tract injuries during gynecological surgeries. • To explore the role of universal cystourethroscopy to detect lower urinary tract injuries during gynecological operations to reduce postoperative morbidity and its sequelae. Study design: A prospective observational study. Settings: A tertiary care center. Materials and methods: This was an observational study conducted in 163 women who underwent gynecological surgery at our department during August 2014 to May 2017. Results: Data are classified according to demography, type, and indication of surgery performed in 163 consecutive subjects. History of previous pelvic surgery, if any, was taken into account to correlate with incidence of lower urinary tract injury intraoperatively. The ureteric and bladder injuries detected by routine intraoperative cystourethroscopy were tabulated. Intraoperatively detected rates of silent ureteric and bladder injury by cystourethroscopy are higher than obvious visually inspected injuries. We obtained intraoperatively ureteric injury rate of 0.61% and a bladder injury rate of 4.29% detected by cystourethroscopy. In two patients (1.23%), in spite of bloodstained urine in urobag, we could not detect any lower urinary tract injury. On long-term follow-up, two subjects (1.23%) attended outpatient department with ureterovaginal fistula and one subject (0.61%) developed vesicovaginal fistula. Conclusion: Use of intraoperative universal cystourethroscopy during gynecological operations should be considered routinely to detect unsuspected lower urinary tract injuries and immediate management to prevent its long-term sequelae.
Obstetrics & Gynecology, 2010
To summarize comparative studies describing clinical outcomes of robotic-assisted surgeries compared with traditional laparoscopic or laparotomy techniques for the treatment of endometrial cancer. DATA SOURCES: Using search words "robotic hysterectomy" and "endometrial cancer," 22 citations were identified from Medline and PubMed (2005 to February 2010). METHODS OF STUDY SELECTION: We selected English language studies reporting at least 25 robotic cases compared with laparoscopic or laparotomy cases that also addressed surgical technique, complications, and perioperative outcomes. Patients underwent total hysterectomy, bilateral salpingo-oophorectomy, and lymphadenectomy. TABULATION, INTEGRATION, AND RESULTS: Eight eligible comparative studies were identified that included 1,591 patients (robotic,985؍ laparoscopic,693؍ and lap-arotomy.)606؍ Pooled means of the resected aortic lymph nodes for robotic hysterectomy and laparoscopy were 10.3 and 7.8 (P,)51.؍ and robotic hysterectomy and laparotomy were 9.4 and 5.7 (P.)82.؍ Pooled means of pelvic lymph nodes for robotic and laparoscopic hysterectomy were 18.5 and 17.8 (P)59.؍ and 18.0 compared with 14.5 (P)11.؍ for robotic hysterectomy compared with laparotomy. Estimated blood loss was reduced in robotic hysterectomy compared with laparotomy (P<.005) and laparoscopy (P.)100.؍ Length of stay was shorter for both robotic and laparoscopic cases compared with laparotomy (P<.01). Operative time for robotic hysterectomy was similar to laparoscopic cases but was greater than laparotomy (P<.005). Conversion to laparotomy for laparoscopic hysterectomy was 9.9% compared with 4.9% for robotic cases (P.)60.؍ Vascular, bowel, and bladder injuries; cuff dehiscence; and thromboembolic complications were similar for each surgical method. Transfusions for robotic hysterectomy compared with laparotomy was 1.7% and 7.2% (P)60.؍ and robotic hysterectomy compared were laparoscopy was 2.6% and 5.0% (P.)22.؍ CONCLUSION: Perioperative clinical outcomes for robotic and laparoscopic hysterectomy appear similar with the exception of less blood loss for robotic cases and longer operative times for robotic and laparoscopy cases.
Cost-effectiveness of universal cystoscopy to identify ureteral injury at hysterectomy
Obstetrics & Gynecology, 2001
To evaluate the cost-effectiveness of routine cystoscopy at the time of abdominal, vaginal, and laparoscopically assisted vaginal hysterectomy in terms of cost per ureteral injury identified and treated. Methods: Using a hospital-based perspective, a decisionanalysis model was constructed to estimate the outcomes and costs of cystoscopy or no cystoscopy at the time of abdominal hysterectomy. A similar model was constructed for vaginal and laparoscopically assisted vaginal hysterectomy to account for the cost of conversion to laparotomy. Cost estimates were based on estimated costs of Duke University Medical Center and from average Medicare reimbursements for similar Diagnostic Related Groups from the Health Care Financing Administration. The incidence of ureteral injury was obtained from a review of the literature. Sensitivity analyses were performed for the following variables: ureteral injury rate, silent ureteral injury rate, cost of cystoscopy, and cost of therapeutic interventions. We assumed a silent renal death rate of 0%. Results: Routine cystoscopy at abdominal hysterectomy was cost-saving above a threshold ureteral injury rate of 1.5%. At a ureteral injury rate of 0.2%, the marginal increase in the cost of routine intraoperative cystoscopy was 108perabdominalhysterectomy,withanassociatedcostof108 per abdominal hysterectomy, with an associated cost of 108perabdominalhysterectomy,withanassociatedcostof54,000 per ureteral injury identified. In comparison, at a ureteral injury rate of 2%, routine cystoscopy gave a marginal cost savings of 44perhysterectomy,withacostsavingsof44 per hysterectomy, with a cost savings of 44perhysterectomy,withacostsavingsof2200 per ureteral injury identified intraoperatively. At the baseline ureteral injury rate of 0.5%, routine cystoscopy had a marginally increased cost of 83perhysterectomy,withanincrementalcost−effectivenessof83 per hysterectomy, with an incremental cost-effectiveness of 83perhysterectomy,withanincrementalcost−effectivenessof16,600 spent per ureteral injury identified. The model constructed for vaginal hysterectomy and laparoscopically assisted vaginal hysterectomy yielded a threshold ureteral injury rate of 2%, above which routine cystoscopy was cost-saving. In both models, the incidence of ureteral injury and the cost of readmission were the two variables with the greatest influence on costeffectiveness. Conclusion: The cost-effectiveness of routine intraoperative cystoscopy depends on the rate of ureteral injury independent of the route of hysterectomy. If that rate exceeds 1.5% for abdominal hysterectomy and 2% for vaginal or laparoscopically assisted vaginal hysterectomy, then routine cystoscopy is cost-effective.