Page 14 - World Journal of Laparoscopic Surgery

Total Laparoscopic Hysterectomies at Tertiary Care Center

dIscussIon The average surgical time in the present study was 50 minutes.
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The proportion of laparoscopic hysterectomies has been increasing The operative time in the study done was Bettaiah et al. ranged
from a minimum of 20 minutes to a maximum of 2 hours. About 10
compared with hysterectomies performed through laparotomy. patients required blood transfusion in the present study.
Despite the fact that hysterectomy is the most frequently performed The most common indication for hysterectomy in the present
major gynecological surgery, there are still controversies regarding study is fibroids which contribute to 49%. These findings were
the optimal route for hysterectomies. 7–9 According to the study 18
done by Garry et al., a surgeon needed to perform 25 cases to similar to the study findings of Rentiya FM and colleagues and
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complete the learning curve and gain adequate experience. The Shin et al. The mean blood loss in our study was 150 mL. The mean
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mean age of women undergoing TLH in the present study was blood loss in the study done by Mani K and coworkers, Suisted
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42 years (Table 1) which was comparable with the findings of the and Chittenden were 163 mL and 153 ± 116.1 mL, respectively.
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study done by Mani et al., Shin et al., Bastidas-Guarín et al., and Complications noted in the present study (Fig. 2) were bladder
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Dojki and Bano colleagues. injury (0.5%) over the dome of the bladder, one case of thermal
About 59% of the patients had a history of prior abdominal ureteric injury (0.5%) followed by ureterovaginal fistula on day
surgery in the present study which was higher as compared with 10. In the case of bladder injury over dome – the central portion
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the findings of the study by Dojki and Bano colleagues. Only 33% diagnosed intraoperatively during the dissection of uterovesical
of patients had prior abdominopelvic surgery. fold in the case of previous 2 LSCS with fibroids was managed
Patients had multiple symptoms on admission and were by suturing the bladder in two layers with vicryl 3-0 and omental
presented with the most common symptom as heavy menstrual interposition followed by keeping the Foley for 14 days. While in
bleeding (75.5%), followed by pain in the abdomen (65.5%). These another case of thermal ureteric injury followed by ureterovaginal
findings were similar to the findings in the study by Bastidas-Guarín fistula on postoperative day, 10 patients complained of leaking
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et al., Dojki and Bano colleagues, and Suisted and Chittenden. 15 per vaginum and they immediately underwent contrast CT. On
In the present study, majority of the patients (70%) underwent examination using contrast enhanced computed tomography
TLH under regional spinal anesthesia, while only 30% required (CECT), the ureterovaginal fistula was confirmed. Bladder integrity
general anesthesia. These findings were comparable with the study was maintained. It was found that the patient had double ureters
findings Chilkund JN and colleague. 16 on the side of the injury with upper and lower moiety drained
separately by two ureters. The opinion of the urologist was
Table 3: Intra- and postoperative events taken followed by DJ stenting. Urine leakage from the vagina
Characteristics Numbers (%) stopped after 3 weeks and DJ stenting was removed after 6
Intraoperative blood loss (in mL) weeks. Thus, all intraoperative and postoperative complications
were recognized and managed successfully as per standard
Less than 100 mL 73 (36.5%)
protocols. These findings were similar to single-center study
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100–150 mL 116 (58%) done by Puntambekar et al. The number of cases converted was
150–200 mL 11 (5.5%) 3 (1.5%), which was comparable to the study conducted by Bettaiah
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Duration of surgery (hours) et al. (0.9%) Out of the 3 cases, 2 cases were having large cervical
fibroids while in the other case, it was severe endometriosis making
Less than 1 hour 69 (34.5%) it difficult to proceed for TLH (Fig. 2).
1–1.5 hours 118 (59%) None of the cases needed re-exploration in the present study.
1.5–2 hours 13 (6.5%)
Duration of hospital stay (days) conclusIon
3 190 (95%)
Total laparoscopic hysterectomy is an effective and safe procedure
4–5 10 (5%) with minimal blood loss, minimal pain with shorter duration

Figs 2A and B: Complications among the study population – intraoperative and postoperative

World Journal of Laparoscopic Surgery, Volume 16 Issue 1 (January–April 2023) 13