Complications of 174 laparoscopic hysterectomies

The case records of 174 patients who underwent laparoscopic hysterectomy between September, 1992 and April, 1995 were retrospectively reviewed. The mean age of the group was 45.4 (range 17.8-68.5) years, mean weight 70.2 (50-121) kg and mean parity 2.3 (0-4). Laparoscopic hysterectomy (i.e. uterine arteries secured laparoscopically) was performed in 98 patients, laparoscopically assisted vaginal hysterectomy in 70, and laparoscopic subtotal hysterectomy in 6. Bilateral or unilateral oophorectomy were performed in 40 cases. The mean operating time was 131 (45-285) minutes and mean hospitalization 2.6 (1-11) days. Endoscopic stapling devices were used in 135 cases, biopolar diathermy in 117, sutures and ties in 84, and the harmonic scalpel in 29. The overall complication rate was 16%. Seven cases (4%) required conversion to laparotomy. These included 2 inadvertent cystotomies (1 after 2 Caesarean sections), 3 cases of dense uterovesical adhesions following previous surgery and 2 instances of excessive uterine size (>16 weeks). The mean follow-up period was 2.2 (1-18) months. One patient had a shortened vagina requiring dilatation and another had vault granulations requiring diathermy treatment. Overall 98.3% of patients were satisfied with their surgery.