Intraoperative management and urinary system complications during Total Laparoscopic Hysterectomy [Laparoskopi·k hi·sterektomi·de üri·ner si·stem kompli·kasyonlari ve yöneti·mi·]

Objective: Many authors were accepted that Total Laparoscopic Hysterectomy (TLH) is interesting and reliable treatment at benign gynecological conditions. The aim of this study is to present intraoperative management and urinary system complications performing TLH. Material and methods: This study was included 116 patients who underwent TLH with or without additional surgical procedure at Ege University Meidcal School, Department of Obstetrics and Gynecolgy between 2002-2008.Bialteral salpingoophorectomy for 77 (66,3%), Burch colposuspension for 9 (8.4%), adhesiolysis for40 (37.7%), and McCall Culdeplasty for 10 (8,6%) were applied as additional surgical procedure. Avarege age of patients was 48.1 years. BMI and parity was 27.1±2.3 kg/m2 and 1.8±1.1, respectively. 24 (20.6%) cases were presented previous surgical procedure and 71 (61.2%) cases were postmenopause. Results: Bladder injury occured as uirnary system complication at 2 (1.7%) women. The other postoperative complications were loss of blood exceed than 500 ml, infection and turned conversion to laparotomy; 9 case (7.75%), 2 case (1.7%) an done case, respectively. However bladder injury was recognized during operation and repaired concurrently. Any long term complication and ureteral injury was seen. Conclusion: The rate of our urinary system complicationwas 1.7% in study group performing TLH. Risk factors were prior caesarean section history, prior pelvic surgery history and extensive endometriosis. Familiarity of pelvic anatomy and operator trainig cure were very important at advanced laparoscopic application. The avoidance of complication can be possible with goog observation of surgical area, gentle dissection and favorable using of energy modality.