Challenges of Laparoscopic Hysterectomy: A 10-year Experience in UK Hospitals

This retrospective study was based on 270 laparoscopic hysterectomies performed by a single surgeon at two hospitals in the United Kingdom in the years 1993–2004. All but 13 cases were completed laparoscopically; these cases were converted to abdominal hysterectomies for a variety of reasons. Most of the women analyzed underwent either total laparoscopic hysterectomy (n = 141) or laparoscopic hysterectomy (n = 103). The remaining patients had laparoscopic-assisted vaginal hysterectomy. All patients had a primary diagnosis of benign gynecological disorder, primarily menstrual disorders or endometriosis and pelvic pain. Participants were selected using criteria designed to optimize the outcome. The overall complication rate in this study was 4.7%, near the lower limit reported in previous studies. The rate of return to the operating theater, the frequency of conversion to laparotomy, and time in hospital all were comparable to the best previously reported results. The most common complications were injuries of the inferior epigastric vessels and ureteric injuries. A majority of inferior epigastric vessel injuries were associated with laparoscopic hysterectomy, and a majority of urinary tract injuries with total laparoscopic hysterectomy. Approximately 30% of patients remained in hospital for 2–3 days postoperatively, and the rest were discharged on day 4 or 5.