Intraoperative complications after total laparoscopic hysterectomy: a retrospective study in training institute

Background: Hysterectomy is a common gynecological surgery performed in premenopausal and menopausal age group. Different types of approaches are there with their advantages and disadvantages, it is mainly indicated for noncancerous conditions. Till today three different surgical approaches to hysterectomy are available: vaginal, abdominal and laparoscopic. TLH has been reported to result in shorter procedure durations, lower blood losses, and shorter hospital stays.Methods: This is a retrospective case study, was carried out over a 5-year period in a tertiary care institute. Study done on patients attending gynecology OPD at our tertiary care institute during the period since September 2013 to September 2018.Results: In present study out of 646 endoscopic hysterectomies in last five years authors studied 420 Total Laparoscopic Hysterectomies. Conversion to open surgery rate was 0.3%. Mean age was 49.26 years (SD-9.53), Performed for various indications with various BMI patients. Mean surgical duration was 116.55 minutes with SD 26.27. Major complication rate was 2.85% with 2 cases of bowel injuries and 3 cases of urological injuries.Conclusions: Total laparoscopic hysterectomy appears safe and effective approach for variety of indications with minimal morbidity. Beneficial for all age group all nulliparous /multiparous patients as well as obese patients. With the knowledge of all complication and its prevention, maximum surgeons can give benefit of advantages of total laparoscopic hysterectomy to all women. More and more randomized clinical trials will motivate surgeons for this approach.

Study of route of hysterectomy

Background: The objective is to study complication rate, advantages and outcome of different route of hysterectomy.Methods: A prospective study of 175 women over a period of 1 year i.e. from 01/01/2011 to 31/12/2011 SSG hospital, Vadodara. Depending on the patient profile, experience of surgeon optimum route of hysterectomy was decided.Results mean operating time in AH group was 68.4±14.4min, which was 80±10.3min, 115.8±40.6min and 148.8±25.5min in NDVH, LAVH and TLH group respectively. TLH was performed by consultants. Febrile morbidity was significantly high in AH (23%). Bladder and ureteral injuries were seen in 4% and 3% cases of NDVH and AH group. Wound complications were seen in AH (10%), whereas vault complications were higher in TLH. The hospital stay was shortest in TLH. Women with TLH had early ambulation, early resumption to normal diet, early return to routine work and better sexual function.Conclusions: Women with excessively enlarged uteri, significant pelvic pathology, or cancer are obvious candidates for AH. On the other hand, VH is frequently chosen for the small uterus in a multiparous woman with a large pelvis and no prior pelvic inflammatory disease or surgery. Although TLH, LAVH have significantly lower complication rate than AH, but overall cost is higher owing to the high operating room charges. The final selection of hysterectomy route should be based on surgeon’s experience and indication for surgery.

Outcome of total laparoscopic hysterectomy in relation to the size of the uterus

Background: Laparoscopic hysterectomy is a safe and feasible technique to manage benign uterine pathology as it offers minimal postoperative discomfort; with shorter hospital stay, rapid convalescence and early return to the activities of daily living. However, to date very few studies have been reported on safety and feasibility of total laparoscopic hysterectomy (TLH) in large sized uteri. The present study was planned to evaluate the intra-operative and post-operative parameters in relation to size of the uterus during TLH.Methods: This study was a comparative study. Fifty women with uterine size less than 12 weeks (Group 1) and fifty women with uterine size more than or equal to 12 weeks (Group 2) for whom TLH was planned for benign indications were included in the study. Intra-operative and post-operative parameters like blood loss, duration of surgery, post-operative pain and complications were compared between the two groups. Comparison was done using independent sample t test. A probability (‘p’ value) of less than or equal to 0.05 at 95% confidence interval was considered as statistically significant.Results: The mean age of the patients in both the groups was matched (44.82 years vs. 43.96 years). The mean operative time (48.80±14.12 minutes vs. 77.3±35.11 minutes; p <0.001) and blood loss (40.10±18.25ml vs. 70.6±65.46 ml; p=0.002) were significantly high in Group 2 compared to Group 1. The mean pain scores were similar in both the groups at 6 hours, 24 hours and at the time of discharge. No significant complications were noted in both the groups.Conclusions: TLH is safe, feasible and acceptable for large size uterus (>12 weeks). However, it is associated with longer operative time, and greater amount of blood loss.

Characterization of Vibrio Parahaemolyticus isolated from oysters and mussels in São Paulo, Brazil / Caracterização de Vibrio parahaemolyticus isolados de ostras e mexilhões em São Paulo, Brasil

Vibrio parahaemolyticus is a marine bacterium, responsible for gastroenteritis in humans. Most of the clinical isolates produce thermostable direct hemolysin (TDH) and TDH-related hemolysin (TRH) encoded by tdh and trh genes respectively. In this study, twenty-three V. parahaemolyticus, previously isolated from oysters and mussels were analyzed by PCR using specific primers for the 16S rRNA and virulence genes (tdh, trh and tlh) and for resistance to different classes of antibiotics and PFGE. Nineteen isolates were confirmed by PCR as V. parahaemolyticus. The tlh gene was present in 100 percent of isolates, the tdh gene was identified in two (10.5 percent) isolates, whereas the gene trh was not detected. Each isolate was resistant to at least one of the nine antimicrobials tested. Additionally, all isolates possessed the blaTEM-116 gene. The presence of this gene in V. parahaemolyticus indicates the possibility of spreading this gene in the environment. Atypical strains of V. parahaemolyticus were also detected in this study.

Vibrio parahaemolyticus é uma bactéria marinha, responsável por gastroenterite em humanos. A maioria dos isolados clínicos produzem hemolisina termoestável direta (TDH) e hemolisina TDH-relacionada (TRH) codificadas por genes tdh e trh, respectivamente. Neste estudo, vinte e três V. parahaemolyticus, previamente isolados de ostras e mexilhões foram analisados por PCR utilizando indicadores específicos para o gene 16S rRNA, genes de virulência (tdh, trh e tlh), resistência a diferentes classes de antibióticos, e PFGE. Dezenove isolados foram confirmados por PCR, como V. parahaemolyticus. O gene tlh estava presente em 100 por cento dos isolados, o gene tdh foi identificado em dois (10,5 por cento) dos isolados, enquanto que o gene trh não foi detectado. Cada isolado foi resistente a pelo menos um dos nove antibióticos testados. Além disso, todos os isolados apresentaram resultado positivo para o gene blaTEM-116. A presença deste gene em V. parahaemolyticus indica a possibilidade de propagação desse gene no ambiente. Cepas atípicas de V. parahaemolyticus foram também detectadas neste estudo.

Development of Loop-mediated Isothermal Amplification (LAMP) Method for Detection of Vibrio parahaemolyticus / 中国生物工程杂志

Vibrio parahaemolyticus has been considered as one of the most important foodborne bacterial pathogens.The loop-mediated isothermal amplification(LAMP) that amplifies DNA with high specificity and rapidity under an isothermal condition was applied for rapid detection of this pathogen for the first time.A set of four primers,two outer and two inner primers,was designed specifically to recognize the thermolabile hemolysin gene(tlh) of V.parahaemolyticus.The LAMP reaction mix was optimized.The most optimal reaction temperature and time of the LAMP assay for the tlh gene were 60℃ and 60min,respectively.Genomic DNAs from 28 bacterial strains including 14 V.parahaemolyticus strains were amplified using LAMP,and no amplicon was observed in other bacterial strains.The detection limit of this LAMP assay was around 90 fg of V.parahaemolyticus genomic DNA and 24 colonies forming units for pure cultures.In addition,this method was applied to detect artificially contaminated food samples,and the detection limit was 89 cfu/g for non-cultured artificially contaminated food samples.These results suggested that detection of V.parahaemolyticus by LAMP is an effective and low-cost procedure with high specificity and sensitivity that requires no specialized equipment.This assay is expected to become a valuable tool for rapid detection and identification of V.parahaemolyticus.

Comparison of Total Laparoscopic Hysterectomy with Laparoscopic-Assisted Vaginal Hysterectomy and Total Abdominal Hysterectomy / 대한산부인과학회지

The objective of this study is to evaluate short-term results of total laparoscopic hysterectomy with those of total abdominal hysterectomy and laparoscopically assisted vaginal hysterectomy in a retrospective study. We compared patient's age, mean uterine weight, total operating time, length of hospital stay and perioperative hemoglobin concentration change between total laparoscopic hysterectomy (300 patients) and total abdominal hysterectomy (100 patients) and laparoscopically assisted vaginal hysterectomy (52 patients). There were no differences in terms of patient's age, parity between the three groups. There were 7 minor complications in the laparoscopically assisted vaginal hysterectomy group compared with 9 minor complications in the abdominal hysterectomy group and 14 minor complications in the total laparoscopic hysterectomy group (P not significant). The length of hospital stay was significantly shorter for total laparoscopic hysterectomy than laparoscopically assisted vaginal hysterectomy and total abdominal hysterectomy (p<.001). This study demonstrates that laparoscopic-assisted vaginal hysterectomy and total laparoscopic hysterectomy appears to be as safe as laparotomy and may replace abdominal hysterectomy in most patients and generally has the advantage of shorter hospital stay and earlier return to normal activities.

The clinical studies on 600 cases of total laparoscopic hysterectomy (TLH) / 대한산부인과학회지

OBJECTIVE: To analyze the clinical characteristics of total laparoscopic hysterectomy. METHODS: Clinical data about 600 cases who received TLH were collected and the hospital stay, operation time and complication were evaluated. RESULTS: The most common indications for TLH were uterine myomas, adenomyosis, severe endometriosis and cervical intraepithelial neoplasia. Mean operating time was 90 minutes (range 35-200 min) and hospital stay was 3 days (range 2 days-10 days). The most important factors for the surgery time were uterine size, assistant's skill and presence of adhesions (obliteration of the cul-de-sac due to severe pelvic endometriosis). Several techniques were used, including bipolar coagulation of the ovarian and uterine vessels, and suture of the stump. A special uterine manipulator (RUMITM uterine manipulator with colpotomizer and pneumooccluder balloon) used in all procedures aided in anatomic definition and performing the circumferential colpotomy. We had two cases of ureteral obliteration by using bipolar coagulator, and 3 cases of bladder injuries during operation which was diagnosed and immediately repaired laparoscopically. We had two cases of ureterovaginal fistula, two cases of postoperative ileus and one case of bowel perforation. But there were no cases of death, thrombophlebitis or other pulmonary complications. CONCLUSIONS: Total laparoscopic hysterectomy can be performed safely and effectively when the surgical team is sufficiently trained. And we believe that total laparoscopic hysterectomy offers benefits to the patients in the form of less post-operative pain, shorter time in hospital.

Laparoscopic Hysterectomy for Large Uterus:A Report of 86 Cases / 中国微创外科杂志

Objective To investigate the operative skills of laparoscopic hysterectomy of large uterus.Methods A retrospective analysis was conducted on clinical data from 86 cases whose uterus were bigger than twelve gestational age uterus and therefore treated with laparoscopic hysterectomy from February 1998 to December 2005.Among the 86 cases,12 received total laparoscopic hysterectomy(TLH),59 received laparoscopic supracervical hysterectomy(LSH),and 15 received laparoscopic-assisted vaginal hysterectomy(LAVH).The location of laparoscopy was determined to be at least 3-5 cm above the fundus of uterus.The most crucial step was the treatment of adnexa and uterine blood vessels.After blocking the uterine blood vessels,most of uterine bodies were rotarily cut in TLH and LAVH.Results All operations(86 cases)were performed successfully under laparoscopy and no severe operative complications were noticed except for 1 case of subcutaneous emphysema.The average operation time and the intra-operative blood loss were(92.3 ?33.5)min and(113 ?31)ml respectively.The average postoperative hospital stay was(4.1?0.3)days.No postoperative complication was found in all cases during the 6-month follow-up.Conclusions Laparoscopic hysterectomy of large uterus is safe and feasible,and does not increase operative risk and incidence of complications,when suitable laparoscopic location is selected and treatments of adnexa and uterine vessel are well performed.

Total laparoscopic hysterectomy by intracorporeal suture and ligature in the three-port method / 대한산부인과학회지

OBJECTIVE: To optimize a technique and evaluate the outcomes of total laparoscopic hysterectomy (TLH) performed by conventional intracorporeal suture and ligature under the 3-port method. METHODS: Eighty six patients had TLH at our hospital between July 1998 and June 2000 due to gynecologic benignancies. Operation procedures, the type and number of suture and ligature and the operation time were analyzed through reviewing of their medical records and operation video tapes. RESULTS: Overall operation time was 93.2 +/- 25.3 (mean +/- SD) minutes. The mean lapsed time was 19.8 +/- 8.5 minutes for securing and dividing the round ligaments, infundibulopelivic or ovarian ligaments, 21.39.3 minutes for securing and dividing the uterine vessels, cardinal and uterosacral ligaments, 18.7 +/- 6.2 minutes for vaginal vault support and closure, 12.1 +/- 6.4 minutes for peritoneal approximation and final inspection. Overall number of suture ligature was 26.8 +/- 2.9. The mean number of suture ligature was 5.5 +/- 1.7 for securing and dividing the round ligaments and infundibulopelivic or ovarian ligaments, 4.2 +/- 1.2 for securing and dividing the uterine vessels, cardinal and uterosacral ligaments, 5.2 +/- 0.9 for vaginal vault support and closure, 12.0 +/- 1.8 for peritoneal closure and final laparoscopic inspection. The uterine weight was 205 +/- 100.3 (range: 50.0-530.0) g. No conversion to laparotomy and major operative complications were occurred except for a case of postoperative transient voiding difficulty and a case of postoperative transfusion. CONCLUSION: TLH with the 3-port method can be performed safely and reasonably in the technical aspect and operation time by using conventional intracorporeal suture and ligature. Operation techniques could be optimized more especially in the procedure of vaginal and peritoneal closure to get the shorter operation time.

Comparative Study of Laparoscopically Assisted Vaginal Hysterectomy (LAVH) and Total Laparoscopic Hysterectomy (TLH) / 대한산부인과학회지

OBJECTIVE: To compare the clinical results between laparoscopically assisted vaginal hysterectomy (LAVH) and total laparoscopic hysterectomy (TLH), and to realize the merits and demerits of both operations, so we know which pelviscopic hysterectomy operation is better method at the present time. METHODS: 30 of LAVH cases and 30 of TLH cases were performed from 12 December 2002 to 25 February 2004 at department of OB and GY, Dankook University Hospital. We analyzed the results with regard to patient's characteristics, indication of hysterectomy, size of uterus, operation time, blood loss, duration of hospitalization and complications. RESULTS: LAVH operations, and TLH operations were performed by same operator respectively. There were no significant differences in patient's characteristics (age, height, weight) between the two groups. The main preoperative indication was myoma uteri in both groups, followed by CINIII in LAVH groups and adenomyosis in TLH groups. The majority of uterine size on operation field was adult fist size in both groups. The mean operation time was 86.3 +/- 19.5 min for LAVH group and 153.3 +/- 44.4 min for TLH group, the operation time is significantly longer in TLH group (P-value0.05). The duration of hospitalization was not significantly different between the two groups (6.1 +/- 0.4 days for LAVH, 6.2 +/- 0.8 days for TLH, P-value>0.05). There is no complication in LAVH group, 3 complications in TLH group. CONCLUSION: LAVH has no significant differences in patient's characteristics, indication of operation, size of uterus, blood loss and duration of hospitalization, compared with TLH, but it has the merits of short operation time and less complication. In this study we consider that LAVH operation method stands at advantage over TLH.

A Comparative Study of Total Lapaproscopic Hysterectomy (TLH) and Total Abdominal Hysterectomy (TAH) / 대한산부인과학회지

OBJECTIVE: To compare the clinical results between total laparoscopic Hysterectomy (TLH) and total abdominal hysterectomy (TAH). METHODS: 100 cases of TLH and 95 cases of TAH, which were performed at Pocheon CHA university from January 2001 to September 2004. We analyzed the results with regard to patient's characteristics (age, parity), uterine weight, operative time, blood loss, hospital stay and complications. RESULTS: There were no differences in terms of patient's age, parity, main operative indication and total operating time between the 2 groups. The mean uterine weight of TAH group was larger than TLH (291 +/- 239 gm for TLH, 404 +/- 174 gm for TAH, p<.05) group. The estimated blood loss was significantly lower for TLH (239.00 +/- 155.63 mL) than for TAH (333.68 +/- 228.4 mL) (p<.05). The length of hospital day was significantly shorter for TLH (6.78 +/- 1.70 day) than for TAH (7.39 +/- 1.49 day) (p<.05). Post-operative complications in the TLH group were dysuria in 2 cases, major hemorrhage requiring transfusion in 4 cases, trocar site hematoma in 1 case and bowel injury in 1 case. Post-operative complications In the TAH group were major hemorrhage requiring transfusion in 7 cases, wound infection in 3 cases and bowel injury in one case. CONCLUSION: The present study demonstrates that, given adequate training in laparoscopic surgery, TLH may replace TAH in most patients who require a hysterectomy, showing clear advantages of shorter hospitalization and the acceptable complication rate.

A Clinical Study on 1594 Cases of Operative and Diagnostic Laparoscopy / 대한산부인과학회잡지

OBJECTIVE: Laparoscopic surgery provides patients with the benefits of shortened hospital stay and faster return to normal activity. The objective is to evaluate the efficacy of laparoscopic surgery in gynecologic patients. METHODS: From January, 1999 to December, 2002, total 1594 patients were performed laparoscopic surgery at Uijongbu St. Mary's Hospital. We reviewed the medical record and analyzed these cases about age, parity, diagnosis, name of operation, operation time, duration of hospitalization and side effect. RESULTS: The results of this study summarized as follows: 1. The mean age of patients was 34.0 years old and the great incidence occurred in 26-30 years old group (24.7%). 2. The average parity of patients was 1.05. 3. The common indications were ovarian cyst (34.4%), myoma uteri (19.1%), infertility (9.5%), ectopic pregnancy (15.0%), etc. In diagnostic pelviscopy, the most common indication was infertility (50.6%), and ovarian cyst (38.3%) was the most common indication in operative pelviscopy. 4. The major types of operative pelviscopy were cystectomy, LAVH, TLH, salpingectomy, adnexectomy, electrocauterization. 5. The mean duration of hospitalization was 3.72 days. 6. The major complication of surgery were intestinal injury, postoperative paralytic ileus, bleeding at resection site, but they were controlled without difficulty. CONCLUSION: Pelviscopic surgery is useful and recommended for the treatment of gynecologic disease, because this is safe and has many advantages.

Total Laparoscopic Hysterectomy: A review of 300 cases / 대한산부인과학회잡지

OBJECTIVE: We analyzed our experience with total laparoscopic hysterectomy to evaluate the clinical data such as operation time, blood loss, hospital stay, and complications. METHODS: A retrospective study was carried out in 300 women who underwent total laparoscopic hysterectomy (TLH). RESULTS: The most common indications for TLH were uterine myomas, chronic pelvic pain (severe endometriosis), cervical intraepithelial neoplasia. Mean operating time was 90 minutes (range 50-200 min) and hospital stay was 3 days (range 2 days-7 days). The most important factors for the surgery time were uterine size, assistant's skill, presence of adhesions (obliteration of the cul-de-sac due to severe endometriosis). Several techniques were used, including bipolar coagulation of the uterine vessels, and suture of the stump. A special uterine manipulator (RUMITM uterine manipulator with colpotomizer and pneumooccluder balloon) used in all procedures aided in anatomic definition and performing the circumferential colpotomy. We had three bladder injuries during operation which was diagnosed and immediately repaired laparoscopically. We had two cases of ureterovaginal fistula and one case of postoperative ileus. But there were no cases of death, thrombophlebitis neither other pulmonary complications. CONCLUSIONS:Total laparoscopic hysterectomy can be performed safely and effectively when the surgical team is sufficiently trained. And we believe that total laparoscopic hysterectomy offers benefits to the patients in the form of less post-operative pain, shorter time in hospital.