Laparoscopic Gynae-oncological Procedures: Lessons Learnt After a Single Institution Audit of Complications and Their Management in 567 Consecutive Patients.

STUDY OBJECTIVE: To retrospectively evaluate the complications of the laparoscopic pelvic surgeries and to formulate the guidelines to avoid them. DESIGN: Retrospective study (Canadian Classification). SETTING: Advanced Laparoscopic Institute. PATIENTS: Nine hundred and seven operated for gynecological malignancies. INTERVENTION: Laparoscopic surgeries. MEASUREMENTS AND MAIN RESULTS: 567 women suffering from different pelvic conditions were studied in a period of 60 months. The median age of the patient was 35 (11-80). Complications occurred in 32 patients (32/567, 5.5 %). The overall incidence of urinary tract injury in all the advanced cases at our institute was 2.1 % (12/567). The incidence of bowel injury at our center was 1.76 %. The incidence of vascular injury at our institute was 1.76 % (10/567). CONCLUSION: Laparoscopic complications are different than those seen following open surgeries. Anticipation, early recognition, and timely intervention help to reduce morbidity. Laparoscopic management of complications is possible. Formulating standard guidelines can help to avoid many such complications.

Single-incision total laparoscopic hysterectomy with conventional laparoscopy ports.

OBJECTIVE: To study the feasibility of performing single-incision total laparoscopic hysterectomy using conventional ports and instruments. METHODS: Patients undergoing laparoscopic surgery at Galaxy Care Laparoscopic Institute, Pune, India, between January 2007 and December 2010 were selected for participation. All procedures were performed using conventional laparoscopic instruments and trocars. Operative data-including operative time (from incision to port closure), blood loss, additional ports used, energy sources used, and intraoperative complications-were recorded. RESULTS: Twenty-three procedures were performed during the study period. All procedures were completed via single incision only. Operative time, blood loss, and hospital stay were comparable with those associated with conventional laparoscopy. CONCLUSION: It is debatable whether laparoscopic surgery via a single incision would threaten the position of the current gold standard of conventional laparoscopic procedures. The present study showed that single-incision laparoscopic surgery using conventional instruments is feasible and effective.