[Laparoscopic hysterectomy and urological lesions: risk analysis based on current literature and preventive strategies]. / Isterectomia laparoscopica e lesioni urologiche: analisi del rischio alla luce della letteratura corrente e strategie di prevenzione.

The aim of the paper is to discuss possible urological complications related to laparoscopic hysterectomy and to focus on the most effective strategies to get their occurrence reduced. A review of the literature concerning the safety of the procedure was conducted, comparing laparoscopic hysterectomy (LH) with abdominal hysterectomy (AH) and vaginal hysterectomy (VH) in terms of urological complications during surgery. The possible effect of the "learning curve" on the frequency of this kind of complications was evaluated. The effect of the "learning curve" has been shown by large observational studies where the number of urological complications occurring during LH seems to diminish as the ability in performing this surgical procedure increases. Also the great variability existing between different centres was highlighted showing that the spreading in case of urological complications varies between 0.4% and 4%. The lesions of the bladder roof are not specific for LH while they are commonly associated with AH, although their rate of occurrence is far higher in the LH group when compared with AH (2% vs 0.8%). Little difference seems to exist between VH and LH regarding this specific lesion (1.6 vs 1.2). Ureteral lesions occur with a frequency of 1.2% in the LH and 0.2% in case of an hysterectomy performed by the abdominal route whereas current data show that these lesions are very rare in those women undergoing VH. The present study stresses the importance of intraoperative diagnosis of urological lesions and gives some practical tips to avoid them providing also a brief description of some procedural aspects of LH as performed at our institution.