Complication rate of uterine morcellation in laparoscopic supracervical hysterectomy: a retrospective cohort study.

BACKGROUND: Over the last decades minimally invasive surgical techniques are increasingly used to treat symptomatic leiomyomas, providing the patient decreased morbidity and more rapid return to daily activities. Morcellation is the fragmentation of a large mass into smaller pieces to make resection through port incisions possible. Over the last year there has been a discussion worldwide about the safety of morcellation. OBJECTIVE: The aim of our study was to identify the complication rate of power morcellation at our institution. STUDY DESIGN: We performed a retrospective chart analysis of patients undergoing laparoscopic supracervical hysterectomy with morcellation. We compared the outcomes of patients undergoing laparoscopic supracervical hysterectomy with the use of power morcellation with a control group of women who underwent laparoscopic-assisted vaginal hysterectomy without morcellation. Women who underwent hysterectomy because of suspected malignancy were excluded. RESULTS: A total of 358 patients underwent laparoscopic hysterectomy between 2004 and 2013; 186 laparoscopic supracervical hysterectomies and 172 laparoscopic-assisted vaginal hysterectomies. The main indication for laparoscopic supracervical hysterectomy was heavy menstrual bleeding and pelvic pressure or pain (94.5%). Baseline characteristics were not significantly different except for body mass index, with a mean of 25.7 in laparoscopic supracervical hysterectomy and 27.0 in laparoscopic-assisted vaginal hysterectomy. There was a significant greater uterine weight in the laparoscopic supracervical hysterectomy group (260g vs. 202g). The overall conversion rate was 5.3% (n=19), with no significant difference between the two groups and 79% of conversions being performed for strategic reasons. There was no statistical difference in intra-operative complication rate (2.1% vs. 1.2%). Pathology reports showed no unexpected malignancies. There was no statistical difference in the complication rate post-operatively (2.2% vs. 2.9%). The overall complication rate of laparoscopic supracervical hysterectomy was 4.3% (n=8). Need for reoperation after laparoscopic supracervical hysterectomy was necessary in 7 patients (3.8%), with cervical amputation being the most common type of reoperation (n=5). In the laparoscopic-assisted vaginal hysterectomy group there were significantly more adhesiolysis performed (n=4). Parasitic myomas were discovered in 1 patient two years after morcellation (0.5%). CONCLUSION: Our study showed no injuries directly related to morcellation. There were no unexpected malignancies morcellated and only one case of parasitic myomas (0.5%).

Diagnostic hysteroscopy: a valuable diagnostic tool in the diagnosis of structural intra-cavital pathology and endometrial hyperplasia or carcinoma?. Six years of experience with non-clinical diagnostic hysteroscopy.

OBJECTIVE: 1045 diagnostic hysteroscopic procedures performed throughout six consecutive years were evaluated, focussing on its value in diagnosing endometrial hyperplasia and carcinoma. DESIGN: Retrospective study performed in the gynaecological endoscopy clinic of a training hospital. Subjects were 1045 pre- and post-menopausal patients. RESULTS: A normal cavity was found in 54.2%. Most common abnormal findings were fibroids (21.0%) and endometrial polyps (14.4%). Hysteroscopically diagnosed hyperplasia of the endometrium was confirmed histologically in only less than half the cases. Endometrial carcinoma was suspected on hysteroscopic view in two cases of a total of seven proven cases. In three cases initially an endometrial polyp and in two cases a fibroid was diagnosed. Once the diagnosis was missed even after biopsy taking. CONCLUSIONS: Diagnostic hysteroscopy is a valuable diagnostic tool in diagnosing structural intra-cavital pathology, very suitable for the outpatient clinic. The value in diagnosing hyperplasia or endometrial carcinoma is limited and even after guided biopsy a malignancy cannot be ruled out.

[Compartment syndrome following laparoscopic procedures in the lithotomy position]. / Compartimentsyndroom na laparoscopische ingrepen in lithotomiepositie.

A laparoscopic tubectomy in the lithotomy position was performed on a healthy 31-year-old woman, as treatment following an extra-uterine pregnancy. The operation proceeded without complications and took 60 minutes. However, on the third day following surgery the woman was diagnosed with compartment syndrome, which was treated with three-compartment fasciotomy. Compartment syndrome is a rare but dangerous complication of an operation in the lithotomy position. Since pressure on leg compartments increases with time spent in the lithotomy position, regardless of the type of stirrups used, it is important to maintain the position only as long as is necessary for the procedure. The patient's legs should be taken out of the lithotomy position as soon as possible, and the position resumed if necessary at a later stage in the procedure. This can easily be achieved with pneumatic stirrups.