Digital Presentation AGES XXVIII Annual Scientific Meeting 2018

Laparoscopic hysterectomy complications: lessons learnt (5482)

Rose McDonnell 1 , Jade Hollingworth 1 , Paola Chivers 2 , Paul Cohen 1 3 , Stuart Salfinger 1 3
  1. KEMH, Perth, WA, Australia
  2. The University of Notre Dame, Perth
  3. St John of God Hospital, Subiaco, WA, Australia

Background

Hysterectomy is one of the most common gynecologic surgical procedures worldwide (1). Rates of total laparoscopic hysterectomy (TLH) in Australia have increased in recent years and now surpass the abdominal and vaginal surgical approaches (2). We performed a retrospective cohort study of 2013 patients who underwent TLH was performed in a tertiary care setting in WA to investigate peri-operative complications.

 

Aim

To present a descriptive review of complications identifying potential contributing factors.

 

Methods

A retrospective analysis of all patients undergoing elective TLH at St John of God Subiaco Hospital, Perth, WA between 2011 and 2016. Data were extracted from medical records. Patients were allocated to one of three groups of surgeons: general gynaecologists (615 cases), AGES trained gynaecologic endoscopists (167 cases) and subspecialists (1231 cases). Complications were analysed by surgeon group, time in specialist practice and surgical case volume.

The primary outcome was any major intraoperative complication. Secondary outcomes were postoperative complications and hospital readmission. Individual case reviews were performed for each complication.

Results

There were 36 intraoperative complications (1.8%), 45 post-operative complications (2.2%)

74 patients were readmitted to hospital (3.7%) within 42 days post surgery. The most common intra-operative complication was cystotomy (n=11, 0.55%)  TLH was performed by general gynaecologists in 8 of the11 patients (72.7%) who sustained a bladder injury. . Nine of 11 patients (81.8%) had undergone previous abdominal surgery. Additional intra-operative complications included: ureteric injury (n=2, 0.1%), vascular injury (n=9, 0.45%),enterotomy (n=6, 0.30%) and bowel serosal injury (n=8, 0.40%). Conversion to laparotomy occurred in 25 cases (1.2%). Ten of these were intended and anticipated pre-operatively due to large uterine size. No significant differences were observed in post-operative complications between surgeon groups (p = .078). AGES endoscopists and subspecialists had fewer patients readmitted to vs. general gynaecologists: 32/615 (5.2%) general gynaecologists, 3/167 (1.8%) AGES endoscopists, 39/1231 (3.2%) subspecialists (p = .043). Time in specialist practice was not associated with intraoperative complications (p = .629) but surgeons who performed >100 TLHs during the study period had fewer intra-operative complications compared to those who performed <100 TLHs (p = .032).

 

Summary

The incidence of any major intraoperative complication was significantly higher amongst general gynaecologists compared to subspecialists (3.3% vs. 1.1%; p=.002).  Cystotomy was the most common intra-operative complication. Previous abdominal surgery was a risk factor for cystotomy and TLH performed by subspecialists vs. general gynaecologists was associated with a reduced incidence of cystotomy.

  1. Hammer A, Rositch AF, Kahlert J, Gravitt PE, Blaakaer J, Sogaard M. Global epidemiology of hysterectomy: possible impact on gynecological cancer rates. American journal of obstetrics and gynecology. 2015;213(1):23-9.
  2. Services DoH. Medicare Australia Statistics: Hysterectomy rates. In: Medicare, editor. 2015-20162016.
  • Have you presented oral, video or DCS at an AGES meeting before?: Yes
  • Are you a trainee and if so at what level?: 5
  • Are you a subspecialists or AGES member?: Yes