Benefits of intracervical injection of sterile saline solution in laparoscopically assisted vaginal hysterectomy with vaginal colpotomy and bladder mobilization.
OBJECTIVE
To evaluate the influence of intracervical saline injection on inexperienced operators and on laparoscopically assisted vaginal hysterectomy (LAVH).


METHODS
This retrospective study included 273 women undergoing LAVH. From July 1997 to June 2002, 138 LAVHs were performed with laparoscopically approached colpotomies and bladder mobilization. Among 135 LAVHs with a vaginal approach, colpotomies/bladder mobilization was done directly in 62 and in the other 73 after a circumferential intracervical saline injection. All operations were performed by inexperienced operators under the supervision of senior surgeons. Blood loss, operative time and complications were analyzed.


RESULTS
The average follow-up period was 41.2 +/- 17.4 months (range, 12-72). No statistically significant differences were observed in age, hemoglobin levels or length of postoperative hospital stay. The incidence of postoperative infection, hematoma and bowel injury was not significantly different. LAVH with vaginal colpotomies/bladder mobilization and intracervical saline injection was associated with the smallest estimated blood loss (p = 0.002) and operative time (p < 0.001). LAVH with laparoscopic colpotomies and bladder mobilization had the longest operative time (p<0.001) and the highest bladder injury rate (p= 0.004).


CONCLUSIONS
A circumferential injection of normal saline at the cervicovaginal junction is a good option for inexperienced operators.
Horng
Shang-Gwo
SG
Department of Obstetrics and Gynecology, Chang-Gung Memorial Hospital, Taipei, Taiwan.
Huang
Kuan-Gen
KG
Lo
Tsia-Shu
TS
Soong
Yoong-Kuei
YK
D016063:Blood Loss, Surgical; D020884:Colpotomy / Q000379:methods*; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000379:methods*; D007431:Intraoperative Complications / Q000453:epidemiology; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D007902:Length of Stay; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012965:Sodium Chloride / Q000008:administration & dosage*; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000293:injuries / Q000601:surgery*
D006454:Hemoglobins; D012965:Sodium Chloride