Cystoscopy with a 5-mm laparoscope and suction irrigator.
To investigate the hypothesis that cystoscopy using a 5-mm suction irrigator and video laparoscope is safe and useful during total laparoscopic hysterectomy (TLH), a retrospective analysis of patients undergoing total or radical laparoscopic hysterectomy over a 10-year period was conducted. Of 744 patients having simple or radical laparoscopic hysterectomy for either benign or malignant indications, 344 had cystoscopy using a 5-mm laparoscope after inflating the bladder with a 5-mm saline suction irrigator. Procedures in which cystoscopy was used took 13 minutes longer (mean: 141 vs 128, p = .0012) and patients lost 30 dL more blood (mean 145 vs 115, p = .0300), but patients did not have a longer hospital stay or more complications. Cystoscopy accurately confirmed cystotomy closure in 12 patients and identified 3 patients with ureteral injury; it did not identify 3 patients who developed a ureteral fistula 7 to 9 days after surgery. One complication was attributable to the cystoscopy. The data from this retrospective series suggest that cystoscopy during TLH is well-tolerated and can accurately reassure surgeons of immediate urologic tract integrity; but it is not useful to identify patients who may later fistulize.
O'Hanlan
Katherine A
KA
Gynecologic Oncology Associates, Portola Valley, California 94028, USA. ohanlan@aol.com
D003558:Cystoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000295:instrumentation* / Q000379:methods; D020706:Laparoscopes; D008875:Middle Aged; D012189:Retrospective Studies; D013396:Suction; D007507:Therapeutic Irrigation; D001743:Urinary Bladder / Q000601:surgery*