title: Retroperitoneal and retrograde total laparoscopic hysterectomy as a standard treatment in a community hospital.
abstract: OBJECTIVE
  To report our experience with a modified procedure for total laparoscopic hysterectomy based on a retrograde and retroperitoneal technique. This surgical approach is analyzed on a consecutive series of patients in a community hospital and theoretical educational advantages are proposed.
  
  
  METHODS
  All patients undergoing hysterectomy from January 2012 to April 2013 were included in the study. A detailed description of the technique is given. As main outcome measures we evaluated: the number and rate of patients excluded from laparoscopic approach, the rate of late complications need readmission, the rate of transfusions, the rate of conversion to laparotomy and the number of minor complications. The main concern of the study was ureteral complications.
  
  
  RESULTS
  Overall 174 patients underwent hysterectomy in our unit. The rate of patients submitted to laparoscopic hysterectomy was 97.5%. The number of complications needing re-admission was three (2%). The rate of conversion was 2.7%. In the study period, two (1.2%) ureteral complications were observed (late fistulae). There were four bladder lesions but the patients were released on the same day as the patients with no lesion.
  
  
  CONCLUSIONS
  Opening the retroperitoneum allows rapid control of the main uterine vessels by coagulation, and constant checks on the ureter. Difficult benign situations can be managed. Even in a non-referral center about 94% of hysterectomies can be performed by laparoscopic surgery. This approach is helpful and may be reproducible in gynecological procedures.
authors: Department of Obstetrics and Gynecology, Sant' Andrea Hospital - ASL n 5, Via Vittorio Veneto 197, 19100 La Spezia, Italy. Electronic address: eugenio.volpi@hotmail.com.
authors: Eugenio
authors: E
authors: Volpi
authors: Department of Obstetrics and Gynecology, Sant' Andrea Hospital - ASL n 5, Via Vittorio Veneto 197, 19100 La Spezia, Italy.
authors: Luca
authors: L
authors: Bernardini
authors: Department of Obstetrics and Gynecology, Sant' Andrea Hospital - ASL n 5, Via Vittorio Veneto 197, 19100 La Spezia, Italy.
authors: Moira
authors: M
authors: Angeloni
authors: Department of Obstetrics and Gynecology, Sant' Andrea Hospital - ASL n 5, Via Vittorio Veneto 197, 19100 La Spezia, Italy.
authors: Stefano
authors: S
authors: Cosma
authors: Department of Obstetrics and Gynecology, Sant' Andrea Hospital - ASL n 5, Via Vittorio Veneto 197, 19100 La Spezia, Italy.
authors: Paolo
authors: P
authors: Mannella
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data; D015331:Cohort Studies; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D004714:Endometrial Hyperplasia / Q000601:surgery; D016889:Endometrial Neoplasms / Q000601:surgery; D004715:Endometriosis / Q000601:surgery; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D007889:Leiomyoma / Q000601:surgery; D008796:Metrorrhagia / Q000601:surgery; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology*; D012187:Retroperitoneal Space / Q000601:surgery; D014515:Ureteral Diseases / Q000453:epidemiology*; D002583:Uterine Cervical Neoplasms / Q000601:surgery; D014591:Uterine Diseases / Q000601:surgery*; D014594:Uterine Neoplasms / Q000601:surgery; D002578:Uterine Cervical Dysplasia / Q000601:surgery
keywords: Retrograde hysterectomy; Retroperitoneal hysterectomy; Total laparoscopic hysterectomy