title: Which one is safer - performing a laparoscopic hysterectomy with a tissue fusion device involving diagnostic cystoscopy or traditional abdominal hysterectomy with ureteral dissection?
abstract: BACKGROUND
  It still remains an unanswered question whether, in the absence of gynecological malignancy and under elective conditions, to perform abdominal hysterectomy (AH), offering a safer approach, or to perform a laparoscopic hysterectomy (LH) procedure.
  
  
  OBJECTIVE
  We aimed to compare LH operations performed with a tissue fusion device accompanied by intraoperative diagnostic cystoscopy with traditional AH operations involving bilateral ureteral dissection.
  
  
  METHODS
  The integrity of the ureters, ureteral peristalsis and the diameter of the ureters were examined during AH by inspection. At the end of LH, the bladder wall was systematically evaluated by cystoscopy and a jet of urine spurting was noted from both ureteral orifices.
  
  
  RESULTS
  The operation time was longer in patients who underwent LH + CYS (p = 0.0001). The decline in hematocrit and hemoglobin levels in the postoperative period was significantly higher in patients who underwent AH + UD (p = 0.0001 and p = 0.002, respectively). No significant difference was found between the two groups in terms of ureteral injury, bowel injury or bladder injury (p = 0.378, p = 1.000 and p = 1.000, respectively). There was no statistically significant difference between the two groups in terms of mean body temperature and postoperative blood transfusion requirements (p = 0.051 and p = 0.210, respectively). Mean parenteral analgesic requirement and length of hospital stay were significantly different between the groups (p = 0.005 and p = 0.0001). No statistically significant difference was found between the two groups in terms of postoperative cardiopulmonary complications, re-operation rate or occurrence of genitourinary fistula (p = 1.000, p = 1.000 and p = 1.000, respectively).
  
  
  CONCLUSIONS
  We concluded that LH performed with a tissue fusion device involving diagnostic cystoscopy yields major and minor complication rates similar to safely performed AH operations preserving ureters.
authors: Department of Obstetrics and Gynecology, Düzce University, Düzce, Turkey.
authors: Ali
authors: A
authors: Yavuzcan
authors: Department of Obstetrics and Gynecology, Bucak State Hospital, Burdur, Turkey.
authors: Gazi
authors: G
authors: Yildiz
authors: Department of Obstetrics and Gynecology, Düzce University, Düzce, Turkey.
authors: Mete
authors: M
authors: Cağlar
authors: Department of Urology, Bucak State Hospital, Burdur, Turkey.
authors: Raşit
authors: R
authors: Altıntaş
authors: Department of Obstetrics and Gynecology, Düzce University, Düzce, Turkey.
authors: Serdar
authors: S
authors: Dilbaz
authors: Department of Obstetrics and Gynecology, Bucak State Hospital, Burdur, Turkey.
authors: Pinar
authors: P
authors: Yildiz
authors: Department of Obstetrics and Gynecology, Düzce University, Düzce, Turkey.
authors: Selahattin
authors: S
authors: Kumru
authors: Department of Obstetrics and Gynecology, Düzce University, Düzce, Turkey.
authors: Yusuf
authors: Y
authors: Ustün
keywords: abdominal hysterectomy; diagnostic cystoscopy; laparoscopic hysterectomy; ureter dissection