Total laparoscopic hysterectomy with previous cesarean section using a standardized technique: experience of Pontificia Universidad Catolica de Chile

摘要

Total laparoscopic hysterectomy (TLH) in the presence of patients with previous cesarean section (CS) is becoming increasingly common. When performing TLH in these patients, bladder adhesions to the uterus may make dissection much more difficult with higher complication rates. The aim of this study was to assess the safety of TLH in patients with previous CS in an OBGYN residence program. Retrospective study of all TLH performed at our center for either benign or malignant conditions. Of our study cohort, 40?% had undergone one or more previous CS. Average surgical time was 128?min for patients without previous CS and 136?min for patients with previous CS ( p = NS). Conversion to laparotomy was required in 1?% of cases showing no variation between the CS and non-CS groups. The overall complication rate among patients undergoing TLH was 3.5?%. Major complication rate was of 3?% ( n =?14), 5 cases with previous CS and 9 cases with no previous CS ( p = NS). Urologic lesion was the most common major complication, accounting for 1.5?% ( n =?7) of all cases, 3 cases with previous CS and 4 with no previous CS ( p = NS). Of urologic complications, three were cystotomies, 1 with no previous CS and 2 with previous CS ( p = NS). TLH in patients with 1 or more previous CS is technically feasible. In the hands of thoroughly trained laparoscopic surgeons using a standardized technique, it is a safe procedure with minimal complication rates and may be even performed by OBGYN residents ensuring the same success rates. Keywords Total laparoscopic hysterectomy Cesarean section.