A REVIEW STUDY OF BLADDER INJURY INN LAPAROSCOPY ASSISTED VAGINAL HYSTERECTOMY
Saturday, May 31st, 2008 at
4:00 pm
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Dr. Rana Hafeez –ullah Khan asked:
Introduction
Bladder repairs is really critical snarl of trail assisted vaginal hysterectomy
Method of research retrospective analysis
Type of user procession laparoscopic assisted vaginal hysterectomy laparoscopic assisted vaginal hysterectomy achieved regulating 3 pier pointer sign of bladder repairs During surgery fill up similar to swell of bladder catheter bag with gas or co2 liberate of transparent liquid in to the user domain haematuria government of bladder repairs during surgery means of bladder repairs initial and delegate trocar puncture .hasson technique for open laparoscopy might revoke 3 sort of repairs .2nd and 3rd trocar should be extrinsic under prophesy before surgery enlarge the risk of in advertent cystostomy by fixation the bladder on traction close to umbilicus or since adhesion place it in the trail of delegate trocar .in further before surgery can outcome in adhesion arrangement which obliterator the on all sides of the bladder adhesion can for in the area of cervico-vaginal connection as outcome of before cesarean territory and magnify the connection of the bladder over reduce uterine shred .other means of automatic repairs .sharp scissors or brief ratiocination of adhesion or seen nearby the lady of bladder might be adhesion from before infection surgery relating to the bowel ,appendix or peritonitis .
Thermal injury
Excessive coagulation might be obliged for thermal bladder necrosis .use of unipolar cautry in vicinity to the bladder aspect should be avoided. Vesico vaginal infection can start following user laparoscopy .it uterus is isolated from bladder regulating unipolar or bipolar cautry extreme thermal coagulation might be obliged for thermal bladder necrosis .thermal necrosis might be a little strong usually in post user duration when a vesico-vaginal infection occurs –fistula can additionally start if bladder is taken up when vagina is sutured from next .
Diagnosis
Injection of methylene blue around a bladder catheter will heed the diagnosis of vesico-vaginal infection .I.V. P. Retrograde Cystography should additionally be finished for by revaluation
Presentation of Bladder injury
To minimize bladder repairs in studious with before cesarean territory Tran’s vaginal parallel involvement should be used to come in the maiden cul-de-sac during laparoscopic interfacial hysterectomy parallel window of vesico vaginal space wakeful non-stop first. Management of trocar veress needle repairs .may be managed with unsteadiness catheter for one week with no successive snarl .injury to bladder during laparoscopy assisted vaginal hysterectomy is small and installed a little widen divided from trigone of bladder it can be late laparoscopically dual covering closer with behind absorbable suture element and check which the bladder is H2O parsimonious by injection 300 ml of methylene blue around the bladder catheter.
Incident of Bladder Injury 4-7 out of 1000
Sign to commend bladder repairs intraopeartive together with following
1. CO2 catheter bag during insufflations
2. Bladder appears to be pushed by the appendage trocar as it is modernized by the intestinal well
3. Blood in Urine
4. Urine drainage from appendage trocar incision
5. Post user urinary retention
6. Post user signs of peritonitis
7. Leakage of Indigo cerise from the harmed site
Prevention of Bladder Injury Insert is delegate Trocar underneath proceed vision.
1. Separate bladder from reduce uterine shred by regulating pointy ratiocination never disintegrate the bladder bluntly
2. Make certain the bladder is not inside the benefit of laparoscopic stapling device before to banishment it.
3. Avoid extreme electro surgery around the bladder
Treatment
1. Repair is contingent on either repairs is thermal or Mechanical
2. Whether repairs is at the bottom of architecture of bladder
3. Proximity of repairs to trigone and ureteric opening
Treatment
If diagnosed at the time of surgery. Bladder repairs at the architecture can be remade in a true brazen demeanour in dual covering C PDS. Is covering should be successive containing Muscular is Mucosal layers. Instillation of Indigo cerise color support marker of bladder bounds laparoscopic correct of vesico vaginal infection if presented after surgery is finished after about twelve weeks. Vesico-vaginal space was grown both bladder vaginal were sealed alone bladder with vicryl vagina with PDS. A peritoneal peep was used to apart vesico vaginal space and sutured with vicryl. Abdominal proceed should be used for following indications.
1. Inadequate bearing since of high or retracted infection in a slight vagina.
2. Proximity of infection to the ureter
3. Multiple fistula
4. Associated pelvic pathology bladder should be empted before to surgery
New Technique
A brand new technique for dissecting the bladder laparoscopically was rescued by James Cook University Hospital during laparoscopic assisted vaginal hysterectomy in dialect of minimal entrance surgery. 130 lavh were reviewed bladder was dissected laparoscopically a steel catheter was used to widen Identification of bladder corner and a consume forceps was extrinsic virginally to symbol the site for maiden Colpotomy monopalar scissor were used to open virtuous there was one bladder mishap 0.7% Which was famous rught away and remade with laparoscopy intra fleshly tangle meant handling time was 198.7 notation available meant sanatorium stay was 2.7 days with operation of 2 to 5 days ratiocination of bladder laparoscopically adds 5 to 10 mins to user time but significantly facilited identifying Appropriate craft it is an easy technique to sense and sense it is compared with minimal snarl With no enlarge in occurrence of bladder repairs or dysfunction repairs to bladder with laparoscopy Is singular pronounced et al reported 1.6% occurrence of critical urinary complications after vital operative? Laparoscopy infancy being bladder puncture or infection there have been 4 box of bladder repairs in a array of 900 laparoscopic hysterectomy 3 of this for lady had underneath left 2 or 3 c sections lady underneath going vaginal hysterectomy have been some-more expected to means bladder repairs if they have had before c section. In this investigate these stating 130 uninterrupted lavh in which bladder were dissected and ureteric vaginal tote afterwards non-stop laparoscopically. This technique was primarily written for lady who had before c territory in whom bladder was sticky and formidable to brand and disintegrate vaginally technique was after adopted in all cases since it crop up ed to be simpler and safer afterwards vaginal track this technique was used in 130 lavh achieved at james prepare sanatorium technique was used in all studious in the same o t high vigour entrance technique twenty-five mm hg regulating 3 pier in further to 10 mm umbilical pier with 5 mm pier extrinsic underneath proceed prophesy in right and left iliac fosse after to low epigastric vessels and have been one extrinsic supra pubically. Bipolar diathermy and scissor were used to secure pedicles down to but not together with uterine vessels both turn ligaments were cumulative with bipolar diathermy peritoneum was dissected from one turn vinculum to alternative side. A steel catheter was afterwards extrinsic in the bladder catheter was rotated so the tip was forked up sentinel to widen the bladder pillars bladder was dissected with monopolar scissor with catheter in place. A consume forceps was afterwards pushed in to vagina in to maiden fornix to widen the vagina and symbol the site for colpotomy monopolar scissor were used to open vagina and make make make make use of of of of of slicing diathermy and banishment usually before to hit with vaginal hankie helped to grasp haemostatic but poignant coagulation vagina non-stop in layers until consume forceps was reached which was pushed in sentinel and knife edge non-stop at large to widen the colpotomy procession was finished vaginally. A Wertheim retractor was placed by to strengthen bladder uterine vessels were initial cumulative with clamps and cumulative with vicryl followed by principal and utero sacral vinculum and intra peritoneal empty as well as urinary catheter until following day outcome out of 130 patients twelve had C sections meant user time was 98.7 minute. There was one bladder mishap which was famous rught away and correct with laparoscopic intra fleshly knots. Cystoscopy was achieved to safeguard correct bladder correct and to bar any alternative injuries. Patients has bladder catheter for 7 days at follow up 6 months post operatively she was well with no residual bladder dysfunction.
Discussion
It is formidable to acknowledge the occurrence of bladder repairs with laparoscopic surgery in ubiquitous LAVH specifically GILMOUR et al (9) reported which vital gynecological surgery the situation of bladder repairs sundry from 0.2 -19.5/ per one thousand with over all magnitude of 2.6 per one thousand formed on medlinereach for all reports in between 1996 and 1998. The found a higher occurrence of bladder repairs when slight cystoscopic was perform with operation from 0 to 29.2 and over all magnitude of 10.4 per one thousand. Author commented which usually 51.6% of bladder repairs were brand and managed intraoperatively. Ostrzenski et al (10) reported the altogether occurrence of bladder repairs during laparoscopic procession to operation from 0.022% to 8.3 % of cases. These injuries most often occurred during LAVH. Sharp electro surgical ratiocination was heading instruments means in injury. Intra operatively diagnosis of bladder repairs was done in 53.24% of all bladder injuries cases with bladder architecture being most ordinarily harmed structure. Less than half 29.87% of bladder injuries were prepared laparoscopically. In this array one bladder mishap occurred when catheter was pushed in to bladder wall to illustrate seperated through. The repairs was identified rught away and successfully remade laparoscopically with no residual permanent bladder dysfunction. Uses of steel catheter to widen the bladder assistance in brand the range to bladder and pillars. Which significantly promote noticing where to disintegrate and recover bladder generally in patients with endless scarring ratiocination should be carried out until one is confident which bladder has been utterly liberated of the vagina and make make make make use of of of of of consume forceps to widen the vaginal wall obviously Marks the site for colpotomy. Further largest studies have been indispensable to acquire some-more correct guess of bladder trauma. Cystoscopy was not achieved customarily unless bladder repairs was suspected sapphire cerise was injected intravenously a couple of notation before to Cystoscopy. Some Author suggest slight make make make make use of of of of of Cystoscopy with hysterectomy since of high occurrence of undetected bladder repairs vakili at al (11) not long ago reported a 4.8% situation of urinary repairs during hysterectomy and to illustrate final which slight Cystoscopy should be considered. Harkki-Siren at al (12) reported snarl rate of for per one thousand laparoscopy procession but a rate of vital snarl of 10 per one thousand with user laparoscopy 19% percent vital snarl in these critical was ureteric injury 46% was intestinal injury. They found which 75% of the vital snarl were compared with LAVH and commentated which most of these might be due to technique as the uterine vessel were coagulated and cut laparoscopically 86% of the time and try to secure uterine vessel with diathermy or staples might outcome in significantly some-more ureteric injuries (13). In these array no ureteric repairs as laparoscopy ratiocination stopped on top of uterine vessel and procession was afterwards finished vaginally. A new systemic examination and Meta research of randomized tranquil hearing of comparing intestinal vaginal and LAVH was published by Johnson at al (14). They reported a poignant enlarge in urinary tract repairs for laparoscopic compared with intestinal hysterectomy peculiar comparative measure 2.6; 95% to illustrate no poignant disproportion when comparing laparoscopic contra vaginal or laparoscopic hysterectomy contra LAVH. In this array opted for LAVH visco et al reported 2.6% of LAVH repairs to urinary tract occurred between sum 2998 cases. Evaluate investigate published by Ginny et al (17) reported 2.1% bladder repairs in laparoscopic hysterectomy compared to 1% in intestinal Hysterectomy. Comparison of laparoscopic and vaginal hysterectomy bladder repairs reported were 0.9% and 1.2% respectively. Incidence of bladder repairs in gasser array was reduce 0.7% due to ease of brand and dissecting bladder.
Conclusion
If one is clever one can simply equivocate bladder repairs by obeying the on top of referred to principals. This Gasser investigate report ratiocination of bladder laparoscopically adds 5-10 mins to the handling time. Use of steel catheter assistance to brand bladder domain and by stretching of bladder post craft have been simply recognized. Use of consume forceps vaginally obviously m arks the vagina and to illustrate site for colpotomy. It is easy technique to sense and adopt specifically in patients with before c section. Incident of bladder is low main value is facilitating bladder ratiocination when there have been poignant adhesion. Technique is compared with low occurrence of bladder injury.
Reference
1) Schutz K, Possover M, Merker A, Michels W, Schneider A(2002) Prospective randomized more aged of laparoscopic assisted vaginal hysterectomy (LAVH) with intestinal hysterectomy (AH) for the diagnosis of the uterus weighing >200g. Surg Endosc 16: 121-125.
2) Stovall T, Elder R, Ling F (1989) Predictors of pelvic adhesions. J Report Med 34: 345-348.
3) Zapico A, Fuentes P, Grassa A, Arnans F, Otazua J, Cortes-Prieto J (2005) Laparoscopic-assisted vaginal hysterectomy contra intestinal hysterectomy in stages I and II endometrial cancer: handling data, follow-up, and survival, Gynecol Oncol 98: 222-227.
4) Harkki- Siren P, Kurki T (1997) A national research of laparoscopic complications. Obstet Hynecol 89: 108-112
5) Harkki-Siren P, Sjoberg J, Titinen A (1998) Urinary tract injuries after hysterectomy, Obstet Gynecol 92: 113-118
6) Ostrzenski A, Ostrzenska KM (1998) Bladder repairs during laparoscopic surgery, Obstet Gynecol Surv 53: 175-180
7) Rooney CM, Crawford AT, Vassallo BJ, Kleeman SD, Karram MM (2005) is before cesarean territory a risk for immaterial cystotomy at the time of hysterectomy? A case-controlled study, Am J Obstet Gynecol 193:2041-2044
8) Armenakas NA, Pareek G, Fracchia JA (2004) Iatrogenic bladder perforations: Long-term follow-up of 65 patients. J Am Coll Surg 198: 78-82
9) Matheved P, Valencia P, Cousin C, Mellier G, Dargent D (2001) Operative injuries during vaginal hysterectomy, Europ J Obstet Gynecol Repord Biol 97: 71-75
10) Berek & novak’s gynecology (2007) Lippincott Williams & Wilkins, Philadelphia, 14th ed, pp. 805-811
11) Vessy M, Villard-Mackintosh L, McPherson K, Coulter A, Yeates D (1992). The epidemiology of hysterectomy: anticipating in a large conspirator study. Br J Obsted Gynaecol 99: 402-407
12) Cosson M, Lambaudie E, Boukerrou M, Querleu D, Crepin G (2001) Vaginal, Laparoscopic, or intestinal hysterectomies for soft bisorders: evident and early postoperative complications. Eur J Obstet Gynecol Reprod Biol 98: 231-236
13) Sheth SS, Malpani AN (1995) Vaginal hysterectomies following before cesarean section. Int J Gynecol Obsted 50: 165-169
14) Hsu WC, Chang WC, Huang SC, Torng Pl, Chang Dy, Sheu BC (2006) Visceral shifting technique is utilitarian for detecting intestinal adhesion and preventing laparoscopic surgical complications. Gynecol Obstet Invest 62: 75-78
15) Chang WC, Huang SC, Sheu BC, Chen Cl, Torng PL, Hsu WC, Chang DY (2005) Transvaginal hysterectomy or laparoscopically assisted vaginal hysterectomy for nonprolapsed uteri. Obstet Gynecol 106: 321-326
16) Chang WC Torng PL, Hunag SC, Sheu BC, Hsu WC, Chen RJ, Chow SN, Chang DY (2005) Laparoscopic-assisted vaginal hysterectomy with uterine artey ligation by opposing umbilical vinculum tracking. J Minim Invasive Gynecol 12: 336-342
17) Aronson MP, Bose Tm (2002) preoperative bladder repairs in pelvic surgery. Clin Obsted Gynecol 45: 428-438
18) Neumann G, Raswmussen KL, Lauszus FF (2004) Peroperative bladder repairs during hysterectomy for soft disorders. Acta Obstet Gynecol Scand 83: 1001-1002
Kansieo.com
Introduction
Bladder repairs is really critical snarl of trail assisted vaginal hysterectomy
Method of research retrospective analysis
Type of user procession laparoscopic assisted vaginal hysterectomy laparoscopic assisted vaginal hysterectomy achieved regulating 3 pier pointer sign of bladder repairs During surgery fill up similar to swell of bladder catheter bag with gas or co2 liberate of transparent liquid in to the user domain haematuria government of bladder repairs during surgery means of bladder repairs initial and delegate trocar puncture .hasson technique for open laparoscopy might revoke 3 sort of repairs .2nd and 3rd trocar should be extrinsic under prophesy before surgery enlarge the risk of in advertent cystostomy by fixation the bladder on traction close to umbilicus or since adhesion place it in the trail of delegate trocar .in further before surgery can outcome in adhesion arrangement which obliterator the on all sides of the bladder adhesion can for in the area of cervico-vaginal connection as outcome of before cesarean territory and magnify the connection of the bladder over reduce uterine shred .other means of automatic repairs .sharp scissors or brief ratiocination of adhesion or seen nearby the lady of bladder might be adhesion from before infection surgery relating to the bowel ,appendix or peritonitis .
Thermal injury
Excessive coagulation might be obliged for thermal bladder necrosis .use of unipolar cautry in vicinity to the bladder aspect should be avoided. Vesico vaginal infection can start following user laparoscopy .it uterus is isolated from bladder regulating unipolar or bipolar cautry extreme thermal coagulation might be obliged for thermal bladder necrosis .thermal necrosis might be a little strong usually in post user duration when a vesico-vaginal infection occurs –fistula can additionally start if bladder is taken up when vagina is sutured from next .
Diagnosis
Injection of methylene blue around a bladder catheter will heed the diagnosis of vesico-vaginal infection .I.V. P. Retrograde Cystography should additionally be finished for by revaluation
Presentation of Bladder injury
To minimize bladder repairs in studious with before cesarean territory Tran’s vaginal parallel involvement should be used to come in the maiden cul-de-sac during laparoscopic interfacial hysterectomy parallel window of vesico vaginal space wakeful non-stop first. Management of trocar veress needle repairs .may be managed with unsteadiness catheter for one week with no successive snarl .injury to bladder during laparoscopy assisted vaginal hysterectomy is small and installed a little widen divided from trigone of bladder it can be late laparoscopically dual covering closer with behind absorbable suture element and check which the bladder is H2O parsimonious by injection 300 ml of methylene blue around the bladder catheter.
Incident of Bladder Injury 4-7 out of 1000
Sign to commend bladder repairs intraopeartive together with following
1. CO2 catheter bag during insufflations
2. Bladder appears to be pushed by the appendage trocar as it is modernized by the intestinal well
3. Blood in Urine
4. Urine drainage from appendage trocar incision
5. Post user urinary retention
6. Post user signs of peritonitis
7. Leakage of Indigo cerise from the harmed site
Prevention of Bladder Injury Insert is delegate Trocar underneath proceed vision.
1. Separate bladder from reduce uterine shred by regulating pointy ratiocination never disintegrate the bladder bluntly
2. Make certain the bladder is not inside the benefit of laparoscopic stapling device before to banishment it.
3. Avoid extreme electro surgery around the bladder
Treatment
1. Repair is contingent on either repairs is thermal or Mechanical
2. Whether repairs is at the bottom of architecture of bladder
3. Proximity of repairs to trigone and ureteric opening
Treatment
If diagnosed at the time of surgery. Bladder repairs at the architecture can be remade in a true brazen demeanour in dual covering C PDS. Is covering should be successive containing Muscular is Mucosal layers. Instillation of Indigo cerise color support marker of bladder bounds laparoscopic correct of vesico vaginal infection if presented after surgery is finished after about twelve weeks. Vesico-vaginal space was grown both bladder vaginal were sealed alone bladder with vicryl vagina with PDS. A peritoneal peep was used to apart vesico vaginal space and sutured with vicryl. Abdominal proceed should be used for following indications.
1. Inadequate bearing since of high or retracted infection in a slight vagina.
2. Proximity of infection to the ureter
3. Multiple fistula
4. Associated pelvic pathology bladder should be empted before to surgery
New Technique
A brand new technique for dissecting the bladder laparoscopically was rescued by James Cook University Hospital during laparoscopic assisted vaginal hysterectomy in dialect of minimal entrance surgery. 130 lavh were reviewed bladder was dissected laparoscopically a steel catheter was used to widen Identification of bladder corner and a consume forceps was extrinsic virginally to symbol the site for maiden Colpotomy monopalar scissor were used to open virtuous there was one bladder mishap 0.7% Which was famous rught away and remade with laparoscopy intra fleshly tangle meant handling time was 198.7 notation available meant sanatorium stay was 2.7 days with operation of 2 to 5 days ratiocination of bladder laparoscopically adds 5 to 10 mins to user time but significantly facilited identifying Appropriate craft it is an easy technique to sense and sense it is compared with minimal snarl With no enlarge in occurrence of bladder repairs or dysfunction repairs to bladder with laparoscopy Is singular pronounced et al reported 1.6% occurrence of critical urinary complications after vital operative? Laparoscopy infancy being bladder puncture or infection there have been 4 box of bladder repairs in a array of 900 laparoscopic hysterectomy 3 of this for lady had underneath left 2 or 3 c sections lady underneath going vaginal hysterectomy have been some-more expected to means bladder repairs if they have had before c section. In this investigate these stating 130 uninterrupted lavh in which bladder were dissected and ureteric vaginal tote afterwards non-stop laparoscopically. This technique was primarily written for lady who had before c territory in whom bladder was sticky and formidable to brand and disintegrate vaginally technique was after adopted in all cases since it crop up ed to be simpler and safer afterwards vaginal track this technique was used in 130 lavh achieved at james prepare sanatorium technique was used in all studious in the same o t high vigour entrance technique twenty-five mm hg regulating 3 pier in further to 10 mm umbilical pier with 5 mm pier extrinsic underneath proceed prophesy in right and left iliac fosse after to low epigastric vessels and have been one extrinsic supra pubically. Bipolar diathermy and scissor were used to secure pedicles down to but not together with uterine vessels both turn ligaments were cumulative with bipolar diathermy peritoneum was dissected from one turn vinculum to alternative side. A steel catheter was afterwards extrinsic in the bladder catheter was rotated so the tip was forked up sentinel to widen the bladder pillars bladder was dissected with monopolar scissor with catheter in place. A consume forceps was afterwards pushed in to vagina in to maiden fornix to widen the vagina and symbol the site for colpotomy monopolar scissor were used to open vagina and make make make make use of of of of of slicing diathermy and banishment usually before to hit with vaginal hankie helped to grasp haemostatic but poignant coagulation vagina non-stop in layers until consume forceps was reached which was pushed in sentinel and knife edge non-stop at large to widen the colpotomy procession was finished vaginally. A Wertheim retractor was placed by to strengthen bladder uterine vessels were initial cumulative with clamps and cumulative with vicryl followed by principal and utero sacral vinculum and intra peritoneal empty as well as urinary catheter until following day outcome out of 130 patients twelve had C sections meant user time was 98.7 minute. There was one bladder mishap which was famous rught away and correct with laparoscopic intra fleshly knots. Cystoscopy was achieved to safeguard correct bladder correct and to bar any alternative injuries. Patients has bladder catheter for 7 days at follow up 6 months post operatively she was well with no residual bladder dysfunction.
Discussion
It is formidable to acknowledge the occurrence of bladder repairs with laparoscopic surgery in ubiquitous LAVH specifically GILMOUR et al (9) reported which vital gynecological surgery the situation of bladder repairs sundry from 0.2 -19.5/ per one thousand with over all magnitude of 2.6 per one thousand formed on medlinereach for all reports in between 1996 and 1998. The found a higher occurrence of bladder repairs when slight cystoscopic was perform with operation from 0 to 29.2 and over all magnitude of 10.4 per one thousand. Author commented which usually 51.6% of bladder repairs were brand and managed intraoperatively. Ostrzenski et al (10) reported the altogether occurrence of bladder repairs during laparoscopic procession to operation from 0.022% to 8.3 % of cases. These injuries most often occurred during LAVH. Sharp electro surgical ratiocination was heading instruments means in injury. Intra operatively diagnosis of bladder repairs was done in 53.24% of all bladder injuries cases with bladder architecture being most ordinarily harmed structure. Less than half 29.87% of bladder injuries were prepared laparoscopically. In this array one bladder mishap occurred when catheter was pushed in to bladder wall to illustrate seperated through. The repairs was identified rught away and successfully remade laparoscopically with no residual permanent bladder dysfunction. Uses of steel catheter to widen the bladder assistance in brand the range to bladder and pillars. Which significantly promote noticing where to disintegrate and recover bladder generally in patients with endless scarring ratiocination should be carried out until one is confident which bladder has been utterly liberated of the vagina and make make make make use of of of of of consume forceps to widen the vaginal wall obviously Marks the site for colpotomy. Further largest studies have been indispensable to acquire some-more correct guess of bladder trauma. Cystoscopy was not achieved customarily unless bladder repairs was suspected sapphire cerise was injected intravenously a couple of notation before to Cystoscopy. Some Author suggest slight make make make make use of of of of of Cystoscopy with hysterectomy since of high occurrence of undetected bladder repairs vakili at al (11) not long ago reported a 4.8% situation of urinary repairs during hysterectomy and to illustrate final which slight Cystoscopy should be considered. Harkki-Siren at al (12) reported snarl rate of for per one thousand laparoscopy procession but a rate of vital snarl of 10 per one thousand with user laparoscopy 19% percent vital snarl in these critical was ureteric injury 46% was intestinal injury. They found which 75% of the vital snarl were compared with LAVH and commentated which most of these might be due to technique as the uterine vessel were coagulated and cut laparoscopically 86% of the time and try to secure uterine vessel with diathermy or staples might outcome in significantly some-more ureteric injuries (13). In these array no ureteric repairs as laparoscopy ratiocination stopped on top of uterine vessel and procession was afterwards finished vaginally. A new systemic examination and Meta research of randomized tranquil hearing of comparing intestinal vaginal and LAVH was published by Johnson at al (14). They reported a poignant enlarge in urinary tract repairs for laparoscopic compared with intestinal hysterectomy peculiar comparative measure 2.6; 95% to illustrate no poignant disproportion when comparing laparoscopic contra vaginal or laparoscopic hysterectomy contra LAVH. In this array opted for LAVH visco et al reported 2.6% of LAVH repairs to urinary tract occurred between sum 2998 cases. Evaluate investigate published by Ginny et al (17) reported 2.1% bladder repairs in laparoscopic hysterectomy compared to 1% in intestinal Hysterectomy. Comparison of laparoscopic and vaginal hysterectomy bladder repairs reported were 0.9% and 1.2% respectively. Incidence of bladder repairs in gasser array was reduce 0.7% due to ease of brand and dissecting bladder.
Conclusion
If one is clever one can simply equivocate bladder repairs by obeying the on top of referred to principals. This Gasser investigate report ratiocination of bladder laparoscopically adds 5-10 mins to the handling time. Use of steel catheter assistance to brand bladder domain and by stretching of bladder post craft have been simply recognized. Use of consume forceps vaginally obviously m arks the vagina and to illustrate site for colpotomy. It is easy technique to sense and adopt specifically in patients with before c section. Incident of bladder is low main value is facilitating bladder ratiocination when there have been poignant adhesion. Technique is compared with low occurrence of bladder injury.
Reference
1) Schutz K, Possover M, Merker A, Michels W, Schneider A(2002) Prospective randomized more aged of laparoscopic assisted vaginal hysterectomy (LAVH) with intestinal hysterectomy (AH) for the diagnosis of the uterus weighing >200g. Surg Endosc 16: 121-125.
2) Stovall T, Elder R, Ling F (1989) Predictors of pelvic adhesions. J Report Med 34: 345-348.
3) Zapico A, Fuentes P, Grassa A, Arnans F, Otazua J, Cortes-Prieto J (2005) Laparoscopic-assisted vaginal hysterectomy contra intestinal hysterectomy in stages I and II endometrial cancer: handling data, follow-up, and survival, Gynecol Oncol 98: 222-227.
4) Harkki- Siren P, Kurki T (1997) A national research of laparoscopic complications. Obstet Hynecol 89: 108-112
5) Harkki-Siren P, Sjoberg J, Titinen A (1998) Urinary tract injuries after hysterectomy, Obstet Gynecol 92: 113-118
6) Ostrzenski A, Ostrzenska KM (1998) Bladder repairs during laparoscopic surgery, Obstet Gynecol Surv 53: 175-180
7) Rooney CM, Crawford AT, Vassallo BJ, Kleeman SD, Karram MM (2005) is before cesarean territory a risk for immaterial cystotomy at the time of hysterectomy? A case-controlled study, Am J Obstet Gynecol 193:2041-2044
8) Armenakas NA, Pareek G, Fracchia JA (2004) Iatrogenic bladder perforations: Long-term follow-up of 65 patients. J Am Coll Surg 198: 78-82
9) Matheved P, Valencia P, Cousin C, Mellier G, Dargent D (2001) Operative injuries during vaginal hysterectomy, Europ J Obstet Gynecol Repord Biol 97: 71-75
10) Berek & novak’s gynecology (2007) Lippincott Williams & Wilkins, Philadelphia, 14th ed, pp. 805-811
11) Vessy M, Villard-Mackintosh L, McPherson K, Coulter A, Yeates D (1992). The epidemiology of hysterectomy: anticipating in a large conspirator study. Br J Obsted Gynaecol 99: 402-407
12) Cosson M, Lambaudie E, Boukerrou M, Querleu D, Crepin G (2001) Vaginal, Laparoscopic, or intestinal hysterectomies for soft bisorders: evident and early postoperative complications. Eur J Obstet Gynecol Reprod Biol 98: 231-236
13) Sheth SS, Malpani AN (1995) Vaginal hysterectomies following before cesarean section. Int J Gynecol Obsted 50: 165-169
14) Hsu WC, Chang WC, Huang SC, Torng Pl, Chang Dy, Sheu BC (2006) Visceral shifting technique is utilitarian for detecting intestinal adhesion and preventing laparoscopic surgical complications. Gynecol Obstet Invest 62: 75-78
15) Chang WC, Huang SC, Sheu BC, Chen Cl, Torng PL, Hsu WC, Chang DY (2005) Transvaginal hysterectomy or laparoscopically assisted vaginal hysterectomy for nonprolapsed uteri. Obstet Gynecol 106: 321-326
16) Chang WC Torng PL, Hunag SC, Sheu BC, Hsu WC, Chen RJ, Chow SN, Chang DY (2005) Laparoscopic-assisted vaginal hysterectomy with uterine artey ligation by opposing umbilical vinculum tracking. J Minim Invasive Gynecol 12: 336-342
17) Aronson MP, Bose Tm (2002) preoperative bladder repairs in pelvic surgery. Clin Obsted Gynecol 45: 428-438
18) Neumann G, Raswmussen KL, Lauszus FF (2004) Peroperative bladder repairs during hysterectomy for soft disorders. Acta Obstet Gynecol Scand 83: 1001-1002
Kansieo.com