Adelaide laparoscopic hysterectomy audit (1991-1998): realistic complication rates!

Abstract

Objective To review complications of laparoscopic hysterectomy occurring in a citywide population of approximately 1 million people. Design All laparoscopic hysterectomy cases were analysed retrospectively independently of the surgeons involved. Setting All private and public hospitals (n = 19) in metropolitan Adelaide, South Australia. Subjects 1904 patients over the period 1991-98. Interventions The majority of cases involved a combined laparoscopic and vaginal approach with a proportion of total laparoscopic hysterectomies (n = 33). Surgical techniques involved both staples and diathermy. Main outcome measures Rates of major complications such as haemorrhage, haematoma formation, laparotomy and urinary tract injury. Results Significant haemorrhage occurred in 3.7% (n = 70) of cases with a haematoma incidence of 3.2% (n = 60). Laparotomy rates reduced from 5% (1991-93) to 1.7% (1996-98) with an overall incidence of 3.4% (n = 64). Overall urinary tract injury rates remained constant over the survey period, i.e. 3.3% (1991-93) vs. 3.1% (1996-98). However there was a significant reduction in ureteral damage but this was countered by an increasing cystotomy rate. Conclusions Laparotomy rates were comparable to those in published data but reduced significantly over the audit period. The incidence of haematoma formation was significantly greater than that in published data, but reduced over the period 1991-98. Urinary, tract damage and haemorrhage exceeded expectations. This audit once again has suggested that the true rate of major complications with laparoscopic hysterectomy is higher than the literature suggests.