Our Summary

This research paper studied the treatment of bladder injuries that happened by accident during total laparoscopic hysterectomies (a type of surgery where the uterus is removed through small incisions in the abdomen). The study looked back at patients who had this surgery for non-cancerous conditions at a large academic hospital from January 2018 to June 2019.

They found that there were nine patients who had bladder injuries during surgery. All of these injuries happened on the back side of the bladder while the surgeons were separating the bladder and uterus. The surgeons were able to fix these bladder injuries with laparoscopic surgery (surgery done through small incisions) during the same operation.

None of these patients had major complications after the surgery. They were able to remove the catheters (tubes placed in the bladder to drain urine) between 5 and 7 days after the surgery.

The authors of the paper conclude that laparoscopic hysterectomy can be a good choice for the right patients if done by experienced surgeons. However, patients should be informed about the potential for bladder injuries, especially in cases of endometriosis (a condition where tissue similar to the lining of the uterus grows outside the uterus) and previous caesarean sections. If an injury to the urinary system is suspected or found during surgery, it needs to be properly identified and treated to avoid problems after surgery and long-term health issues.

FAQs

  1. What is the cause of bladder injuries during total laparoscopic hysterectomy?
  2. How are bladder injuries managed during the procedure?
  3. Are there any long-term complications associated with laparoscopic repair of bladder rupture?

Doctor’s Tip

One helpful tip a doctor might tell a patient about laparoscopic hysterectomy is to be aware of the potential for bladder injury during the procedure, particularly during vesicouterine dissection. It is important for patients to understand the risks and for surgeons to take care during this part of the surgery to minimize the chances of bladder injury. If a bladder injury does occur, prompt and successful laparoscopic repair is possible, but it is important to ensure proper identification and treatment to avoid postoperative complications.

Suitable For

Patients who are typically recommended for laparoscopic hysterectomy include those with benign gynaecological conditions such as fibroids, endometriosis, or abnormal uterine bleeding. Additionally, patients who are looking for a minimally invasive surgical option with faster recovery times and lower risk of complications may also be recommended for laparoscopic hysterectomy. It is important for patients to be well-informed about the potential risks and complications associated with the procedure, and for the surgery to be performed by well-trained laparoscopic surgeons to ensure successful outcomes.

Timeline

Before laparoscopic hysterectomy:

  1. Patient undergoes pre-operative consultation with gynecologist to discuss procedure and potential risks.
  2. Patient may undergo pre-operative testing such as blood work and imaging studies.
  3. Patient is instructed on pre-operative preparation including fasting and medication management.
  4. Patient undergoes laparoscopic hysterectomy procedure.
  5. Intraoperatively, bladder injury is detected during vesicouterine dissection.
  6. Laparoscopic repair of bladder injury is performed successfully.
  7. Foley catheter is placed post-operatively.

After laparoscopic hysterectomy:

  1. Patient is monitored in recovery room before being transferred to hospital room.
  2. Patient is monitored for post-operative complications such as infection or bleeding.
  3. Foley catheter is removed 6.67 ± 0.7 (5-7) days after surgery.
  4. Patient is discharged home with post-operative instructions and follow-up appointments.
  5. Patient follows up with gynecologist for post-operative care and monitoring.

What to Ask Your Doctor

  1. How many laparoscopic hysterectomies have you performed, and what is your success rate?
  2. What are the potential risks and complications of laparoscopic hysterectomy, including the risk of bladder injury?
  3. How will you ensure that the bladder is not injured during the procedure?
  4. What is the typical recovery time and post-operative care after a laparoscopic hysterectomy?
  5. How will you monitor for and address any potential complications, such as bladder injury, after the surgery?
  6. What are the alternatives to laparoscopic hysterectomy, and why do you recommend this procedure for me?
  7. How will you involve me in the decision-making process and ensure that I understand the risks and benefits of the surgery?
  8. What is the likelihood of needing a catheter after the surgery, and for how long?
  9. Can you provide me with information or resources to help me prepare for the surgery and recovery process?
  10. Are there any specific lifestyle changes or precautions I should take before and after the surgery to optimize my recovery and outcome?

Reference

Authors: Aydin C, Mercimek MN. Journal: Int J Clin Pract. 2020 Jun;74(6):e13507. doi: 10.1111/ijcp.13507. Epub 2020 Apr 16. PMID: 32267049