Inadvertent cystotomy at laparoscopic hysterectomy : Sydney West Advanced Pelvic Surgery (SWAPS) Unit January 2001 to June 2009

Objective: To review the rate of inadvertent cystotomy during laparoscopic hysterectomy performed by the Sydney West Advanced Pelvic Surgery Unit (SWAPS). To compare this rate with other published data. To identify the risk factors for bladder injury at laparoscopic hysterectomy and to review the management and outcome following such injury. Method: This was a retrospective observational study. All hysterectomies where the SWAPS clinical fellow was involved were included. The study period was from January 2001 to June 2009. Simple statistical formulae were used to analyse data in this study. Results: There were 1223 hysterectomies performed during this period. Eighty-one percent of these were performed laparoscopically. There were 14 (1.1%) bladder injuries reported during this period. All bladder injuries occurred in the laparoscopic group. The majority were managed by laparoscopic repair or conservative management (86%). Two cases (14%) were converted to laparotomy. There were no short- or long-term sequelae. With increasing experience, a fall in the incidence of inadvertent cystotomy was noted during the study period. Conclusion: Inadvertent cystotomy is a recognised complication at hysterectomy. The rate in the SWAPS unit is comparable to that of other published series. Overall, there has been a decline in the rate of bladder injury, which appears attributable to more experience gained with an acquisition of increased skill levels and improved techniques.