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[Complication of laparoscopic radical hysterectomy and lymphadenectomy: an analysis of 23 cases].

OBJECTIVE
To explore complications of laparoscopic radical hysterectomy and lymphadenectomy in patients with cervical and endometrial carcinoma, and its prevention.


METHODS
From July 2000 to December 2004 at our institution, a total of 278 laparoscopic radical hysterectomy and lymphadenectomy procedures were performed in 242 patients with cervical carcinoma and 36 patients with endometrial carcinoma. We reviewed the clinical data of patients who underwent laparoscopic radical hysterectomy and lymphadenectomy to check their complications and other factors related to this open surgical procedure.


RESULTS
All but 4 surgical procedures were completed laparoscopically. Paraaortic lymphadenectomy was performed in 108 patients and pelvic lymphadenectomy was performed in all of 278 patients. Major and minor intraoperative complications occurred in 4.7% (13/278) of patients. The overall conversion rate was 1.4% (4/278), consisting of 3 emergency and 1 elective conversions. Vascular injuries occurred in 7 patients, five of them were repaired or treated laparoscopically and one left external iliac vein injury required laparotomy, another patient underwent laparotomy to control bleeding. Operative cystotomies occurred in 4 patients and all were repaired laparoscopically. One patient underwent laparotomy because of hypercapnia. Another patient underwent laparotomy because of ascending colon injury. Postoperative surgery complications occurred in 3.6% (10/278) of patients. Three patients had a ureterovaginal fistula and three patients had a vesicovaginal fistula after the operation that required reoperation. There was one patient with ureterostenosis while three patients with urinary retention.


CONCLUSIONS
Laparoscopic radical hysterectomy in combination with lymphadenectomy is becoming a routine procedure in the armamentarium of many gynecologists. Complications that are unique to laparoscopy exist but they decrease with more practice and experience.