Complications of laparoscopic hysterectomy: comparison of the first 250 cases with the second 250

Objective A comparison of the complications of the first and second halves of a series of 500 laparoscopic hysterectomies using a constant stapling technique. Design A prospective study of a series of patients followed by retrospective data analysis by the author and an independent audit. Setting Specialist gynaecological practice at two private hospitals. Subjects Patients presented randomly and were offered the procedure, unless preoperative assessment precluded the use of the technique because of anticipated technical difficulty. This would have been for example, on account of excessive uterine size, coincidental abdominoplasty, patient preference or invasive pelvic cancer. In these cases conventional abdominal hysterectomy was offered instead. Results The complication rates were reduced with the passage of time and increasing experience. This was despite more difficult procedures being undertaken and the inclusion of other procedures, such as bladder neck suspension, appendicectomy and laparoscopic repair of prolapse. My rates compared favourably with those in other published reports on laparoscopic hysterectomy. Conclusion A single operator has used a constant surgical stapling technique for laparoscopic hysterectomy over 7 years. There is demonstrated in the series a steady improvement in complication rates.