The technique of laparoscopic difficult total hysterectomy to avoid bladder injury

Objective To explore the technique of laparoscopic difficult total hysterectomy (LTH) to avoid bladder injury in the patients who underwent caesarean section. Methods A total of 85 patients who underwent laparoscopic hysterectomy in the Third People's Hospital of Dongguan from May 2013 to May 2016 were retrospectively studied. All the patients had a history of cesarean section for more than 2 times. Among the 85 patients, 50 patients received uterine cup and were injected with 300 mL normal saline containing methylene blue into bladders before separation and push-down vesical peritoneal reflection (group A); 35 patients received normal uterine manipulator and were injected with 300 mL normal saline containing methylene blue into bladders before push-down vesical peritoneal reflection (group B). The technique used in group B was used at the beginning, and switched to that used in group A later. The number of cases of bladder injury, degree of injury, estimated blood loss, operation time and postoperative hospital stay were compared between the two groups. Results The two groups presented no significant difference (P>0.05)in gravidity and parity history, age, number of cesarean section, period since the last cesarean section and body mass index (BMI). Bladder injury occurred in 1 patient in Group A and 6 patients in group B. The average estimated bleed loss was 58 mL in group A and 130 mL in group B. The average operation time was 78 min in group A and 126 min in group B. The average postoperative hospital stay was 7 d in group A and 10 d in group B. The cases of bladder injury, estimated bleed loss, operation time, postoperative activity time and postoperative hospital stay in group A were significantly less than those of group B, which presented statistically significant differences (P 0.05). Conclusion The use of uterine cup and injection of methylene blue solution into bladder before push-down vesical peritoneal reflection to make the vesical peritoneal reflection fully exposed during laparoscopic difficult total hysterectomy can effectively advoid bladder injury, thereby reducing the intraoperative bleeding, operation time and postoperative hospital stay. It is worth popularizing. Key words: Laparoscopy; Total hysterectomy; bladder injury; uterine cup