Routine cystoscopy after laparoscopically assisted hysterectomy: what's the point?

Objective: To define the role of routine cystoscopy following laparoscopically assisted hysterectomy in the early detection of ureteric injuries. Design: A retrospective observational study based on casenote review. Subjects: A consecutive series of 436 women who underwent routine video cystoscopy after intrafascial laparoscopically assisted hysterectomy, with or without bilateral salpingo-oöphorectomy. Results: In 436 cystoscope evaluations, six cases aroused suspicion of a ureteric injury. Subsequent evaluation confirmed injury in two of these cases. A further two cases were not suspected on cystoscopic grounds but were detected in the early postoperative period. One ureteric injury was associated with endoscopic staples, two with electrosurgery and one with the harmonic scalpel. The staple injury was suspected clinically during the operative procedure; the remainder were not. Conclusion: Routine cystoscopy at intrafascial laparoscopically assisted hysterectomy has not contributed to the early diagnosis and treatment of ureteric injuries sustained with the authors' current technique. Thus cystoscopy ought to be done selectively according to clinical intraoperative concern. The distal pelvic ureter should be routinely inspected for dilatation, via peritoneal windows, at the end of the hysterectomy. Every endogynaecologist should review their data on cystoscopy and ureteric injuries associated with laparoscopically assisted hysterectomy to ascertain whether cystoscopy is justifiable in their practice, and whether surgical techniques need to be modified to enhance ureteric protection.Seman, Elvis I. ; O' Shea, Robert T. ; Gordon, Simon ; Miller, Joh