Objective: To analyze the feasibility and technique of dissecting the urinary bladder from the lower uterine segment during total laparoscopic hysterectomy in women who have previously delivered by cesarean section.
Design: Retrospective review (Canadian Task Force classification II-1).
Setting: Dedicated high-volume gynecologic laparoscopy center.
Patients: Two hundred sixty-one women who underwent total laparoscopic hysterectomy at our center. There were no exclusion criteria based on the size of the uterus or the number of previous cesarean section deliveries.
Intervention: All patients underwent total laparoscopic hysterectomy and lateral dissection of the bladder.
Measurements and Main Results: Of the study cohort, 52% had undergone 1 cesarean section, 42% had undergone 2 cesarean sections, and 6% had undergone 3 caesarean sections. Median (range) clinical size of the uterus was 12 (6–30) weeks; weight of the specimen was 200 (40–2200) g; total duration of surgery was 80 (30–240) min; and total blood loss was 50 (10–2000) mL.
Conclusion: Total laparoscopic hysterectomy in patients with previous cesarean section deliveries is technically feasible. It can be performed by experienced surgeons irrespective of the size of the uterus or the number of previous cesarean sections. Journal of Minimally Invasive Gynecology (2010) 17, 513–517.
Keywords: Bladder adhesions; Bladder injury; Cesarean section; Total laparoscopic hysterectomy