Johnston Keith, Rosen David, Cario Gregory, Chou Danny, Carlton Mark, Cooper Michael, Reid Geoffery
Sydney Women's Endosurgery Centre, St George Private Hospital, Kogarah, New South Wales, Sydney, Australia.
J Minim Invasive Gynecol. 2007 May-Jun;14(3):339-44. doi: 10.1016/j.jmig.2006.12.003.
To identify the volume and type of laparoscopic surgery being performed. To review the incidence, nature of associated complications, and reasons for conversion to laparotomy.
A multicenter, prospective case load analysis and chart review, identifying operations performed by 6 advanced laparoscopic surgeons over a 12-month period (1/1/05 to 12/31/05).
Surgical cases were performed in 5 hospitals in Sydney, New South Wales.
One thousand two hundred sixty-five women underwent a variety of major and advanced operative procedures.
A total of 1265 major and advanced laparoscopic procedures were performed. Laparoscopic hysterectomy accounted for 364 cases (28.8%), pelvic floor repair and Burch colposuspension 280 cases (22.2%), excisional endometriosis surgery 354 cases (28%), adnexal surgery 177 cases (13.9%), adhesiolysis 75 cases (5.9%), and miscellaneous cases 15 (1.2%). Overall major complications in terms of bowel, urologic, or major vessel injuries accounted for 8 cases (0.6%). There were 4 injuries of the bowel, 2 injuries to the bladder, and 2 injuries to ureters. There were no major vessel injuries. There were no injuries associated with primary trocar or Veres needle insertion. The most common perioperative morbidity reported was the requirement for blood transfusion (11 cases [0.9%]), and the second most common was venous thromboembolism (4 patients [0.3%]). Six (0.5%) cases were converted to laparotomy, 2 as a result of a complication and 4 for technical reasons. Six of the 8 complications were managed laparoscopically, and a multidisciplinary input was sought only in 4 of the 8 complications.
Despite the advanced nature of laparoscopic procedures performed by our group, the complication rate and conversion to laparotomy remain low. There is an increasing feasibility to perform traditional open operations laparoscopically. An increasing number of these complications are now being managed laparoscopically by the gynecologist.
确定正在进行的腹腔镜手术的数量和类型。回顾相关并发症的发生率、性质以及转为开腹手术的原因。
一项多中心前瞻性病例负荷分析及图表回顾，确定6位高级腹腔镜外科医生在12个月期间（2005年1月1日至2005年12月31日）所进行的手术。
手术病例在新南威尔士州悉尼的5家医院进行。
1265名女性接受了各种大型和高级手术操作。
共进行了1265例大型和高级腹腔镜手术。腹腔镜子宫切除术占364例（28.8%），盆底修复及Burch阴道悬吊术280例（22.2%），切除性子宫内膜异位症手术354例（28%），附件手术177例（13.9%），粘连松解术75例（5.9%），其他病例15例（1.2%）。就肠道、泌尿系统或大血管损伤而言，总体主要并发症占8例（0.6%）。有4例肠道损伤，2例膀胱损伤，2例输尿管损伤。无大血管损伤。无与初次套管针或Veress针插入相关的损伤。报告的最常见围手术期发病率是输血需求（11例[0.9%]），第二常见的是静脉血栓栓塞（4例患者[0.3%]）。6例（0.5%）病例转为开腹手术，2例因并发症，4例因技术原因。8例并发症中有6例通过腹腔镜处理，8例并发症中仅4例寻求多学科介入。
尽管我们团队所进行的腹腔镜手术具有先进性，但并发症发生率和转为开腹手术的比例仍然较低。腹腔镜下进行传统开放手术的可行性在增加。现在越来越多的这些并发症由妇科医生通过腹腔镜处理。
