634 ROBOTIC-ASSISTED HIATAL HERNIA AND GASTROESOPHAGEAL DISEASE SURGERY: INITIAL RESULTS AND EXPERIENCE IN A SINGLE INSTITUTION

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Sara Sentí Farrarons ◽  
Arantxa Clavell Font ◽  
Cristina Albero Bosch ◽  
Marta Viciano Martin ◽  
Elisenda Garsot Savall
Keyword(s):  
Hiatal Hernia ◽  
Intraoperative Complications ◽  
Major Complication ◽  
Common Disease ◽  
Complication Rates ◽  
Robotic Approach ◽  
Mediastinal Dissection ◽  
Urgent Surgery ◽  
Total Fundoplication ◽  
The Mean

Abstract   Gastroesophageal reflux disease, associated with sliding or large paraesophageal hiatal hernia, represents a common disease that frequently needs a surgical solution. The repair of large paraesophageal hiatal hernias is still a challenge in minimally invasive surgery but the robotic approach seems to gain widespread acceptance because offers enhanced visualization, dexterity and reach, which may facilitate the hiatal reconstruction and mediastinal dissection. Methods Between June 2019 and February 2021, 23 patients (5 male, 18 female) underwent robotic approach fundoplication (19 sliding hernia, 3 paraesophageal and 2 gastroesophagic reflux) after being pre operative diagnosed. All surgeries were elective. Biosynthetic tissue absorbable mesh was applied in one patient with double time recurrence hernia. Sixteen patients underwent total fundoplication (Nissen), 6 patients had Toupet fundoplication, and one patient had hiatus repair without fundoplication. Results The mean age of the patients was 61 years. Biosynthetic mesh was used in one patient. The mean operative time was 127 minutes (80-240) and no intraoperative complications were described. There were no conversions to open or laparoscopic procedures. Nine of the twenty-three patients underwent redo hiatal hernia repairs and the mean hospital stay was 2 days. Only one patient had a major complication (Clavien Dindo 3b) requiring urgent surgery. The early and 30 day mortality rate was 0%. Conclusion In our experience, robotic approach to paraesophageal repair seems safe and effective with low complication rates even in high-risk patients and those with redo surgery. Subjectively, the robotic approach provides the surgeon better vision and maneuverability during the intervention. We hope to progressively increase the number of robotic cases to analyse long-term clinical outcomes such as hiatal hernia recurrences, need of medical therapy and quality of life.

677 ROBOTIC-ASSISTED HIATAL HERNIA AND GASTROESOPHAGEAL REFLUX DISEASE RE-DO SURGERY: A SINGLE INSTITUTION EXPERIENCE

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Arantxa Clavell Font ◽  
Sara Senti Farrarons ◽  
Marta Viciano Martin ◽  
Elisenda Garsot Savall
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Hiatal Hernia ◽  
Reflux Disease ◽  
Hernia Recurrence ◽  
Complication Rates ◽  
Robotic Approach ◽  
Clinical Recurrence ◽  
The Mean ◽  
Hiatal Hernia Recurrence

Abstract   Hiatal hernia recurrence (HHR) after surgical repair associated with dysphagia, gastroesophageal reflux disease or other symptoms represents a non-negligible disease that frequently needs a reoperative solution. The repair of a relapsed hiatal hernia represents a surgical challenge due to anatomic changes and fibrosis, and the robotic approach seems to provide benefits because offers enhanced visualization and dexterity. Methods Between June 2019 and February 2021, 7 patients (1 male, 6 female) underwent redo robotic approach surgery for hiatal hernia recurrence after being pre operative diagnosed. All surgeries were elective and all patients had both clinical and radiologic recurrence. Biosynthetic tissue absorbable mesh was applied in one patient with double time recurrence hernia. Four patients underwent total fundoplication (Nissen), 2 patients had Toupet fundoplication, and one patient had hiatus repair without fundoplication. Results The mean age of the patients was 62.7 years and the main expressed symptom for the patient was dysphagia. Time to clinical recurrence was 13 months. Biosynthetic mesh was used in one patient. The mean operative time was 143 minutes (80–240) and no intraoperative complications were described. There were no conversions to open or laparoscopic procedures. The early and 30 day mortality rate was 0% and mean hospital stay was 2.7 days. Conclusion Robotic support, when available, can be beneficial in redo surgery for GERD and hiatal hernia recurrence. Despite our short experience, we believe the robotic approach for redo hiatal surgery is safe and effective with low complication rates even in high-risk patients.

scholarly journals Intraoperative Surgical Complications in Transoral Laser CO2 Microsurgery of the Larynx: An Observational, Prospective, Single-Center Study

2019 ◽  
pp. 014556131988278
Author(s):  
Carlos Miguel Chiesa-Estomba ◽  
Jon Alexander Sistiaga-Suarez ◽  
Jose Angel González-García ◽  
Ekhiñe Larruscain ◽  
Xabier Altuna-Mariezcurrena
Keyword(s):  
Intraoperative Complications ◽  
Tumor Resection ◽  
Major Complication ◽  
Preoperative Assessment ◽  
Oncologic Outcomes ◽  
Anatomical Location ◽  
Complication Rates ◽  
Inclusion Criteria ◽  
Prospective Data ◽  
Single Center Study

Introduction: Despite good outcomes of CO2 laser of the larynx, a lack of prospective data related to intraoperative complications in the indexed literature is evident. Materials and Methods: An observational, prospective, nonrandomized study. Results: One hundred and twenty-eight patients met the inclusion criteria. The total rate of intraoperative complications was 14.8% (19/128). The rate of complications according to anatomical location was 7 (38.8%) of 18 for supraglottic tumors and 11 (10.3%) of 107 for glottic tumors, and 1 (33.3%) of 3 for subglottic tumors ( P = .001). We do not found difference in complications according to severity (minor vs major complication). Conclusion: Previous studies reported good oncologic outcomes and low complication rates with CO2 transoral laser microsurgery (TOLMS) compared to traditional open surgery. However, it is important to consider the different intraoperative surgical, major and minor complications related to CO2 TOLMS and discuss this with our patients during the preoperative assessment, especially in those patients who need a supraglottic tumor resection.

Complications of Diagnostic Arteriography Performed by a Vascular Surgeon in a Recent Series of 558 Patients

Vascular ◽  
2007 ◽  
Vol 15 (2) ◽  
pp. 92-97 ◽  
Author(s):  
Ali F. AbuRahma ◽  
Michael Elmore ◽  
John Deel ◽  
Bandy Mullins ◽  
John Hayes
Keyword(s):  
Operative Time ◽  
Perioperative Complications ◽  
Operating Time ◽  
Major Complication ◽  
Aortic Aneurysms ◽  
Complication Rates ◽  
Vascular Surgeon ◽  
Technical Success Rate ◽  
Abdominal Aortic ◽  
The Mean

This article analyzes the complication rates of diagnostic arteriographies performed by a single vascular surgeon and compares them to those previously published by interventional radiologists. Five hundred fifty-eight consecutive patients who underwent diagnostic arteriographies were analyzed. A modification of one study's criteria was used to compile perioperative complications. The technical success rate was 99%. These included 345 aortoiliofemoral arteriograms with runoff, 64 aortoiliofemoral arteriograms for abdominal aortic aneurysms, 83 aortoiliofemoral arteriograms with contralateral selective iliacs, 35 aortoiliofemoral arteriograms with carotids, and 27 aortoiliofemoral arteriograms with selective visceral/renal. Femoral artery puncture was used in 93%, and left brachial artery in 7%. The mean amount of contrast was 97 cc and the mean operative time was 25 minutes. The overall complication rate was 3.8% (1.3% major), which was comparable to what was published previously (1.9% and 2.9%) but superior to what we published previously as performed by our radiologists (7%, p <.001). A logistic regression could not find any variables that were significant for the prediction of a major complication. However, increased age, a longer operating time (≥ 30 minutes), and smoking were associated with an increase in overall complications. It was determined that diagnostic arteriography can be done safely by experienced vascular surgeons with low complication rates that compare favorably with what was published by interventional radiologists.

Intermediate-term Experience With the STAR Total Ankle in the United States

2018 ◽  
Vol 40 (3) ◽  
pp. 268-275 ◽  
Author(s):  
Evan M. Loewy ◽  
Thomas H. Sanders ◽  
Arthur K. Walling
Keyword(s):  
United States ◽  
Perioperative Complications ◽  
Case Series ◽  
Major Complication ◽  
The United States ◽  
Complication Rates ◽  
Level Of Evidence ◽  
Patient Reported ◽  
The Mean

Background: Limited intermediate and no real long-term follow-up data have been published for total ankle arthroplasty (TAA) in the United States. This is a report of clinical follow-up data of a prospective, consecutive cohort of patients who underwent TAA by a single surgeon from 1999 to 2013 with the Scandinavian Total Ankle Replacement (STAR) prosthesis. Methods: Patients undergoing TAA at a single US institution were enrolled into a prospective study. These patients were followed at regular intervals with history, physical examination, and radiographs; American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale scores were obtained and recorded. Primary outcomes included implant survivability and functional outcomes scores. Secondary outcomes included perioperative complications such as periprosthetic or polyethylene fracture. Between 1999 and 2013, a total of 138 STAR TAAs were performed in 131 patients; 81 patients were female. The mean age at surgery was 61.5 ± 12.3 years (range, 30-88 years). The mean duration of follow-up for living patients who retained both initial components at final follow-up was 8.8±4.3 years (range 2-16.9 years). Results: The mean change in AOFAS Ankle-Hindfoot scores from preoperative to final follow-up was 36.0 ± 16.8 ( P < .0001). There were 21 (15.2%) implant failures that occurred at a mean 4.9 ± 4.5 years postoperation. Ten polyethylene components in 9 TAAs (6.5%) required replacement for fracture at an average 8.9 ± 3.3 years postoperatively. Fourteen patients died with their initial implants in place. Conclusion: This cohort of patients with true intermediate follow-up after TAA with the STAR prosthesis had acceptable implant survival, maintenance of improved patient-reported outcome scores, and low major complication rates. Level of Evidence: Level IV, case series.

Perioperative and swallowing outcomes in patients undergoing 4- and 5-level anterior cervical discectomy and fusion

2021 ◽  
pp. 1-8
Author(s):  
S. Harrison Farber ◽  
David J. Mauler ◽  
Soumya Sagar ◽  
Mark A. Pacult ◽  
Corey T. Walker ◽  
...  
Keyword(s):  
Food Intake ◽  
Perioperative Complications ◽  
Intraoperative Complications ◽  
Feeding Tube ◽  
Solid Food ◽  
Anterior Cervical Discectomy ◽  
Complication Rates ◽  
Cervical Discectomy ◽  
The Mean ◽  
Swallowing Outcomes

OBJECTIVE Anterior cervical discectomy and fusion (ACDF) is a common and robust procedure performed on the cervical spine. Literature on ACDF for 4 or more segments is sparse. Increasing the number of operative levels increases surgical complexity, tissue retraction, and risks of complications, particularly dysphagia. The overall risks of these complications and rates of dysphagia are not well studied for surgery on 4 or more segments. In this study, the authors evaluated their institution’s perioperative experience with 4- and 5-level ACDFs. METHODS The authors retrospectively reviewed patients who underwent 4- or 5-level ACDF at their institution over a 6-year period (May 2013–May 2019). Patient demographics, perioperative complications, readmission rates, and swallowing outcomes were recorded. Outcomes were analyzed with a multivariate linear regression. RESULTS A total of 174 patients were included (167 had 4-level and 7 had 5-level ACDFs). The average age was 60.6 years, and 54.0% of patients (n = 94) were men. A corpectomy was performed in 12.6% of patients (n = 22). After surgery, 56.9% of patients (n = 99) experienced dysphagia. The percentage of patients with dysphagia decreased to 22.8% (37/162) at 30 days, 12.9% (17/132) at 90 days, and 6.3% (5/79) and 2.8% (1/36) at 1 and 2 years, respectively. Dysphagia was more likely at 90 days postoperatively in patients with gastroesophageal reflux (OR 4.4 [95% CI 1.5–12.8], p = 0.008), and the mean (± SD) lordosis change was greater in patients with dysphagia than those without at 90 days (19.8° ± 13.3° vs 9.1° ± 10.2°, p = 0.003). Dysphagia occurrence did not differ with operative implants, including graft and interbody type. The mean length of time to solid food intake was 2.4 ± 2.1 days. Patients treated with dexamethasone were more likely to achieve solid food intake prior to discharge (OR 4.0 [95% CI 1.5–10.6], p = 0.004). Postsurgery, 5.2% of patients (n = 9) required a feeding tube due to severe approach-related dysphagia. Other perioperative complication rates were uniformly low. Overall, 8.6% of patients (n = 15) returned to the emergency department within 30 days and 2.9% (n = 5) required readmission, whereas 1.1% (n = 2) required unplanned return to surgery within 30 days. CONCLUSIONS This is the largest series of patients undergoing 4- and 5-level ACDFs reported to date. This procedure was performed safely with minimal intraoperative complications. More than half of the patients experienced in-hospital dysphagia, which increased their overall length of stay, but dysphagia decreased over time.

Pterygium Surgery with Conjunctival Autograft Fixation Using Bipolar Electrocauterization

2020 ◽  
pp. 112067212096548
Author(s):  
Fernando Quadros Costa ◽  
Ricardo Quadros Costa ◽  
José Bonifácio Barbosa ◽  
José Álvaro Pereira Gomes
Keyword(s):  
Outcome Measure ◽  
Intraoperative Complications ◽  
Case Series ◽  
Bulbar Conjunctiva ◽  
Complication Rates ◽  
Safe Procedure ◽  
Conjunctival Autograft ◽  
Pterygium Surgery ◽  
The Mean

Purpose: To report a case series of pterygium surgery with conjunctival autograft fixation using bipolar electrocautery. Design: A noncomparative, retrospective, interventional case series of pterygium surgery with follow-up longer than 12 months to assess recurrence and other complication rates. Participants: Fifty-six eyes of 37 patients were treated between April 2011 and January 2018, either for primary ( n = 53 cases) or recurrent ( n = 3 cases) pterygia. Intervention: After pterygium excision, free conjunctival grafts from the inferior bulbar conjunctiva of the same eye were harvested and fixated with the use of bipolar electrocautery. Main outcome measure: Recurrence of the pterygium and complications. Results: The mean follow-up was 41 months (range 12 to 81 months). There were no intraoperative complications. Recurrence of the lesion was seen in three eyes (5.36%). There were no other postoperative complications such as graft detachment, or formation of dellen or granulomas. Conclusion: Conjunctival autograft fixation using bipolar electrocautery seems to be a fast, costly and safe procedure that can be applied in most cases of pterygium surgery.

Đánh giá kết quả sớm điều trị ung thư đại tràng bằng phẫu thuật nội soi

2021 ◽  
Author(s):  
Thanh Xuan Nguyen
Keyword(s):  
Colon Cancer ◽  
Laparoscopic Surgery ◽  
Intraoperative Complications ◽  
Common Disease ◽  
Diagnostic Colonoscopy ◽  
Female Ratio ◽  
Operative Outcomes ◽  
Male Female Ratio ◽  
Duration Of Hospitalization ◽  
The Mean

TÓM TẮT Đặt vấn đề: Ung thư đại tràng là một bệnh lý hay gặp ở Việt Nam, đứng hàng thứ hai sau ung thư dạ dày trong ung thư đường tiêu hóa. Điều trị ung thư đại tràng chủ yếu là phẫu thuật cắt đoạn đại tràng mang theo khối u kèm hạch và hóa chất bỗ trợ. Phẫu thuật nội soi điều trị ung thư đại tràng mang lại nhiều hiệu quả và ngày càng được ứng dụng rộng rãi. Phương pháp nghiên cứu: Nghiên cứu tiến cứu, lâm sàng mô tả 35 bệnh nhân được chẩn đoán là ung thư đại tràng được phẫu thuật nội soi tại bệnh viện Trung ương Huế cơ sở 2 từ tháng 1/2019 đến 6/2021. Kết quả: Tuổi trung bình 62,4 ± 17,8 (34 - 82), giới tính nam/nữ: 1,2. Vị trí u bao gồm: u đại tràng phải chiếm 31,4%, đại tràng ngang 11,5%, đại tràng trái 25,7%, đại tràng sigma 31,4%. Hình ảnh quan sát qua nội soi đại tràng thể sùi chiếm tỷ lệ cao nhất 82,9%. Nồng độ CEA tăng trước mổ chiếm 42,9%. Theo TNM u tập trung ở giai đoạn II, III chiếm tỉ lệ cao nhất 80%. Thời gian phẫu thuật trung bình: 168,7 ± 31,4 phút, thời gian nằm viện sau mổ trung bình: 10,8 ± 4,9 ngày. Tai biến trong mổ không có, biến chứng sớm sau phẫu thuật có 5/35 bệnh nhân nhiễm trùng vết mổ. Kết luận: Phẫu thuật nội soi điều trị ung thư đại tràng là một phương pháp hiệu quả, an toàn, tỉ lệ tai biến và biến chứng sau mổ ít. ABSTRACT OPERATIVE OUTCOMES OF LAPAROSCOPIC SURGERY FOR COLON CANCER Background: Colon cancer is a common disease in Vietnam, ranking second after gastric cancer in gastrointestinal cancers. Treatment of colon cancer is mainly based on surgery to excise the colon with tumor and adjuvant chemotherapy. Laparoscopic surgery for colon cancer increasingly shows its effectiveness and is widely used. Methods: A prospective, descriptive study was conductedon 35 patients with colon cancer who were treated by laparoscopicsurgery at the Hue Central Hospital - Branch 2 from January 2019 to June 2021. Result: The mean age was 62.4 ± 17.8 (34 - 82); the male/ female ratio was 1.2. The sites of cancer were: right colon 31.4%; transverse colon 11.5%; left colon 25.7%; sigma colon 31.4%. Protrusive tumors were accounted for 82.9% by diagnostic colonoscopy. Elevation of CEA serum level wasfound in 42.9% preoperatively. TNM stage of II and III were the most 80%. The mean operativetime was 168.7 ± 31.4 minutes. The mean duration of hospitalization was 10.8 ± 4.9 days. No intraoperative complications were found. The rate of wound infection was 14.3%. Conclusion: Laparoscopic surgery for colon cancer is a safe and effective surgical technique with less postoperative pain and a low rate of postoperative complications. Keywords: Colon cancer, laparoscopic.

scholarly journals Endovascular treatment of medium and large intracranial aneurysms with large volume coils: A single-center experience

2022 ◽  
Vol 13 ◽  
pp. 9
Author(s):  
Giancarlo Saal-Zapata ◽  
Basavaraj Ghodke ◽  
Melanie Walker ◽  
Ivethe Pregúntegui-Loayza ◽  
Rodolfo Rodríguez-Varela
Keyword(s):  
Endovascular Treatment ◽  
Clinical Outcomes ◽  
Large Volume ◽  
Intracranial Aneurysms ◽  
Intraoperative Complications ◽  
Complication Rates ◽  
Single Center ◽  
Single Center Experience ◽  
The Mean

Background: Large volume coils are an alternative to conventional coils for the treatment of intracranial aneurysms. However, there are no published reports documenting occlusion and complication rates in medium and large intracranial aneurysms. Therefore, we present our results in this subgroup of aneurysms. Methods: A single-center, retrospective analysis of consecutive patients treated with Penumbra coils 400 in aneurysms ≥7 mm was performed. Demographics, aneurysm features, procedural details, intraoperative complications, clinical outcomes, and occlusion rates were analyzed. Results: Thirty-three patients were included for analysis, and a total of 33 intracranial aneurysms were analyzed. Mean age was 57.6 years (SD ± 12.4) and 85% of the patients were women. Large aneurysms represented 46% of cases. Paraclinoid (55%) followed by posterior communicating (30.3%) aneurysms was the most frequently treated. Ruptured and saccular aneurysms were found in 49% and 63% of the cases, respectively. The mean aneurysmal dimensions were 14.2 mm width, 11.9 mm length, 5.4 mm neck, and 2.4 dome-to-neck ratio. A dome-neck ratio <2 was identified in 39% of cases. The mean number of coils per aneurysm was 4.8. Immediate modified Raymond–Roy Grades 1, 2, and 3A were achieved in 15%, 21%, and 64%, respectively. Twenty-six patients were evaluated at a mean follow-up period of 11 months, with an adequate occlusion of 92% and a good clinical outcome (modified Rankin score ≤2) in 96% of patients. Conclusion: Endovascular treatment with PC400 coils is an effective and safe option for medium and large intracranial aneurysms with high occlusion rates, few complications, and good clinical outcomes at follow-up.

scholarly journals Blossom smart expander technology for tissue expander-based breast reconstruction facilitates shorter duration to full expansion: A pilot study

2020 ◽  
Vol 47 (5) ◽  
pp. 419-427
Author(s):  
Youna K. Choi ◽  
Danielle H. Rochlin ◽  
Dung H. Nguyen
Keyword(s):  
Pilot Study ◽  
Breast Reconstruction ◽  
Complication Rate ◽  
Tissue Expander ◽  
Major Complication ◽  
Combination Group ◽  
Complication Rates ◽  
Patient Reported ◽  
The Mean ◽  
Study Participants

Background This study evaluated the Blossom system, an innovative self-filling, rate-controlled, pressure-responsive saline tissue expander (TE) system. We investigated the feasibility of utilizing this technology to facilitate implant-based and combined flap with implant-based breast reconstruction in comparison to conventional tissue expansion.Methods In this prospective, single-center, single-surgeon pilot study, participants underwent either implant-based breast reconstruction or a combination of autologous flap and implantbased breast reconstruction. Outcome measures included time to full expansion, complications, total expansion volume, and pain scores.Results Fourteen patients (TEs; n=22), were included in this study. The mean time to full expansion was 13.4 days (standard error of the mean [SEM], 1.3 days) in the combination group and 11.7 days (SEM, 1.4 days) in the implant group (P=0.78). The overall major complication rate was 4.5% (n=1). No statistically significant differences were found in the complication rate between the combination group and the implant group. The maximum patient-reported pain scores during the expansion process were low, but were significantly higher in the combination group (mean, 2.00±0.09) than in the implant group (mean, 0.29±0.25; P=0.005).Conclusions The reported average duration for conventional subcutaneous TE expansion is 79.4 days, but this pilot study using the Blossom system achieved an average expansion duration of less than 14 days in both groups. The Blossom system may accommodate single-stage breast reconstruction. The overall complication rate of this study was 4.5%, which is promising compared to the reported complication rates of two-stage breast reconstruction with TEs (20%–45%).

scholarly journals Histerectomia Totalmente Laparoscópica: Análise Retrospetiva de 262 Casos

2014 ◽  
Vol 27 (1) ◽  
pp. 73 ◽  
Author(s):  
Cristina Nogueira-Silva ◽  
Samuel Santos-Ribeiro ◽  
Sónia Barata ◽  
Conceição Alho ◽  
Filipa Osório ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Operating Time ◽  
Length Of Hospital Stay ◽  
Major Complication ◽  
Laparoscopic Hysterectomy ◽  
Total Laparoscopic Hysterectomy ◽  
Complication Rates ◽  
Uterine Weight ◽  
Average Hospital ◽  
The Mean

<strong>Introduction:</strong> Hysterectomy is one of the most common gynecological procedures and may be performed either by vaginal approach, laparotomy or laparoscopy. Although total laparoscopic hysterectomy has multiple advantages, conflicting major complication rates have been previously reported.<br /><strong>Objectives:</strong> To describe our experience performing TLH and to evaluate complication rates.<br /><strong>Material and Methods:</strong> A retrospective observational study of all total laparoscopic hysterectomy performed in our department, by the same surgical team, between April 2009 and March 2013 (n = 262), was conducted. Medical records were reviewed for patient characteristics, operating time, uterine weight, post-operative hemoglobin variation, length of hospital stay, and intra and postoperative complications.<br /><strong>Results:</strong> Patient average age was 48.9 ± 9.0 years and 49.2% had previous abdominopelvic surgery. The average body mass index was 26.5 ± 4.5 kg/m2 and 42% of women were either overweight or obese. The mean operating time during the total study period was 77.7 ± 27.5 minutes, but it decreased significantly as the surgical team’s training increased. Average uterine weight was 241.0 ± 168.4g and average hospital stay was 1.49 ± 0.9 days. The mean postoperative hemoglobin variation was -1.5 ± 0.8g/dL. The major and minor complication rates were 1.5% (n = 4) and 11.5% (n = 30), respectively. One procedure was converted to laparotomy and two women<br />had a vaginal vault dehiscence. No important urinary tract or bowel injuries occurred.<br /><strong>Conclusions:</strong> This study demonstrates that, in experienced hands, total laparoscopic hysterectomy is safe and with low complications rates.

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