Hum. Reprod. Advance Access originally published online on January 3, 2009
Human Reproduction 2009 24(4):842-849; doi:10.1093/humrep/den467
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Incidence and risk factors of bladder injuries during laparoscopic hysterectomy indicated for benign uterine pathologies: a 14.5 years experience in a continuous series of 1501 procedures
1 Université Paris Descartes, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Universitaire (GHU) Ouest, Centre Hospitalier Universitaire (CHU) Cochin Saint Vincent de Paul, Service de Gynécologie Obstétrique II et Médecine de la Reproduction (Professor Chapron), Paris, France 2 Institut Cochin, Université Paris Descartes, CNRS (UMR 8104), Paris, France 3 INSERM, Unité de Recherche U567, Paris, France
4 Correspondence address. Department of Gynaecology and Obstetrics II and Reproductive Medicine, CHU Cochin—Saint Vincent de Paul, Pavillon Lelong, 82 avenue Denfert Rochereau, Paris 75014, France. Tel: +33-1-58-41-19-14; Fax: +33-1-58-41-18-70; E-mail: charles.chapron{at}cch.ap-hop-paris.fr
BACKGROUND: Laparoscopic hysterectomy is indicated as an alternative to laparotomy when the vaginal route is potentially difficult because of an immobile uterus and a poor vaginal accessibility. The aim of this study was to evaluate the rate, the risk factors for bladder injuries in a series of 1501 laparoscopic hysterectomies indicated for benign uterine pathologies.
METHODS: This study was conducted retrospectively from January 1993 to 2000 and prospectively from 2001 to July 2007.The indications, patients’ characteristics and complications were recorded. The overall rate of bladder injuries, the comparison of means (t test) and percentages (exact 
2 test) between the cases and the population with no injury, the odd ratios (OR) and multivariate analysis were performed using the statistical package for the social sciences software.
RESULTS: The rate of bladder injuries was 1% (15 patients). Risks factors were previous Caesarian section [OR: 4.33, 95% confidence interval (CI): 1.53–12.30] and previous laparotomy (OR: 4.69, 95% CI: 1.59–13.8). The rate of injury decreases with the surgeons' experience and reaches a plateau of 0.4% after 100 hysterectomies performed.
CONCLUSIONS: The rate of bladder injury during total laparoscopic hysterectomy is low and decreases with the surgeon's experience. Bladder injury is not linked to an increase of post-operative morbidity when recognized and repaired during the same laparoscopic procedure. The comparison with other routes of hysterectomies should take into account these risk factors.
Key words: total hysterectomy/operative laparoscopy/laparoscopic hysterectomy/complications/bladder injuries
Submitted on June 30, 2008; resubmitted on November 15, 2008; accepted on November 24, 2008.