Cystoscopy with a 5-mm laparoscope and suction irrigator

To investigate the hypothesis that cystoscopy using a 5-mm suction irrigator and video laparoscope is safe and useful during total laparoscopic hysterectomy (TLH), a retrospective analysis of patients undergoing total or radical laparoscopic hysterectomy over a 10-year period was conducted. Of 744 patients having simple or radical laparoscopic hysterectomy for either benign or malignant indications, 344 had cystoscopy using a 5-mm laparoscope after inflating the bladder with a 5-mm saline suction irrigator. Procedures in which cystoscopy was used took 13 minutes longer (mean: 141 vs 128, p = .0012) and patients lost 30 dL more blood (mean 145 vs 115, p = .0300), but patients did not have a longer hospital stay or more complications. Cystoscopy accurately confirmed cystotomy closure in 12 patients and identified 3 patients with ureteral injury; it did not identify 3 patients who developed a ureteral fistula 7 to 9 days after surgery. One complication was attributable to the cystoscopy. The data from this retrospective series suggest that cystoscopy during TLH is well-tolerated and can accurately reassure surgeons of immediate urologic tract integrity; but it is not useful to identify patients who may later fistulize.