Acta Obstet Gynecol Scand 2001; 80: 383–391 Copyright C Acta Obstet Gynecol Scand 2001 Printed in Denmark ¡ All rights reserved Acta Obstetricia et Gynecologica Scandinavica ISSN 0001-6349 REVIEW ARTICLE Safety aspects of laparoscopic hysterectomy PA ¨ IVI HA ¨ RKKI, TAPIO KURKI, JARI SJO ¨ BERG AND AILA TIITINEN From the Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland Acta Obstet Gynecol Scand 2001; 80: 383–391. C Acta Obstet Gynecol Scand 2001 Key words: complication; laparoscopic hysterectomy; laparoscopy; registers; safety Submitted 26 June, 2000 Accepted 27 November, 2000 Hysterectomy is one of the most frequently per- formed of all surgical operations and approxi- mately 10,000 hysterectomies are performed annu- ally in Finland (1). A lifetime risk of a woman to undergo hysterectomy has been 30% in the United States (2), 20% in Finland (1) and in the United Kingdom (3), but only 10% in Sweden (4) and Denmark (5). Traditionally the uterus has been removed by an abdominal or vaginal route. In spite of the lower complication rate in vaginal hysterectomies (6), ab- dominal hysterectomy has been the main method of hysterectomy in most of the countries. More than ten years ago 90–95% of hysterectomies were performed abdominally in Finland (1) and in Sweden (7), 70–80% in the United States (8) and in the United Kingdom (3) but only 40% in Aus- tria (9). The optimum approach to hysterectomy would retain the advantages of the abdominal route, which include clear visualization and ease of manipulation of the adnexal structures, and to combine these features with the principal advan- tage of vaginal hysterectomy, namely avoidance of a large abdominal incision. Laparoscopic hyster- ectomy tries to combine these techniques and it has already influenced approaches to hysterectomy, offering a short recovery for the patient (10). How- Abbreviations: LAVH: laparoscopically assisted vaginal hysterectomy; LH: laparoscopic hysterectomy; LSH: laparoscopic supracervical hysterectomy; SAH: subtotal abdominal hysterectomy; TAH: total abdominal hysterectomy; TLH: total laparoscopic hyster- ectomy; VH: vaginal hysterectomy. C Acta Obstet Gynecol Scand 80 (2001) ever, the benefits as regards the size of scars, post- operative pain and recovery times will be irrelevant if the procedure causes unreasonable risks for the patient. Kurt Semm in Germany first described a tech- nique for laparoscopic assistance in vaginal hyster- ectomy in 1984. The adnexa were separated laparo- scopically in order to simplify vaginal hyster- ectomy (11, 12). This was later called laparoscopically assisted vaginal hysterectomy (LAVH) (13). Harry Reich performed the first laparoscopic hysterectomy (LH) in January, 1988. The ligaments and uterine vessels were cut laparo- scopically but the uterosacral ligaments were clamped as well, as the uterus was removed va- ginally (14). The first laparoscopic hysterectomy in Nordic countries was performed in Norway in 1991 (15) and the first in Finland in 1992 (16). Many alternative ways to combine laparoscopy and hysterectomy have been described. Total laparoscopic hysterectomy (TLH) means that the whole hysterectomy and the closure of vaginal in- cision are carried out laparoscopically (17). Dur- ing laparoscopic supracervical hysterectomy (LSH), the uterine cervix is amputated and the corpus uteri is morcellated or removed through the posterior wall of the vagina (18). Kurt Semm decribed laparoscopic classical intrafascial supra- cervical hysterectomy. The perforation rod is intro- duced transcervically up through the fundus uteri under laparoscopic control. The transcervical- transuterine cylinder is cut and the remaining cer- vix is electrociagulated as the uterus is morcellated