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We retrospectively analysed our first 1,275 laparoscopic hysterectomies for ureteric injuries. All patients scheduled for hysterectomy in two private gynaecological practices in Sydney and Adelaide over the past decade were offered laparoscopic hysterectomy using a linear cutter stapling device for securing uterine vascular pedicles. The stapling of the uterine vascular pedicles resulted in the injury of four ureters in the first 275 cases (1.45%), whereas in the subsequent 1,000 cases there was only one such injury (0.1%). In light of our data and the reviewed literature, we conclude regarding ureteric injury at laparoscopic hysterectomy that: in the early days it was probably more the result of surgical inexperience and technique development rather than instrument failure; in experienced hands and with a perfected technique the rate is probably no higher than for abdominal hysterectomy; in experienced hands the rate is probably similar whether stapling or bipolar diathermy is used to secure the uterine vascular pedicles.

Laparoscopic hysterectomy and ureteric injury: a comparison of the initial 275 cases and the last 1,000 cases using staples