Kratz, Katherine G., Spytek, Stephanie H., Caceres, Aileen, Lukman, Roy, McCarus, Steven D.
abstract
Study Objective: To prospectively evaluate time required to perform cystoscopy with a laparoscope or a cystoscope after laparoscopic hysterectomy. Urinary tract symptoms, infection, adverse events, and expense were also evaluated. Design: Randomized, single-blind pilot study (Canadian Task Force classification 1). Setting: Suburban private gynecology group practice and local community hospital. Subjects: Sixty-six subjects scheduled to undergo laparoscopic hysterectomy between January and July 2009. Intervention: Either cystoscopy with a laparoscope or a cystoscope. Measurements and Main Results: Subjects were randomized to undergo either form of cystoscopy, and events were reported. Each subject completed self-reported urinary tract symptom questionnaires before surgery and at 2 weeks after surgery. Clean-catch urine samples were obtained before surgery and postoperatively at day I and 2 weeks. In the group who underwent laparoscope cystoscopy, a suction-irrigator device, a 5-mm needle-nose suction irrigator tip, and a 5-mm 0-degree video laparoscope were required. In the group who underwent traditional cystoscopy, a 70-degree video telescope with a 17F sleeve, irrigation fluid, and a light source were required. Subjects were followed up for 6 weeks postoperatively. Adverse events were minimal, with 1 in the laparoscope group and 6 in the traditional cystoscope group. Two postoperative urinary tract infections occurred in the traditional cystoscopy group. The mean total procedural time for laparoscope cystoscopy of 137 seconds was statistically less (p < .001) compared with the 296 seconds in the traditional cystoscopy group. Improvements in urinary tract symptom scores improved from baseline, but were not statistically significantly different between the groups. Traditional cystoscopy equipment cost approximately $60 more per subject. Conclusion: The study results suggest that laparoscope cystoscopy is more time-efficient and cost-effective than traditional cystoscopy and that the incidence of urinary tract symptoms, infection, and injury did not increase. Journal of Minimally Invasive Gynecology (2012) 19, 606-614 (c) 2012 AAGL. All rights reserved.