A Retrospective Audit of Gynaecological Laparoscopy performed at Groote Schuur Hospital from July 2015 to June 2017

Bagratee, Sharvay

A Retrospective Audit of Gynaecological Laparoscopy performed at Groote Schuur Hospital from July 2015 to June 2017

Thesis / Dissertation

2026

Publisher

University of Cape Town

Department

Department of Obstetrics and Gynaecology

Faculty

Faculty of Health Sciences

Abstract

INTRODUCTION: The development and refinement of laparoscopic procedures has resulted in a paradigm shift in the management of surgical conditions. MATERIALS AND METHODS: This study was a retrospective folder review of women who had an elective gynaecological laparoscopy between 1 July 2015 and 30 June 2017. Patients were identified from theatre records. Folders were retrieved and data were collected using a template. The data were double entered and then compared to eliminate capture error. Statistical analysis was performed with STATA Statistics. Inclusion criteria were all elective gynaecological laparoscopies during the stipulated period. RESULTS: A total of 355 patients were identified from theatre records, 49 patients were excluded (6 laparotomies, 30 emergencies, 13 folders absent or missing notes). Finally, 306 patients were included in the study. The age range was 17 to 80 years. BMI was recorded for 148 patients (48,3%) of whom 42 (28,4%) were overweight and 62 (41,9%) were obese. Medical comorbidities were reported in 113 (37%) patients, mainly hypertension and diabetes (combined 26%). At least one previous abdominal surgical procedure was recorded for 132 patients (43,1%). Of these, 104 patients (33,4%) had a previous laparoscopy and 58 patients (19%) had a previous laparoscopy for the same indication or diagnosis. The most reported symptoms were pain (n=138; 45,1%), infertility (n=84; 27,5%) and abnormal uterine bleeding 8 (n=82; 26,8%). The common diagnoses were infertility (n=82; 26,8%), chronic pelvic pain (n=72; 23,5%), adnexal mass (n=47; 15,4%) and endometriosis (n=42; 13,8%). The Reproductive Medicine Unit performed 169 (55,2%) of the surgeries. A specialist or subspecialist trainee was the primary surgeon in 258 cases (84,3%). The procedures most performed were diagnostic laparoscopy (n=86; 28,1%), salpingectomy (n=55; 18%), total laparoscopic hysterectomy (n=50; 16,3%), cystectomy (n=40; 13,1%) and excision of endometriosis (n=29; 9,5%). Adhesiolysis was an unexpected additional procedure in 108 (35,3%) surgeries. The average procedure duration was 117 minutes (SD 65,4 minutes). The average blood loss, where numerically recorded, was 160,4ml (SD 176,6ml). The complication rates, both intra-operative (n=25; 8,2%) and post-operative (n=24; 7,8%), were comparable to international rates. There was no mortality secondary to surgery. Intra-operative conversion to laparotomy was required in 11 (3,6%) patients. Nine women had visceral injury. Sepsis was the most common post-operative complication (n=9; 2.94%), either systemic or at the local port-site. Three patients required relook laparotomies (0,98%). Follow up data were available for 226 (73,9%) patients of whom 151 (66%) reported resolution of symptoms and satisfaction with the surgery. CONCLUSION: Laparoscopy has become an increasingly utilized surgical approach in gynaecology. The gynaecology units at GSH perform appropriate, safe, and at times complex laparoscopic procedures with good outcomes and low complication rates. Emphasis must be placed on the development of laparoscopic skills in all specialist trainees.