Management of Bladder Injury in Total Laparoscopic Hysterectomy

In Total laparoscopic hysterectomy (TLH), bladder injuries typically occur at the dome with an incidence ranging from 0.02% to 8.3%, necessitating careful identification, closure, and postoperative follow-up. This chapter addresses the challenges in preventing bladder injuries during laparoscopic surgeries, emphasizing the complexity of scenarios encountered in total laparoscopic hysterectomy (TLH) and trying to avoid them by meticulous dissection of vesico-uterine peritoneal folds. Intra-operative recognition of bladder injuries is crucial, with signs such as gas in Foley’s catheter, hematuria, or a suprapubic mass. Missed intra-operative injuries lead to postoperative complications hence, confirmatory measures include transurethral injection of indigo carmine or methylene blue and cystosufflation. Careful laparoscopic closure and follow up these injuries has been discussed.