2972 Two-Port Laparoscopic Hysterectomy and Cuff Closure without the use of a Multiport Channel

Abstract

Video Objective To demonstrate a novel technique for a two-port hysterectomy and laparoscopic cuff closure using an operative laparoscope. Setting The previously described port-reducing, single-port or two-port hysterectomy techniques fall into two broad categories. The first employs the use of a multiport channel, which requires a larger fascial defect and is associated with more postoperative pain and higher risks of postoperative hernia formation. The multiport channel is also technically limited by the loss of triangulation and instrument collision. The second technique for port-reducing hysterectomy uses two 5-10 mm ports and requires transvaginal cuff closure. The benefit of smaller incisions and better triangulation comes at the expense of higher rates of cuff dehiscence associated with transvaginal cuff closure. Interventions Two-port laparoscopic hysterectomy, salpingo-oophorectomy, and laparoscopic cuff closure using a 10 mm operative scope plus one additional 5 mm suprapubic port. Conclusion While we acknowledge that vaginal hysterectomy remains the most minimally invasive route of surgery; a two-port hysterectomy would better serve a number of patients with limited vaginal access, or whose indication for surgery is pelvic pain if the initial survey reveals limited pathology. The novel technique we describe combines the benefit of smaller incisions, better triangulation, and laparoscopic cuff closure. To our knowledge, our group is the first to describe that procedure.