Abstract
Video Objective We describe a unique technique to hide trocar scars while performing concurrent laparoscopic hysterectomy and excision of endometriosis at the time of abdominoplasty. Setting This patient is a 40 y/o female undergoing concomitant abdominoplasty and hysterectomy for chronic pelvic pain, abnormal uterine bleeding, and suspected endometriosis. Combining abdominoplasty with gynecologic surgery reduces total anesthesia and operative times, intraoperative blood loss, hospitalization and total recovery time when compared with having both of the procedures performed separately. Additionally, combined surgery does not appear to be associated with an increase in complications. Interventions We perform a total laparoscopic hysterectomy (TLH) and excision of endometriosis with concomitant abdominoplasty. First, the abdominoplasty flap is raised by the plastic surgeon. Then, the TLH and excision of endometriosis is performed. Finally, the rectus is plicated, excess tissue is excised, and the abdominoplasty is completed. Conclusion Performing concomitant total laparoscopic hysterectomy and abdominoplasty offers many benefits to the patient including shorter total operative and anesthesia, as well as shorter recovery when compared to 2 separate procedures. There are no large fascial defects when the hysterectomy is performed laparoscopically with 5 mm ports, so there is minimal concern for hernia or fascial dehiscence. The laparoscopic approach also offers a detailed survey for endometriosis lesions which can be excised at the same time as hysterectomy for definitive therapy. Aesthetically, the laparoscopic trocar sites are hidden when utilizing this technique, which is advantageous for cosmesis.
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