How to Avoid Laparotomy Doing Laparoscopic Hysterectomy

Abstract

Uterine fibroids are benign smooth muscle tumors of the uterus. They are seen in approximately one in three women and cause significant symptoms in at least half of them (Gentry et al. 2001). Hysterectomy is the ultimate treatment for women suffering from symptomatic myomas, menstrual disorders, endometriosis, and malignancy in the uterus. In Scandinavia, the prevalence of hysterectomy is mostly the same in Denmark, Norway, and Sweden, while the prevalence is almost threefold in Finland (Scott and Scott 1995). About 15 % of Norwegian women will have had a hysterectomy at the age of 60, while the figure will be approximately 40 % among American women (Backe and Lilleeng 1993; Lepine et al. 1997). The difference from one country to another may reflect to what degree women accept symptoms and the impact of doctors’ advice in the current situation. This difference also reflects the treatment modalities chosen by the doctor, in particular with bleeding disorders (i.e., hysterectomy vs. transcervical resection [TCRE] or insertion of levonorgestrel intrauterine device). Since Harry Reich first described total laparoscopic hysterectomy (LH) in 1988 (Reich 1992), endoscopic hysterectomies have become a routine procedure in many gynecologic departments, even though open abdominal hysterectomy is still the dominant surgical technique worldwide. Many advocate the vaginal approach for hysterectomy as an excellent alternative to both abdominal and laparoscopic hysterectomy techniques (Garry et al. 2004). To perform hysterectomy in uterus myomatosus, there are several surgical techniques. For a uterine weight of >1,000 g, after a caesarean section and in nullipara per vaginam, the most common surgical technique for hysterectomy in patients is hysterectomy per laparotomy. There are several surgical techniques: vaginal hysterectomy, abdominal hysterectomy, laparoscopic assisted vaginal hysterectomy, laparoscopic supracervical hysterectomy, and total laparoscopic hysterectomy, according to the wishes of the patient, her parity, and the clinical findings, e.g., adhesions. With a uterine weight of >1,000 g, after a caesarean section and as a nullipara per vaginam, the patient was classified as a difficult minimal-invasive case regarding surgical intervention.