Safety Of Total Laparoscopic Hysterectomy Research Articles

Comparison of the efficacy and safety of total laparoscopic hysterectomy without and with uterine manipulator combined with pelvic lymphadenectomy for early cervical cancer.

Some studies have reported that the prognosis of total laparoscopic hysterectomy (TLH) for early-stage cervical cancer (CC) is worse than that of open surgery. And this was associated with the use of uterine manipulator or not. Therefore, this study retrospectively analyzes the efficacy and safety of TLH without uterine manipulator combined with pelvic lymphadenectomy for early-stage CC. Fifty-eight patients with CC (stage IB1-IIA1) who received radical hysterectomy from September 2019 to January 2020 were divided into no uterine manipulator (n = 26) and uterine manipulator group (n = 32). Then, clinical characteristics were collected and intraoperative/postoperative related indicators were compared. Patients in the no uterine manipulator group had significantly higher operation time and blood loss than in the uterine manipulator group. Notably, there was no significant difference in hemoglobin change, blood transfusion rate, number of pelvic nodules, anal exhaust time, complications and recurrence rate between the two groups. Additionally, patients in the uterine manipulator group were prone to urinary retention (15.6%) and lymphocyst (12.5%), while the no uterine manipulator group exhibited high probability of bladder dysfunction (23.1%) and urinary retention (15.4%). Furthermore, the 1-year disease-free survival rate and the 1-year overall survival rate were not significantly different between the two groups. There was no significant difference in the efficacy and safety of TLH with or without uterine manipulator combined with pelvic lymphadenectomy in the treatment of patients with early-stage CC. However, the latter requires consideration of the negative effects of high operation time and blood loss.

Impact of clinicopathological variables on laparoscopic hysterectomy complications, a tertiary center experience.

To analyze intraoperative and postoperative complications according to Clavian-Dindo Classification (CDC) and evaluate the influence of clinicopathological features on the feasibility and safety of total laparoscopic hysterectomy (TLH) in patients that underwent surgery in a tertiary center. We retrospectively reviewed the database of 469 patients that underwent surgery for patients who underwent extra facial TLH from 2013 to 2020. A total of 86 (18.3%) peri-postoperative complications were observed. The incidence of intraoperative complications was 2% (n = 10). The overall conversion rate to open surgery was 1.9% (n = 9). A total of 76 postoperative complications were observed in 61 patients (14.3%). The incidence of minor (Grade I [n = 16, 3.4%] and II [n = 42, 8.9%]) and major complications (Grade III [n = 15, 3.2%], IV [n = 2, 0.4%] and V [n = 1, 0.2 %]) were 12.3% and 3.8%, respectively. A higher BMI and performing surgery at the first step of learning are found to be associated with intraoperative and postoperative complications (p < 0.05). Postoperative complications related to having a history of the cesarean section, additional comorbidities, and uterine weight ≥ 300 g (p < 0.05). The implementation of TLH by experienced surgeons appears to have remarkable advantages over open surgery. However, the risk factor for complications should be taken into account by surgeons in the learning curve in selecting the appropriate patient for surgery.

Feasibility and safety of total laparoscopic hysterectomy for uteri weighing from 1.5kg to 11.000kg.

To assess the feasibility and safety of total laparoscopic hysterectomy (TLH) for uteri ≥ 1.5kg. We prospectively evaluated all elective TLHs (with or without adnexectomy) performed for fibromatous uteri between August 2009 and August 2019 in the Department of Obstetrics and Gynecology, Sirai Hospital, Carbonia, and the Department of Gynecologic Oncology, Businco Hospital, Azienda Ospedaliera Brotzu, Cagliari. Patients with large myomatous uteri (uterine weight ≥ 1.5kg on pathology reports) were included in the analysis. We examined all procedures and collected data about intra- and post-operative short-term and long-term complications, intraoperative blood loss, operative time, hospital stay, and time to achieve well-being. Seventy-eight patients were included. The median weight was 2,000g (range 1,500-11,000g), estimated blood loss was 100mL (range 10-700mL), operating time was 135min (range 60-300min), and hospital stay was 2days (range 2-5days). Conversion to laparotomy occurred in 4 patients (5.1%) with uterine weight ranging from 3 to 5.5kg, due to severe adherence syndrome or inadequate visualization. As for intraoperative complications, 1 patient (who had the largest removed uterus weighing 11,000g) experienced an intraoperative ureteral injury (grade III). No major postoperative complications occurred. This study provides the largest case series of TLH for fibromatous uteri > 1.5kg and includes some of the largest uteri reported to date in the literature (weighing 5,320, 5,720, and 11,000g, respectively). The study reaffirms the feasibility and safety of a minimally invasive hysterectomy even in the case of abnormally large uteri.

Outcome of total laparoscopic hysterectomy in relation to BMI – A prospective study

Introduction: Laparoscopy can be more complicated in the obese patient, but the complications tend to decrease over time with surgical experience. The aim of this study was to know the safety of total laparoscopic hysterectomy (TLH) for benign diseases in overweight and obese women when compared with women with lesser BMI. Materials and Methods: Total of 105 cases of TLH were analysed prospectively from October 2014 to August 2016. The patients were divided into 4 groups based on BMI; underweight, normal weight, overweight and obese and the demographic data and intra and post-operative parameters were recorded until one month post-operative follow up. The data obtained was analyzed using descriptive and inferential statistics. Result: Of 105 patients, 2(1.9%) were underweight, 14(13.3%) were normal weight, 20(19.0%) were overweight and 69 (65.7%) were obese. Majority were in the age group of 40 to 50 years. Fibroid was the main indication for hysterectomy. There were more number of women with blood loss of more than 100ml in overweight and obese group but the difference was not statistically significant. None of the women in all the groups suffered any major complication. The operation time was more in obese women when compared with the other groups but the difference was not statistically different. Also, when we compared the pain scores at 6 hours, 24 hours and at discharge, we found no difference between the groups. Conclusion: TLH is safe and effective in women of all BMI categories undergoing hysterectomy for benign diseases. Keywords: TLH, BMI, Operation time, Complications, Pain score, Opioid analgesia.

Feasibility and safety of total laparoscopic hysterectomy for huge uteri without the use of uterine manipulator: description of emblematic cases

BackgroundUterine manipulator is a very useful tool in performing total laparoscopic hysterectomy (TLH) for large uteri; however, in some cases, it cannot be used due to unfavorable anatomical conditions. The feasibility and safety of TLH for very large uteri without the use of uterine manipulator has not yet been established.ResultsWe describe two emblematic cases of TLH for huge fibromatous uteri: the first one for a uterus weighing 5700 g, which is the largest uterus laparoscopically removed to date reported in literature, and the second one for a uterus of 3670 g associated with a severe lymph node neoplastic disease.In both cases, TLH was successfully and safely performed even without the use of uterine manipulator, thus allowing a rapid recovery, especially in the second case, which was essential for a fast start of the most appropriate oncological treatment, the best quality of life and undoubtedly cosmetic advantages.ConclusionsAlthough we believe in the great usefulness of the uterine manipulator in performing TLH for huge uteri, in the present paper, we demonstrate the feasibility and safety of such complex surgery also when the use of this tool is not possible due to unfavorable anatomical condition.

腹腔鏡下子宮全摘出術における3つの術式の比較検討―LAVH（laparoscopically assisted vaginal hysterectomy）、LH（laparoscopic hysterectomy）とTLH（total lapaloscopic hysterectomy）の後方視的検討―

Objective: We aimed to confirm the safety of total laparoscopic hysterectomy (TLH). We compared surgical morbidity in laparoscopically-assisted vaginal hysterectomy (LAVH), laparoscopic hysterectomy (LH), and TLH in the treatment of benign gynecologic diseases.

Safety of total laparoscopic hysterectomy in patients with prior cesarean section.

Patients who have undergone a cesarean section (CS) prior to hysterectomy are at a higher perioperative risk of complications. The purpose of this study was to evaluate the safety of total laparoscopic hysterectomy (TLH) in patients with prior CS. We enrolled 482 patients treated with TLH. Surgical outcomes including major complications were compared between patients without prior CS (no CS group; n = 324) and patients with prior CS (prior CS group; n = 158). Major complications included vaginal cuff dehiscence, and bowel, bladder, ureter and great vessel injuries. Major complications, uterus weight, hospital day, unscheduled transfusion and conversion to laparotomy did not differ significantly between groups. One bowel injury occurred in the no CS group. Two vaginal cuff dehiscences and one bladder injury occurred in the prior CS group. There were no ureter or great vessel injuries. Operation duration was longer (P = 0.030) in the prior CS group, but only seven minutes longer than the no CS group. The Foley catheter indwelling day was also significantly longer (P < 0.001) in the prior CS group, but did not last one day. The number of prior CS had no effect on the major complication rate. After treatment of major complications, no long-term sequelae were observed. TLH in patients with a history of CS can be performed safely as such history had no effect on the major complication rate. Complications were rare and were treated successfully.

Low-cost total laparoscopic hysterectomy by single-incision laparoscopic surgery using only reusable standard laparoscopic instruments

The purpose of this study was to demonstrate the feasibility and safety of total laparoscopic hysterectomy (TLH) by single-incision laparoscopic surgery (SILS) with conventional, reusable laparoscopic instruments, inserted through an inexpensive, self-constructed single-port device. Between June 2013 and April 2014, 15 TLHs by SILS were performed by a single surgeon (BJ). Only conventional, reusable laparoscopic instruments were used. The self-constructed single-port device was made by assembling a surgical glove, a wound protector, one reusable 10-mm trocar, and four reusable 5-mm trocars. The vaginal cuff was closed by intracorporeal suturing. Patient and perioperative data were analysed. Fifteen patients underwent TLH by SILS, and no conversion to standard laparoscopy or laparotomy was necessary. Mean operation time was 97 min (55–135 min), and mean drop in haemoglobin level was 1.2 g/dl (0–2.4 g/dl). There were no operative complications. Postoperative pain scores were low. The mean weight of the removed uterus was 118 g (50–208 g). TLH by SILS is feasible even when performed with reusable, conventional laparoscopic instruments. An inexpensive, self-constructed single-port device allows every surgeon worldwide to accomplish single-incision surgery without the need to invest in expensive ports, disposable instruments, sealing devices, or auto-locking sutures.

Feasibility and safety of outpatient total laparoscopic hysterectomy.

Background and Objective:Ambulatory total laparoscopic hysterectomy (TLH) could lead to significant cost savings, but some fear the effects of what could be premature postsurgical discharge. We sought to estimate the feasibility and safety of TLH as an outpatient procedure for benign gynecologic conditions.Methods:We report a prospective, consecutive case series of 128 outpatient TLHs performed for benign gynecologic conditions in a tertiary care center.Results:Of the 295 women scheduled for a TLH, 151 (51%) were attempted as an outpatient procedure. A total of 128 women (85%) were actually discharged home the day of their surgery. The most common reasons for admission the same day were urinary retention (19%) and nausea (15%). Indications for hysterectomy were mainly leiomyomas (62%), menorrhagia (24%), and pelvic pain (9%). Endometriosis and adhesions were found in 23% and 25% of the cases, respectively. Mean estimated blood loss was 56 mL and mean uterus weight was 215 g, with the heaviest uterus weighing 841 g. Unplanned consultation and readmission were infrequent, occurring in 3.1% and 0.8% of cases, respectively, in the first 72 hours. At 3 months, unplanned consultation, complication, and readmission had occurred in a similar proportion of inpatient and outpatient TLHs (17.2%, 12.5%, and 4.7% versus 18.1%, 12.7%, and 5.4%, respectively). In a logistic regression model, uterus weight, presence of adhesions or endometriosis, and duration of the operation were not associated with adverse outcomes.Conclusion:Same-day discharge is a feasible and safe option for carefully selected patients who undergo an uncomplicated TLH, even in the presence of leiomyomas, severe adhesions, or endometriosis.

Does previous abdominal surgery effect the feasibility of total laparoscopic hysterectomy?

The primary aim of this study is to evaluate the effects of previous abdominal surgery on the feasibility of performing and the safety of total laparoscopic hysterectomy (TLH). In this retrospective study, we analysed 62 laparoscopic hysterectomies which were performed at our institute between February 2011 and January 2013. We chose to perform laparoscopic surgery for all patients, including those who had previously undergone abdominal surgery. The patients were classified into two groups: Group 1 included patients with a history of abdominal surgery (n=24) and Group 2 included patients without a history of abdominal surgery (n=38). THE OPERATING PERIOD WAS COMPARED IN BOTH GROUPS: 184.43±51.0 min. for Group 1 and 195.41±64.1 min. for Group 2 (p=0.471). Postoperative hospital stay and blood loss was also compared. There was just 1 conversion from TLH to a laparotomy in both groups. None of the patients in Group 1 needed a blood transfusion, whereas 1 in Group 2 did. We found that operation time, postoperative hospital stay, blood loss, rate of operative complications or conversion rate to open surgery between patients with and without a history of abdominal surgery were comparable. Therefore, it appears that a history of abdominal surgery does not adversely affect the safety of TLH.

Evaluation of total laparoscopic hysterectomy with lymphadenectomy in surgical treatment of endometrial cancers

The study was conducted to evaluate the efficacy feasibility and safety of total laparoscopic hysterectomy (TLH) with lymphadenectomy in the treatment of endometrial cancer The retrospective study included 31 patients with endometrial cancer who underwent TLH with lymphadenectomy and 42 patients with endometrial cancer who were operated by laparotomy. In both groups the following parameters were analyzed: age, BMI, accompanying diseases, previous surgeries, parity duration of the surgery blood loss (complete blood count before and after the operation was compared), necessity of blood transfusion, length of hospital stay uterine volume, grade, stage of endometrial cancer (FIGO), and intra/ postoperative complications. Mean age of patients was lower in the laparoscopic group than in women operated by laparotomy: 54 and 64, respectively (p = 0.0001). There were no significant differences between both groups in BMI, uterine volume, grade, staging (FIGO), and parity The percentage of patients with accompanying chronic diseases in the TLH group was lower than in the laparotomy group: 48.39% and 83.34%, respectively (p = 0,032). There were no significant differences between both group in the history of previous laparotomies (p = 0.704). Mean duration of surgery was shorter in the case of laparotomy than in case of laparoscopy: 130.6 and 151.77, respectively (p = 0.003). Laparotomy was associated with greater blood loss during surgery Statistically significantly higher decrease in the Hb concentration and Hct values was noted in the group operated by laparotomy when compared to laparoscopy (mean values.: Hb-1.1 7 g/dl, Hct-3.49% for the TLH technique and Hb-7.8 g/dl Hct-5.47% for laparotomy; p = 0.011-Hb; p = 0.003-Hct). Mean hospital stay after laparoscopy was shorter than after laparotomy--4 and 9 days, respectively (p = 0,0001). The influence of the operational technique on the number of pelvic lymph nodes taken for histopathological examination was evaluated. No statistically significant correlation between the number of lymph nodes taken for histopathological examination during the surgery and the operational technique was noted (p = 0.083). Mean number of nodes taken for examination was 15 during the TLH surgery and 19 during laparotomy Postoperative complications were observed in 2 patients from the TLH and in 12 patients from the laparotomy groups (p = 0.038). The most statistically significantly frequent complication in the laparotomy group was postoperative wound infection: 8 (19.05%) patients. Total laparoscopic hysterectomy with lymphadenectomy in endometrial cancer therapy is a safe and feasible procedure. It is characterized by significantly smaller percentage of complications and shorter hospital stay This technique offers an alternative for laparotomy when it is performed by a highly experienced surgeon.

Assessing the Feasibility of Prolapse Repair with TLH without the Use of Mesh

To assess the efficacy, success and safety of Total Laparoscopic Hysterectomy for significant utero vaginal prolapse without the use of mesh. Patients of utero vaginal prolapse who needed hysterectomy and prolapse repair. Tertiary referral centre for advance endoscopic surgery doing dedicated work in urogynaecology. 7 patients with significant cystocoele, rectocoele and utero vaginal descent outside the introitus. Prolapse repair without the use of mesh. Uterosacral plication and pubocervical fascia plication is done before the colpotomy. After colpotomy the vaginal vault angles are sutured and reinforced by anterior and posterior non-absorbable suture plication. All patients withstood the procedure well and good cures were found immediate post-op and after one year follow-up. Site specific repair of prolapse appears to be a safe and effective way of treating various degrees of prolapse.

Total Laparoscopic Hysterectomy (TLH) Using Roticulating Stapler System Via Transumbilical 12mm Port

The aim of this study was to evaluate the efficacy and safety of total laparoscopic hysterectomy (TLH) by using the roticulating stapler system via transumbilical 12 mm port. We conducted a retrospective review of cases who underwent TLH by using the roticulating stapler system via transumbilical 12 mm port over 1 years. This study was conducted in a tertiary care hospital setting, at the Department of Obstetrics and Gynecology. (Seoul, Korea) A total of 110 patients of TLH done for uterine pathology [leiomyoma in 67 (60.9%), dysfunctional uterine bleeding in 34 (30.9%), and others in 9 (8.1%)]. Total laparoscopic hysterectomy, using the roticulating endo-GIA (Tyco U.S. Surgical, Norwalk, Connecticut) via transumbilical 12 mm port, was done. The mean age of the patients was 43.1 +/- 0.602 years and mean body mass index was 25.19 +/- 0.39 kg/m2. The mean operating time was 57.91 +/- 10.4 minutes, mean intraoperative blood loss was 70.09 +/- 11.64 mL, and the mean weight of the removed uterus was 350.14 +/- 60.62 g. One patients were converted from a laparoscopic to an open procedure (Dense adhesion). There was no intraoperative complication. Postoperative complications included paralytic ileus in 3 (2.7%), retention of urine in 2 (1.8%), and febrile morbidity in 12 (10.9%) patients. There were no bladder or bowel injuries. Laparoscopic hysterectomy by roticulating endo-GIA (Tyco U.S. Surgical, Norwalk, Connecticut) via transumbilical 12 mm port is a safe, efficient procedure with a low complication rate.

Total laparoscopic hysterectomy in patients with previous abdominal surgery

To evaluate the effects of previous abdominal surgery on the feasibility and the safety of total laparoscopic hysterectomy (TLH). One hundred seventy-four consecutive patients who underwent TLH in private hospital between February 2008 and December 2009 were retrospectively reviewed. Surgical history, operation time, blood loss, transfusion, conversion to an open surgery, complications and hospital stay were assessed in each patient. The patients were classified into two groups; patients with or without a history of abdominal surgery. Group 1 included patients with a history of abdominal surgery (n = 44) and Group 2 included patients without a history (n = 130). The complication rate was 6.8% in patients with (Group 1) and 5.4% in patients without (Group 2) a history of abdominal surgery, respectively. No bladder, bowel, ureteral, or vascular injuries occurred in either group. Transfusion was required in one patient without a history of abdominal surgery (Group 2; 0.8%). Three patients with (Group 1; 6.8%) and two patients without (Group 2; 1.5%) a history of abdominal surgery were converted to laparotomy. No statistically significant difference was noted between the groups with respect to the complication and conversion rates. In our study, TLH can be performed successfully in patients with a history of abdominal surgery.

A Cost Effective Method of Total Laparoscopic Hysterectomy for Developing Nations

Study Objective: To study the efficacy and safety of total laparoscopic hysterectomy using only a bipolar forceps, scissors and a single chip camera. Design: Retrospective analysis of 50 consecutive cases of total laparoscopic hysterectomy with a follow up at one week and three months. Setting: A private maternity and endoscopy unit in a developing country. Patients: Fifty women between the ages of 35 to 60 years underwent a total laparoscopic hysterectomy for various indications. Intervention: Total laparoscopic hysterectomy. Measurements and Main Results: A total laparoscopic hysterectomy was performed in all 50 women using only a bipolar forceps as the energy source in combination with laparoscopic scissors and a single chip camera. In 38 patients (76%), the procedure was completed under spinal anesthesia alone. Emphasis was on identification of tissue planes and visualisation of at least 2 cm of uterine artery before coagulation. The average blood loss was 15ml. The average time taken for surgery was one hour and forty minutes. 14 patients (7%) had a previous Caesarean section and required careful bladder dissection. In 4 patients (2%) there was pelvic endometriosis. Both these categories entailed lengthier surgery. There was no conversion to LAVH or open hysterectomy. All the patients were discharged on the 3rd postoperative day with minimal morbidity. Of the 42 patients who came for follow up at one week and three months, all were doing well. There were no delayed complications. Conclusion: Total laparoscopic hysterectomy using only a bipolar forceps, scissors and a single chip camera can be performed safely and effectively in countries where cost is a consideration for the type of instrumentation used. Majority of the cases were completed under spinal anesthesia which is very cost effective. Bringing down the cost of surgery ensures that we can offer the benefits of the laparoscopic approach to a larger segment of women who require hysterectomy.

Case Series Analysis: Biclamp® Total Laparoscopic Hysterectomy Versus Biclamp® Vaginal Hysterectomy – Is There a Clear Winner?

Study Objective: To compare burgeoning techniques of hysterectomy, compare efficacy of and safety of Total Laparoscopic Hysterectomy (TLH) versus Vaginal Hysterectomy (VH) both approaches utilising ERBE Biclamp® technology. Design: A retrospective case series comparing operative profiles of 35 consecutive Biclamp® Total Laparoscopic Hysterectomies with 35 consecutive Biclamp® Vaginal Hysterectomies performed between 1/11/07 to 03/4/09. Setting: Antrim Area Hospital, Department of Gynaecology, Northern Ireland. Patients: 70 patients with varying indications for hysterectomy. Measurements and Main Results: Operative time, blood loss, complications and hospital stay were the primary outcomes of study. Mean operating time for the TLH group was 73 minutes (range 45-175 min) versus 83 minutes (range 50-120 min) for the VH series. Estimated blood loss was approximately 4 times less in the TLH group, average 56 ml versus 200ml in the VH series. Mean uterine size was 169 grams (range 62-575 grams) in the TLH group versus 118 grams in the vaginal hysterectomy series (range 48- 602 grams). A much shorter hospital stay was noted in the TLH series with an average of 34 hours, which approached 24 hours towards the end of the series. This compared to an average of 84 hours in the VH series. No major intra-operative complications were observed in either group. In the TLH series one patient developed a port site hernia and one experienced transient urinary retention. In the VH series 2 patients required blood transfusions and 2 urinary tract infections occurred. Conclusion: Considerably shorter hospital stay, operative time, blood loss and morbidity where noted in the total laparoscopic hysterectomy series compared with the vaginal hysterectomy series.

Feasibility and safety of total laparoscopic hysterectomy (TLH) using the Hohl instrument in nonobese and obese women

The aim of the present study was to evaluate the feasibility, safety, and complication rates of total laparoscopic hysterectomy (TLH) using the Hohl instrument in nonobese and obese women. A prospective controlled trail (Canadian Task Force classification II-1) was conducted at the Department of Obstetrics and Gynecology, Erlangen University Hospital, Erlangen-Nuremberg, Germany. Two hundred and fifty-seven women underwent total laparoscopic hysterectomy using the Hohl instrument between January 2006 and May 2008. The laparoscopic approach was used when the patient had undergone previous pelvic abdominal operation and/or had a reduced vaginal capacity. Women were classified according to their body mass index (BMI), with a cutoff point of 30 kg/m(2). Total laparoscopic hysterectomy was performed using the Hohl instrument. One ureteral injury, one bladder injury, one vaginal injury, and one injury to the epigastric vessels occurred. Blood transfusion was necessary in one patient. One conversion to abdominal hysterectomy was performed in a woman with a uterus weighing 893 g. In the postoperative phase, suture dehiscence at the vaginal closure occurred in three patients, one patient had bladder infection, one woman developed unexplained fever, and a hematoma without infection at the vaginal vault occurred in one woman. All complications occurred in women with BMI < 30 kg/m(2). TLH using the Hohl instrument is feasible and safe in nonobese and obese patients.

A Review of Total Laparoscopic Hysterectomy Using LigaSure Uterine Artery-Sealing Device: AIIMS Experience

The aim of this study was to evaluate the efficacy and safety of total laparoscopic hysterectomy (TLH) by using the Ligasure system for the sealing of uterine arteries. We conducted a retrospective review of cases who underwent TLH over 1.5 years. This study was conducted in a tertiary care hospital setting, at the Department of Obstetrics and Gynecology, All India Institute of Medical Sciences (New Delhi, India). A total of 110 patients of TLH done for uterine pathology [leiomyoma in 67 (60.9%), dysfunctional uterine bleeding in 34 (30.9%), and others in 9 (8.1%)]. Total laparoscopic hysterectomy, using the LigaSure system (Valleylab Inc., Boulder, CO), was done by the sealing of uterine arteries and Prashant Mangeshikar uterine manipulator for elevation of the uterus. The mean age of the patients was 43.1 +/- 0.602 years and mean body mass index was 25.19 +/- 0.39 kg/m(2). The mean operating time was 116.91 +/- 3.4 minutes, mean intraoperative blood loss was 173.09 +/- 11.64 mL, and the mean weight of the removed uterus was 224.14 +/- 17.62 g. Six patients were converted from a laparoscopic to an open procedure (large myoma in 4 and dense adhesion in 2) and 1 was converted to laparoscopically assisted vaginal hysterectomy (tear in vaginal cuff). One patient (0.9%) developed lung emphysema during the intraoperative period. Postoperative complications included paralytic ileus in 3 (2.7%), retention of urine in 2 (1.8%), and febrile morbidity in 12 (10.9%) patients. There were no bladder or bowel injuries. Laparoscopic hysterectomy by uterine artery sealing with LigaSure is a safe, efficient procedure with a low complication rate.

A Novel Technique of Total Laparoscopic Hysterectomy for Routine Use: Evaluation of 140 Cases

Hysterectomy is one of the most commonly performed gynecological procedures. Although the first laparoscopic hysterectomy was performed in 1989, this technique accounts for only a few of all hysterectomies performed today. To assess the safety of total laparoscopic hysterectomy through a novel technique that we have evolved, a retrospective analysis of 140 patients with benign uterine pathologies operated at our institute between 2004 and 2007 was performed. All patients underwent total laparoscopic hysterectomy (TLH) using a simple technique. The highlight of this technique was the omission of any vaginal manipulator. The mean operation time was 88.75 ± 52.72 minutes, the mean blood loss 53.80 ± 35.94 ml and the mean hospital stay 2.21 ± 1.12 days. No conversion to open surgery was necessary. Iatrogenic complications were bowel injury (n=1) and vaginal tears (n=3) and were managed laparoscopically. The new method of TLH proved to be reproducible and safe with decreased morbidity and operation time. This can be attributed to the performance of the same standardized steps each time. Our technique provides a safe procedure suitable for routine use in gynecological surgery.

Feasibility and safety of total laparoscopic hysterectomy using bipolar coagulation and scissors

Feasibility and safety of total laparoscopic hysterectomy using bipolar coagulation and scissors