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[Total laparoscopic hysterectomy: current role in gynecology surgery]
1Oddĕlení gynekologie a minimálnĕ invazivní chirurgie Nemocnice Na Homolce, Praha.
Unlabelled:
Total laparoscopic hysterectomy (TLH) could be performed in the place of either Total abdominal hysterectomy or Vaginal hysterectomy, thus, there are not any special indications for this procedure. In recent times there has been developed a specially designed uterine manipulator which renders this procedure safe. This manipulator eliminates the necessity of ureteral dissection and also the necessity of incising through the uterosacral ligaments. This last aspect also causes an improvement in support of the vaginal vault. Hysterectomy of this type enables the surgeon to continue laparoscopically in the correction of the enterocoele by means of Moschowitz-McCall culdoplasty.
Objective:
To evaluate indications, results and complications of 27 Total laparoscopic hysterectomies performed from 1/97-6/98.
Design:
Prospective study.
Methods:
27 patients have undergone TLH (type IV of hysterectomy according to Clermont Ferrand classification). For the surgery a KOH manipulator (RUMI) was used. A pneumooccluder was used in order to prevent the loss of pneumoperitoneum. The most often encountered indications were menorrhagia, cervical dysplasia and fibroid uterus. An additional indication in some of the patients was the presence of enterocoele. Mean age was 42.5 years (35-52).
Results:
Mean operating time was 92 min. +/- SD. Mean uterine weight 154 g +/- 25 SD. Mean blood loss 140 ml. No complications were noted. Mean length of hospitalization was 3.6 days.
Conclusions:
According their early experience the authors are convinced that it is safely possible for a gynaecological surgeon to ad TLH to his surgical armamentarium on condition that, he is well familiar with the performance of laparoscopically assisted vaginal hysterectomy. The early results with TLH are encouraging.