[Laparoscopic hysterectomy]

Abdominal hysterectomy is one of the most common major operations in gynecology. However, it is associated with considerable morbidity and relatively slow recovery. We describe a laparoscopic procedure for removal of the uterus, with or without the adnexa, in women in whom abdominal hysterectomy would otherwise be indicated. Laparoscopy is performed with the 3-puncture technic and an additional incision for the electrocoagulation instrument. The infundibulopelvic and round ligaments are dissected and divided if oophorectomy is to be done. If not, the broad ligament lateral to the uterine body is similarly treated and finally the dissections are extended to the uterine vessels and the uterosacral and upper parts of the transverse cervical ligaments. Surgery is completed vaginally after deflation of the abdomen, as in vaginal hysterectomy. Laparoscopy is repeated when the vagina has been closed, to ensure hemostasis. We have successfully performed laparoscopic hysterectomy, with or without salpingo-oophorectomy, in 7 women, aged 39-57. The procedure lasted 90-160 minutes and postoperative discomfort was minimal. All patients returned to normal activity within 4 weeks and were delighted with the outcome as well as with the cosmetic results. This technique offers an attractive alternative to conventional approaches and has significant advantages. Nevertheless, further studies are necessary to evaluate the true efficacy of the procedure.