Total Laparoscopic Hysterectomy Under Regional Anesthesia

Area of Science:

• Gynecologic surgery
• Anesthesiology
• Minimally invasive procedures

Background:

• Laparoscopic hysterectomies are common in the US.
• Traditionally performed under general anesthesia.
• Regional anesthesia offers patient benefits but is less common for this procedure.

Observation:

• A 51-year-old woman underwent total laparoscopic hysterectomy, bilateral salpingectomy, and endometriosis excision.
• The procedure was performed using epidural anesthesia without sedation or narcotics.
• Adequate visualization was achieved with 12 mm Hg pneumoperitoneum and 15° Trendelenburg.
• Midthoracic and low lumbar epidural catheters were used, with bilevel positive airway pressure for respiratory support.

Findings:

• Total laparoscopic hysterectomy was successfully completed under epidural anesthesia with the patient fully awake.
• The procedure was uncomplicated.

Implications:

• Regional anesthesia, specifically epidural anesthesia, is a viable option for select patients undergoing laparoscopic hysterectomy.
• Careful patient selection, meticulous planning, and awareness of potential complications are crucial for success.
• This case highlights a potential alternative to general anesthesia for minimally invasive hysterectomy, offering enhanced recovery possibilities.