Modified Use of Classical Rein Technique in Laparoscopic Hysterectomy for Uterine Manipulation

Background and Objectives: Vaginal uterine manipulators facilitate laparoscopic hysterectomy but are limited by cost and anatomical constraints. The Boztosun method offers a cost-effective intra-abdominal alternative. This study evaluated the clinical performance and safety of this technique. Materials and Methods: This single-center, retrospective descriptive study analyzed 40 patients who underwent laparoscopic hysterectomy using the Boztosun method at Akdeniz University Hospital between October 2021 and June 2022. Clinical characteristics and perioperative outcomes were assessed. Results: The mean operative time was 78.5 ± 20.6 min, and the mean colpotomy time was 8.05 ± 3.57 min. Conversion to laparotomy occurred in 3 patients (7.5%), primarily due to extensive adhesions or large uterine size. No intraoperative complications, organ injuries, or blood transfusions were recorded. All patients were discharged within two days. Patients with prior abdominal surgery had significantly longer operative and colpotomy times (p < 0.05). Conclusions: The Boztosun method is a safe, efficient, and low-cost alternative to vaginal manipulators in laparoscopic hysterectomy. It may be particularly useful in resource-limited settings or when vaginal manipulation is not feasible.