Laparoscopic Retrograde Hysterectomy: A Review of Techniques, Indications, and Outcomes

Laparoscopic retrograde hysterectomy (LRH) represents an innovative minimally invasive approach for managing complex pelvic pathology where conventional techniques are contraindicated. This review synthesizes current evidence regarding its techniques, indications, and outcomes. LRH employs a strategic caudal-to-cephalad dissection, prioritizing early identification of ureters and uterine vessels before addressing fundal attachments. Primary indications include severe endometriosis with obliterated cul-de-sac, large uterine size (>300 g), multiple previous surgeries with dense adhesions, and distorted pelvic anatomy. Outcomes demonstrate significant advantages, including reduced conversion rates to laparotomy (0-2.9%), acceptable operative times (66-285 minutes), minimal blood loss (79-450 mL), and short hospital stays (two to six days). The technique maintains low complication rates (2.2-4.7%) despite challenging conditions. However, LRH requires advanced laparoscopic skills and has a substantial learning curve (~65 cases). Widespread adoption necessitates structured training programs and further comparative studies. LRH effectively expands minimally invasive options for complex gynecological surgery, demonstrating particular utility in frozen pelvis scenarios while preserving the benefits of laparoscopy.