A simpler approach to hysterectomy: one-suture laparoscopic hysterectomy

This article describes in detail a new approach to laparoscopic hysterectomy. It is based on understanding the vasculature of the uterus, cervix, and cardinal ligament. The result of this appreciation of the anatomy is a clean, logical, rapid, anatomic approach to hysterectomy not previously promoted. There is a dissectible, loose, fibrous plane that lies between the uterus and the portion of the uterine artery that courses up and down the side of the uterus. It is traversed by multiple small branches of the uterine artery, which are coagulated easily with monopolar coagulation current. By the dissection of this plane down the side of the uterus and cervix, the cardinal ligament can be peeled off the cervix. This allows a bloodless dissection well away from any risk of injury to the ureter. The anatomy and surgical technique are described for laparoscopic hysterectomy and laparoscopically assisted vaginal hysterectomy.