A technique for laparoscopic completion of vaginal hysterectomy

Recently, the use of laparoscopic assistance in vaginal hysterectomy has become popular, although its role in gynecologic surgery has not been well established. A way to define this role is to start the hysterectomy vaginally and use laparoscopic assistance only if it becomes necessary. We present a new technique in which vaginal hysterectomy proceeds to the opening of the peritoneal reflections and ligature of uterine vessels and uterosacral ligaments. If laparoscopic assistance becomes necessary at this point, a uterine manipulator with an adapted inflatable balloon is inserted vaginally, allowing completion of the procedure laparoscopically while maintaining a pneumoperitoneum. Eight operations were performed successfully in our institution using this new technique. Operative time was less than with conventional laparoscopically assisted vaginal hysterectomy. The technique also simplified the management of the uterine vessels and detachment of the bladder.