Total laparoscopic Hysterectomy: Contemporary Rolein Gynaecological Surgery

Overview

Total laparoscopic hysterectomy (TLH) could be performed in the place of either Total abdominalhysterectomy or Vaginal hysterectomy, thus, there are not any special indications for this proce-dure. In recent times there has been developed a specially designed uterine manipulator whichrenders this procedure safe. This manipulator eliminates the necessity of ureteral dissection andalso the necessity of incising through the uterosacral ligaments. This last aspect also causes animprovement in support of the vaginal vault. Hysterectomy of this type enables the surgeon tocontinue laparoscopically in the correction of the enterocoele by means of Moschowitz-McCallculdoplasty.Objective: To evaluate indications, results and complications of 27 Total laparoscopic hysterecto-mies performed from 1/97 - 6/98.Design: Prospective study.Methods: 27 patients have undergone TLH (type IV of hysterectomy according to Clermont Fer-rand classification). For the surgery a KOH manipulator (RUMI) was used. A pneumooccluder wasused in order to prevent the loss of pneumoperitoneum. The most often encountered indicationswere menorrhagia, cervical dysplasia and fibroid uterus. An aditional indication in some of thepatients was the presence of enterocoele. Mean age was 42.5 years (35 - 52).Results: Mean operating time was 92 min. ± SD. Mean uterine weight 154g ± 25 SD. Mean bloodloss 140 ml. No complications were noted. Mean length of hospitalization was 3.6 days.Conclusions: According their early experience the authors are convinced that it is safely possiblefor a gynaecological surgeon to ad TLH to his surgical armamentarium on condition that, he iswell familiar with the performance of laparoscopically assisted vaginal hysterectomy. The earlyresults with TLH are encouraging.

Key words:
hysterectomy, total laparoscopic hysterectomy (TLH), laparoscopically assisted vagi-nal hysterectomy (LAVH), uterine manipulator (RUMI), pneumoperitoneum-pneumooccluder, cer-vicovaginal junction