A review of total laparoscopic hysterectomy: role, techniques and complications

Elkington, Nicholas M.; Chou, Danny

doi:10.1097/01.gco.0000233930.21307.5a

Cited by 37 publications

(32 citation statements)

References 25 publications

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“…Approval for the review of medical records was granted by the Institutional Review Board of the Seoul National University Bundang Hospital. TLH was performed under general anesthesia, as described [8]. TLH outcomes were correlated with patient demographic features and clinical characteristics.…”

Section: Methodsmentioning

confidence: 99%

“…Laparoscopy-assisted vaginal hysterectomy (LAVH) differs from TLH in that LAVH is performed via a vaginal approach from uterine artery ligation. Common complications of TLH include injuries to the ureter, bladder, and bowel [3,8,11]. TLH has been performed in women with persistent or recurrent CIN, positive resection margins, or the presence of atypical glandular cells, as well as in women who request this type of surgery.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical outcomes of 1,041 total laparoscopic hysterectomies: Six years of experience in a single center

문정민

노재홍

전용탁

et al. 2011

Korean J Obstet Gynecol

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ObjectiveTo evaluate the association between outcomes of total laparoscopic hysterectomy (TLH) and patient demographic and clinical factors. MethodsThe present study was performed on a total of 1,041 women who underwent TLH, with or without bilateral/unilateral salpingooophorectomy, from May 2003 to December 2008, excluding patients who also underwent other procedures simultaneously, including ovarian cystectomy, colporrhaphy, incontinence surgery, pelvic/para-aortic lymph node dissection, and/or omentectomy. The medical records were reviewed and clinical outcomes were analyzed. ResultsMean patient age was 46.6 ± 13.4 years, mean operation time was 103.4 ± 42.3 minutes, and mean duration of total hospital stay was 5.4 ± 2.9 days. The mean decrease in hemoglobin concentration from before operation to 1 day after surgery was 1.4 ± 0.9 g/ dL, and one patient required an intraoperative transfusion. The main diagnosis was leiomyoma including concomitant adenomyosis (62.2%), followed by adenomyosis (16.0%) and 32 early stage gynecologic malignancies including 20 patients with microinvasive cervical cancer, 10 with endometrial cancer, 1 with borderline ovarian cancer, and 1 with uterine sarcoma. Laparotomy conversion was occurred in 45 patients (4.2%), because of severe pelvic/abdominal adhesion or huge uterine size. Large uterine size was associated with a signifi cantly higher rate of conversion (7.9% vs. 2.6%, P < 0.01), and a signifi cantly longer operation time (110.5 minutes vs. 93.1 minutes vs. 95.3 minutes, P < 0.01). Overall, 6 patients (0.6%) experienced major complications, including two bowel perforations, two ureteral injuries requiring surgical repair, one vaginal evisceration, and one incisional hernia. ConclusionTLH is a safe and acceptable alternative to standard hysterectomy for various indications, including malignancy. Hysterectomy is the most common operation in gynecology. For example, one-third of American women will have undergone a hysterectomy by age of 65 years [1], and 20% of women in the United Kingdom will have undergone a hysterectomy by age of 55 [2]. Several surgical techniques are currently utilized for hysterectomy, including total abdominal hysterectomy (TAH), vaginal total hysterectomy, and total laparoscopic hysterectomy (TLH), with the proportion of patients treated with the latter operation increasing. In our institute, the proportion of TLH has increased from 59% in 2003 to 74% in 2008. This increase is attributable to the de-ORIGINAL ARTICLE Korean J Obstet Gynecol 2011;54(10):618-622 http://dx

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Section: Methodsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of 1,041 total laparoscopic hysterectomies: Six years of experience in a single center

문정민

노재홍

전용탁

et al. 2011

Korean J Obstet Gynecol

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“…Vaginal hysterectomy (VH) is recommended over AH when feasible [3]. LH may replace AH in cases where VH is not accessible [4].…”

Section: Introductionmentioning

confidence: 99%

Total laparoscopic hysterectomy, vaginal hysterectomy and total abdominal hysterectomy using electrosurgical bipolar vessel sealing technique: a randomized controlled trial

Allam

Makled

Gomaa

et al. 2014

Arch Gynecol Obstet

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“…However, instrumentation, require advanced surgical skill, adaptation to two-dimensional view, and decreased tactile feedback have been considered as limitations of this technique 4 . Moreover, challenges with uterine manipulation and colpotomy during TLH remain important concerns for laparoscopic gynecologists 5 . Therefore, different techniques and equipments have been developed to improve the TLH procedure.…”

Section: Introductionmentioning

confidence: 99%

Iatrogenic uterine perforation and bowel penetration using a Hohlmanipulator: A case report

Akdemir

Çırpan

2014

International Journal of Surgery Case Reports

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INTRODUCTIONAdequate exposure is a vital factor in total laparoscopic hysterectomy, and uterine manipulators have been used in achieving that. The Hohl uterine manipulator has been considered to be one of the safer manipulators. Beside adequate exposure, it is associated with lower intraoperative complications. However, we report a case of iatrogenic uterine rupture with the Hohl manipulator which also caused bowel penetration.PRESENTATION OF CASEA 52-year-old woman with endometrial hyperplasia was scheduled for total laparoscopic hysterectomy. Prior to entering into the abdomen, the Hohl uterine manipulator was introduced into the uterine cavity without force. During the laparoscopic exploration, we noted that the tip of the Hohl manipulator had perforated the posterior uterine fundus and penetrated the bowel. Therefore, laparotomy was performed, and the bowel injury was repaired by a colorectal surgeon.DISCUSSIONThe Hohl uterine manipulator is safe and easy to use, and is associated with decreased intraoperative injuries. However, the complications observed due to the improper use of an uterine manipulator can overshadow any advantages of manipulator. In the present report, we describe a case of uterine perforation and bowel penetration caused by the Hohl uterine manipulator during total laparoscopic hysterectomy, which required conversion to laparotomy. The cause for this complication is associated with improper usage of the uterine manipulator.CONCLUSIONUterine manipulator may cause uterine perforation and bowel penetration at the beginning of the hysterectomy procedure. These types of complications can be prevented by proper application of the Hohl manipulator into the uterus under direct pelvic visualization.

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A review of total laparoscopic hysterectomy: role, techniques and complications

Cited by 37 publications

References 25 publications

Clinical outcomes of 1,041 total laparoscopic hysterectomies: Six years of experience in a single center

Clinical outcomes of 1,041 total laparoscopic hysterectomies: Six years of experience in a single center

Total laparoscopic hysterectomy, vaginal hysterectomy and total abdominal hysterectomy using electrosurgical bipolar vessel sealing technique: a randomized controlled trial

Iatrogenic uterine perforation and bowel penetration using a Hohlmanipulator: A case report

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