An attempt to simplify total laparoscopic hysterectomy procedures at our hospital

Ujita, Mari; Sumitomo, Masahiro; Takakura, Masahito; Kawamura, Yosuke; Takakura, Kenji; Konishi, Ikuo

doi:10.5180/jsgoe.33.2_293

Cited by 2 publications

(2 citation statements)

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“…Innovations in minimally invasive surgery for TLH were first documented by Reich et al [16], since which their application has increased in Japan. However, TLH should be performed by experienced surgeons to avoid complications, such as injury to the bladder and rectum [17][18][19]. TLH was initiated in our department in 2014 and has been carried out since then as a standardized procedure.…”

Section: Discussionmentioning

confidence: 99%

Impact of Uterine Size on Outcomes of Total Laparoscopic Hysterectomy for Uterine Leiomyomas

Ishibashi¹,

Nakayama²,

Sultana³

et al. 2022

Clin. Exp. Obstet. Gynecol.

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Background: Given that total laparoscopic hysterectomy (TLH) is less invasive than open surgery, its popularity has increased in Japan. The aim of the present study was to determine the most appropriate uterine size for the safe completion of TLH for the treatment of uterine leiomyomas. Methods: This retrospective study included 505 patients who underwent TLH for uterine leiomyomas. Patients were divided into three groups according to the weight of the excised uterus (<500 g, n = 347; 500-1000 g, n = 125; >1000 g, n = 33). TLH procedures were performed by a resident physician under the supervision of an attending physician. Clinical outcomes including blood loss and duration of surgery were collected from patients' electronic medical records and compared according to uterine size. Magnetic resonance imaging (MRI) was performed prior to TLH for detection, localization, and measurement of the myoma. Results: Mean operation times were shortest (<500 g: 163 min; 500-1000 g: 190 min; >1000 g: 209 min) and the mean volume of blood lost was lowest (<500 g: 116 mL; 500-1000 g: 208 mL; >1000 g: 402 mL) in patients with a uterus weighing less than 500 g. There were no significant differences in operation time or bleeding between those with a uterine weight of 500-1000 g or >1000 g. MRI revealed that myomas tended to be restricted within the sacral promontory in patients with uterine weights <500 g, whereas those in the other two groups tended to extend beyond this region. Conclusions: TLH outcomes are best when the uterine weight is <500 g. The use of MRI prior to TLH may provide insights into uterine size and/or mass and thus allow for improved surgical planning.

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Section: Discussionmentioning

confidence: 99%

Impact of Uterine Size on Outcomes of Total Laparoscopic Hysterectomy for Uterine Leiomyomas

Ishibashi¹,

Nakayama²,

Sultana³

et al. 2022

Clin. Exp. Obstet. Gynecol.

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“…Laparoscopic surgery has many benefits compared to traditional open surgery, such as less scarring, less pain after surgery, a shorter recovery time, and less bleeding. However, laparoscopic surgery should be performed by experienced surgeons to avoid complications, such as injury to the bladder and rectum [1,2]. In patients with a history of surgery, the difficulty of surgery increases due to adhesion in the abdominal cavity; the tissue is hard, and the borderline is unclear [3].…”

Section: Introductionmentioning

confidence: 99%

A case of rectal injury due to vaginal pipe misinsertion during total laparoscopic hysterectomy

Yoshimura¹,

Nakayama²,

Sawada³

et al. 2021

Clin. Exp. Obstet. Gynecol.

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Total laparoscopic hysterectomy (TLH) is one of the techniques feasible for the treatment of myoma. Our department has performed more than 1,000 laparoscopic hysterectomies since 2014. In our department, these surgeries are performed by a supervising doctor, operator, and a first assistant who is o ten insu ficiently experienced. There are several types of injuries that can occur during laparoscopic surgery; however, cases in which the vaginal pipe is inserted incorrectly are very rare. Here, we report the case of a 47-year-old nulliparous woman who experienced a rectal injury caused by the misinsertion of a vaginal pipe into the rectum. Seven years prior, she had undergone a myomectomy for leiomyomas. Later, she developed recurrent leiomyomas and worsening hypermenorrhea; therefore, she underwent a total laparoscopic hysterectomy. During the operation, the first assistant usually inserts a vaginal pipe into the vagina when the vaginal wall is cut. In this case, when the vaginal wall was cut, the vaginal pipe was inserted into the rectum, and the rectal wall was incised, allowing communication between the rectum and vagina. The rectum was repaired with the support of a gastroenterological surgeon, and the operation was completed laparoscopically. On the 7th postoperative day, an enema was performed to confirm that no leaks were present, and feeding was restarted. The patient was discharged home on the 17th postoperative day. The current case highlights the necessity of surgeons to be aware of various factors when performing this procedure to prevent complications, even those that are rare.

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An attempt to simplify total laparoscopic hysterectomy procedures at our hospital

Cited by 2 publications

References 1 publication

Impact of Uterine Size on Outcomes of Total Laparoscopic Hysterectomy for Uterine Leiomyomas

Impact of Uterine Size on Outcomes of Total Laparoscopic Hysterectomy for Uterine Leiomyomas

A case of rectal injury due to vaginal pipe misinsertion during total laparoscopic hysterectomy

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