Instruments & Methods A technique of minilaparotomy-assisted vaginal hysterectomy

Abstract

In minilaparotomy-assisted vaginal hysterectomy, the operation begins vaginally by opening the peritoneal folds and ligating the uterine vessels and uterosacral ligaments. Minilaparotomy is then performed for myomectomy, cutting the fallopian tubes and the utero-ovarian ligaments and detaching any adhesions on the anterior peritoneal angle. In 26 women who underwent this procedure, the feasibility rate was 100% and no intraoperative complications or postoperative morbidity was observed (except in one case of ovarian bleeding), indicating that vaginal hysterectomy assisted by minilaparotomy is a feasible approach for hysterectomy in the setting of large myomas, myomas with adhesions caused by endometriosis or previous pelvic surgery, and adenomyosis.

Closure of the peritoneum is not necessary in obstetric and gynecologic surgeries

“…Present author routinely performs minilaparotomy surgery wherever possible in all cases of hysterectomy, surgery for ectopic pregnancy and recanalization and tuboplasty procedures and never closes either visceral or parietal peritoneum with minimum post operative morbidity, rapid recovery and shorter hospital stay (40, 42, 43). Similarly in minilaparotomy assisted vaginal hysterectomy and laparoscopic minilaparotomy hysterectomy, peritoneal closure is usually abandoned with less complications and shorter hospital stay than abdominal hysterectomy (44, 45). In laparoscopic surgery, including laparoscopic assisted vaginal hysterectomy, peritoneum is almost never closed and the minimal complications and short hospital stay are well known (46).…”

Closure of the peritoneum is not necessary in obstetric and gynecologic surgeries

“…Present author routinely performs minilaparotomy surgery wherever possible in all cases of hysterectomy, surgery for ectopic pregnancy and recanalization and tuboplasty procedures and never closes either visceral or parietal peritoneum with minimum post operative morbidity, rapid recovery and shorter hospital stay (40,42,43). Similarly in minilaparotomy assisted vaginal hysterectomy and laparoscopic minilaparotomy hysterectomy, peritoneal closure is usually abandoned with less complications and shorter hospital stay than abdominal hysterectomy (44,45). In laparoscopic surgery, including laparoscopic assisted vaginal hysterectomy, peritoneum is almost never closed and the minimal complications and short hospital stay are well known (46).…”

The value of minilaparotomy for total hysterectomy for benign uterine disease: A comparative study with conventional Pfannenstiel and laparoscopic approaches

“…However, the minilaparotomy procedure (a transverse abdominal incision into the pubic hair no longer than 6 cm in length in which it is possible to place a circular elastic retractor that enables a better exposure of the pelvic field) is another possible option [ 2 - 4 ]…”