Safety of laparoscopically assisted vaginal hysterectomy for women with anterior wall adherence after cesarean section

Ko, Jung Hwa; Choi, Joong Sub; Bae, Jaeman; Lee, Won Moo; Koh, Ara; Boo, H.; Lee, Eunhyun

doi:10.5468/ogs.2015.58.6.501

Cited by 4 publications

(6 citation statements)

References 15 publications

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“…Similar to previous observations, 4 , 9 prolongation of mean operation time in this study was due to additional time consumed by adhesiolysis to separate the uterus from the anterior abdominal wall in the laparoscopic phase and the uterus from the bladder in the vaginal phase of LAVH.…”

Section: Discussionsupporting

confidence: 90%

“… 3 , 5 – 7 Fixed adhesion of the uterus to anterior abdominal wall (ventrofixed uterus) was observed in ~14.9%–17.9% of hysterectomies for benign indication associated with previous CS. 4 , 6 , 9 It may occur even after one previous CS ( Table 1 ).…”

Section: Discussionmentioning

confidence: 99%

“…This has been attributed to the unclear anatomy during anterior dissection in cases with previous CS. 9 , 15 , 16 The present technique avoided conventional bladder flap preparation during the laparoscopic phase of LAVH and utilized the posteroanterior approach during the vaginal phase of LAVH to avoid a bladder injury. 6 …”

Section: Discussionmentioning

confidence: 99%

“… 6 However, the operation time in this study is shorter than that of conventional LAVH (149.71 vs 175 minutes) in a similar series reported by a previous study. 9 …”

Section: Discussionmentioning

confidence: 99%

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A laparovaginal strategy to avoid bladder injury during laparoscopic-assisted vaginal hysterectomy in cases with ventrofixed uterus following previous cesarean section

Purohit¹,

Sharma²,

Meher³

et al. 2018

IJWH

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BackgroundLaparoscopic hysterectomy for benign indications in cases with ventrofixed uterus following previous cesarean section (CS) increases the surgeon’s concern of bladder injury. The present study describes a laparovaginal strategy to avoid bladder injury during laparoscopic-assisted vaginal hysterectomy (LAVH) in cases with ventrofixed uterus following previous CS.MethodsIn a retrospective study conducted in our private general hospital, we included consecutive cases of laparoscopically confirmed ventrofixed uterus associated with previous CS. These were from the cases who underwent LAVH for benign indications. Cases with uterus size >16 weeks of gestation were excluded. Patients’ clinical, intraoperative and postoperative characteristics were studied to evaluate the feasibility of the described laparovaginal strategy to prevent bladder injury during LAVH in cases with ventrofixed uterus.ResultsA total of 35 cases with ventrofixed uterus underwent LAVH during the study. Six (17.14%) cases had a history of one CS, while 29 (82.86%) cases had a history of previous two or more CSs. A supravesical loose fatty tissue plane (supravesical space) indicating reach to the bladder wall during laparoscopic lysis of the uterus from the anterior abdominal wall was successfully demonstrated in all the cases. The bladder flap preparation was avoided. Uterovesical adhesions were dissected by posteroanterior approach during vaginal phase of LAVH in all the cases. LAVH was successfully performed in all the cases. None of the cases had bladder injury, laparotomic conversion or other major complications. Mean operating time for LAVH was 149.71±38.36 minutes (70–200 minutes). Mean uterine specimen weight was 162.85±92.57 g (60–500 g). Mean postoperative hospital stay was 2.42±0.73 days (2–5 days).ConclusionIn spite of severe adhesions in cases with a ventrofixed uterus following previous CS, bladder injury can be avoided during LAVH by the described laparovaginal approach in the present study.Short synopsisThe described laparovaginal approach may avoid bladder injury during laparoscopic-assisted vaginal hysterectomy in cases with a ventrofixed uterus following previous cesarean section.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“… 6 However, the operation time in this study is shorter than that of conventional LAVH (149.71 vs 175 minutes) in a similar series reported by a previous study. 9 …”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

A laparovaginal strategy to avoid bladder injury during laparoscopic-assisted vaginal hysterectomy in cases with ventrofixed uterus following previous cesarean section

Purohit¹,

Sharma²,

Meher³

et al. 2018

IJWH

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show abstract

“…Adhesion occurs in 60% of patients with midline incision and in 30% of patients with Pfannenstiel incision. Adhesion makes surgery more difficult, requiring longer operation time …”

Section: Introductionmentioning

confidence: 99%

Safety of total laparoscopic hysterectomy in patients with prior cesarean section

Lim

Lee

Choi

et al. 2016

J of Obstet and Gynaecol

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Bladder safety during natural orifice transluminal endoscopic surgery hysterectomy in the patients with extensive vesicouterine adhesion

Tantitamit

Temtanakitpaisan

Lee

2019

Gynecol Minim Invasive Ther

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Adhesion at the vesicouterine fold presents a great challenge when performing hysterectomy through transvaginal natural orifice transluminal endoscopy surgery (NOTES) in women with a history of cesarean section. An attempt to lyse adhesions often prolongs the procedure and may inadvertently result in cystostomy. The purpose of this report is to demonstrate a safe technique for the lysis of vesicouterine adhesions during NOTES hysterectomy. We present the cases of two patients with a history of cesarean section. Severe adhesions at the vesicouterine peritoneum were encountered in both cases, and one patient had an extensive adhesion involving lower half of the uterus. Although the lateral approach is sufficient in most cases, it does not allow a surgeon to approach the peritoneal cavity if there is extensive adhesion. In cases such as these, direct dissection of the adhesion on the uterus is required.

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Safety of laparoscopically assisted vaginal hysterectomy for women with anterior wall adherence after cesarean section

Cited by 4 publications

References 15 publications

A laparovaginal strategy to avoid bladder injury during laparoscopic-assisted vaginal hysterectomy in cases with ventrofixed uterus following previous cesarean section

A laparovaginal strategy to avoid bladder injury during laparoscopic-assisted vaginal hysterectomy in cases with ventrofixed uterus following previous cesarean section

Safety of total laparoscopic hysterectomy in patients with prior cesarean section

Bladder safety during natural orifice transluminal endoscopic surgery hysterectomy in the patients with extensive vesicouterine adhesion

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