Total laparoscopic extirpation of a fixed uterus from benign gynecological disease

Abstract

Frequently, a fixed pelvis is encountered that is caused by a benign disease, either severe endometriosis or severe adhesions with or without fibroid uterus. We present two cases of nulligravida and multiparous women who had absolute frozen pelvises with no motion whatsoever of their pelvic structures on bimanual examination. Conventionally, these patients would have been approached by open hysterectomy only. We do not consider a frozen pelvis from what appears to be a benign case a contraindication to the laparoscopic approach.

Laparoscopic hysterectomy in frozen pelvis—an alternative technique of retrograde adhesiolysis

“…This can be explained by the severity of the disease process and grossly distorted anatomical planes, necessitating meticulous dissection and slow progression. Mean (SD; 95 % CI) weight of the uterus was 390.2 (441.59; 207.91-572.49) g. The mean estimated blood loss in our series was 384 ml whereas Chalermchockchareonkit reported a mean blood loss of 302.6 ml [8], while that reported by Walid et al was 150 ml in laparoscopic hysterectomy for severe endometriosis [6]. The length of hospital stay was 1.3±1.07 days in our series which is shorter when compared to 3.5±1.1 days reported in the literature [8].…”

“…The risk of complications depends upon the extent of bowel involvement, adhesions and extent of endometriosis infiltration, surgeon experience and bowel resection [16,17]. The operating time was 210 min in our study compared to 185±48.7 min mentioned by Chalermchockchareonkit et al, while it was 131 and 147 min in two case reports by Walid et al [6] in laparoscopic hysterectomy for severe endometriosis [8]. This can be explained by the severity of the disease process and grossly distorted anatomical planes, necessitating meticulous dissection and slow progression.…”

“…Hysterectomy is the commonest major gynaecological procedure [5]. Most hysterectomies can be performed laparoscopically including those with large myomas and severe endometriosis [6][7][8]. Various techniques have been described previously to tackle difficult hysterectomies, but the level of expertise needed limits the general use of these techniques [9,10].…”

An intention‐to‐treat study of total laparoscopic hysterectomy

“…2). The extremes were cases with severe adhesions due to previous cesarean deliveries or abdominal operations [9]. Operative time correlated slightly with the weight of the resected uterus (r = 0.145, P b 0.01) and the patient's body mass index (r = 0.136, P b 0.01) in TLH cases without extra procedures (Fig.…”

Completion of vaginal hysterectomy by electro surgery using anteroposterior approach in benign cases faced with obliterated posterior cul-de-sac

“…However, our total operation time of 109.92±40.13 minutes by vaginal hysterectomy was less than the operation time reported by Chalermchockchareonkit et al (185.1±48.7 and 139.9±52.4 minutes for laparoscopic hysterectomy and abdominal hysterectomy, respectively), and by few more previous studies for laparoscopic hysterectomy, in a similar condition of benign severe pelvic adhesions. 3 , 4 , 20 It was nearly 2 times more than that of mean operation time for vaginal hysterectomy by electrosurgery in cases without severe endometriosis, and was nearly one and a half time more than that of mean operation time in cases with history of previous cesarean section. 7 , 8 Compared with outcomes in our previous studies, however, the major intraoperative and postoperative complications like injury to bladder, ureter, and rectum did not increase due to vaginal hysterectomy and additional procedures in cases with severe benign pelvic adhesions by the present approach.…”