Mastering the Anterior Approach of Laparoscopic Hysterectomy for the Huge Uterus
To expand laparoscopic surgical skills, we need to strategies to cope with the very large uterus.Traditionally, there are three techniques to detect and mobilize the ureter and uterine artery: the anterior, lateral and posterior approach. Generally, the lateral approach is most common as one can easily detect the ureters transperitoneally at the rim of psoas muscle. But, in the case of a large and bulky uterus, advanced techniques are required.
The objectives of our study were to (i) examine the rate of vesico-ureteral injury at benign hysterectomy by surgical approach and (ii) compare the risk of vesico-ureteral injury specifically between minimally-invasive laparoscopic and abdominal hysterectomy on a populational level.DesignRetrospective population-based observational study.SettingThe National Inpatient Sample.Patients501,110 women who underwent hysterectomy for benign gynecological disease from 1/2012-9/2015 were included: total abdominal hysterectomy (TAH, n=284,365 [56.7%]), total laparoscopic hysterectomy (TLH, n=60,410, [12.1%]), abdominal supracerv...
ConclusionThe pinpoint accuracy of the bipolar method allowed for safe and complete dissection.
ConclusionThe FlexDex platform allows similar amplitude and intuitive wrist movement of the surgeon during complex procedures such as the one here presented – being a cost-effective alternative to the robot technology in countries where it is not readily available.
Evaluate the detection of ureteral injuries with the use of laparoscopic lens of 5 mm and 30 ° for cystoscopy after total laparoscopic hysterectomy.
To demonstrate an alternative method to evaluate for ureteral patency following benign hysterectomy.
We will present two cases which suffered from ureteral vaginal fistula after hysterectomy and underwent repair at our institute.
We examined the impact of surgical approach (minimally-invasive laparoscopy versus laparotomy) on vesico-ureteral injury during inpatient hysterectomy for benign gynecological disease.
Conclusions: GnRHa pretreatment in patients with a large barrel-shaped uterus during SPH is feasible with shortened operative time. However, the higher complication rates in these patients suggest that a weight-reduced barrel-shaped uterus that is achieved with GnRHa treatment could still be difficult and should be handled in cautious. PMID: 31341378 [PubMed - in process]
A 30-year-old woman with recurrent endometriosis presents for definitive surgical management with a hysterectomy. Her surgical history includes four laparoscopic excisions of endometriosis including bilateral ovarian cystectomies and an appendectomy. Given her surgical history, the retroperitoneum was opened to definitively identify the course of her ureters. Exploration of the right retroperitoneum revealed two right ureters which fused two centimeters proximal to the ureterovesicular junction (Figure 1, Figure 2).
CONCLUSION: Genitourinary injury occurs in 1.8% of hysterectomies for benign indications; immediate identification and repair is associated with a reduced risk of subsequent genitourinary fistula formation. PMID: 31306326 [PubMed - as supplied by publisher]