A Device of Operative Method for Laparoscopic Subtotal Hysterectomy.

[Objectives]
We introduce Laparoscopic subtotal hysterectomy(LSH) into our hospital and perform operative method improvement for standardization of surgical technique. This time, we reviewed examinations of the changes of this operative method, the device of operative method and operation results.

[Operative procedure]
The utero-ovarian ligament, fallopian tube and round ligament are initially dissected with a Vessel sealing system(LigaSure Atlas;Valleylab, Boulder, CO). The anterior leaves of the broad ligament are separated using the Harmonic Scalpel (Ethicon Endo-Surgery, Cincinnati, OH) and thereby enabling dissection of the bladder from the lower uterine segment. The parametrium containing the ascending uterine vessels are coagulated with the bipolar grasper at the level of internal cervical os.
The ischemic change of the uterine corpus is confirmed and detaching the uterine corpus from cervix is performed. The excision of the endocervix in a reverse cone pattern is performed by Harmonic Scalpel and isolated uterine vessels are ligated. After the cervical stump plasty with several generous single suture, bladder peritoneum cover this cervical stump and do it with the operation end afterwards.

[Examinations]
A total of 76 LSH were performed between February 2006 and July 2009. The principal clinical indication for hysterectomy was mainly uterine myoma. The mean age of the study participants was 44.7 years. The mean duration of surgery was 231.1 minutes. The mean operative blood loss was 98.0 ml. The mean uterine myoma weight was 370.1g. Three women suffered from cyclical vaginal bleeding and one woman from intestinal obstruction postoperatively and there were no major complications in this study.

[Conclusion]
According to the latest American Association of Gynecologic Laparoscopists(AAGL) surbey, the performance of Laparoscopic subtotal hysterectomy(LSH) is apparently increasing and suggest that the procedure is easier to perform, is less duration of surgery, and carries a lower risk of ureteric injuries and infectious complications compared with total laparoscopic hysterectomy. The results of this study indicated that LSH is safe and technically easy method performed equally between younger doctors and veteran laparoscopists. It seemed that LSH is able to become one of the minimally invasive surgery methods for uterine myoma in the future.


Session: Poster

Program Number: P501

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