When performing laparoscopic hysterectomy (LH) for benign uterine tumors, we currently employ two-step laparoscopic hysterectomy (LTSH), a two-step procedure in which the cervix is removed after amputation of the uterine body. We have already reported on the usefulness of this procedure at conferences of the Society. We conducted an analysis to determine the factors that cause difficulty with the LTSH procedure. It was found that poor visualization of the operative field due to the location and/or size of the tumor was the major factor. It is necessary to devise countermeasures to overcome such factors in order to expand the indications for LH and improve safety. Here we report on the use of two-step total laparoscopic hysterectomy combined myomectomy(TTLH-CM), a procedure that allows us to perform LH after leiomyomectomy in cases where standard laparoscopic hysterectomy proves to be difficult.
(methods/results) We stuedied 17 and 175 patients who underwent abdominal hysterectomy and LTSH, respectively, for uterine myoma/adenomyosis from January 2006 to June 2009.
The results were as follows. In 2006, there were 9 cases of AH and 48 cases of LTSH (include 1 case of TTLH-CM), and the laparoscopic procedure success rate was 84.2%. In 2007, there were 4 cases of AH and 33 cases of LTSH (including 4 cases of TTLH-CM), and the laparoscopic procedure success rate was 89.5%. In 2008, there were 3 cases of AH and 41 cases of LTSH (including 1 case of TTLH-CM), and the laparoscopic procedure success rate was 93.2%. In 2009, there was 1 case of AH and 37 cases of LTSH (including 11 cases of TTLH-CM), and the laparoscopic procedure success rate was 100%.
The above results indicate that the application of LH has expended since the introduction of TTLH-CM. We would like to state that, this procedure may be an alternative for conventional laparoscopic hysterectomy as a standard procedure in our institute.
Program Number: P495