Total laparoscopic hysterectomy: Single surgeon experience in a regional centre after changing uterine manipulator and surgical technique — YRD
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Total laparoscopic hysterectomy: Single surgeon experience in a regional centre after changing uterine manipulator and surgical technique (1421)

Raymond Steve , Hasan Titiz

ABSTRACT

INTRODUCTION

The advantages of total laparoscopic hysterectomy (TLH) include less blood loss, fewer wound complications, less post-operative pain, quicker recovery, quicker return to normal activity and work, when compared to abdominal hysterectomy (1). But total laparoscopic hysterectomy can be challenging and may require experienced surgical assistance (fellow, another gynaecologist) and experienced theatre team. Uterine manipulator is essential for this challenging operation and having better instruments and easier surgical steps can simplifyTLH.

SETTING AND DESIGN 

This gynaecologist (the first author),working in a non metropolitan private hospital, has started doing laparoscopic hysterectomies in 1995.He has decided to do TLHs for all patients requiring non vaginal hysterectomy for benign disease in an unselected gynaecological population in 2011. 112 TLH procedures were planned from January 2011 to March 2014.In these cases, combination of Valtchev uterine manipulator and McCartney tube were used. Conversion to laparotomy was required for 12 patients. There was 2 bladder injury and no ureteral, bowel or vascular injuries.

In April 2014, new instrumentation (Titiz utero-vaginal manipulator) and a standardized surgical technique starting with a laparoscopic anterior colpotomy were used (2). 52 TLH procedures have been undertaken since and all were completed laparoscopically. The mean hospital stay was 2 days. There were no major complications. No ureteral, bladder, bowel or vascular injury occurred.

This video demonstrates: 1. Data analysis of the TLHs before and after changing uterine manipulator and surgical technique.2. Benefits of this new utero-vaginal manipulator and surgical technique

3.  Video demonstration of step-by-step surgical technique of TLH with the use of new utero-vaginal manipulator in easy and difficult cases.

CONCLUSION

The data and the surgeon’s experience show that introduction of the new instrumentation and standardized surgical technique has led to:

  1. Reduced operating time

  2. Reduced conversion to laparotomy rate

  3. Easier use of utero-vaginal manipulator when there is only inexperienced surgical and theatre staff assistance available

  4. Less bladder injury.

  1. Nieboer TE, Johnson N, Lethaby A, et al Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev 2009:CD003677
  2. Titiz H, Total laparoscopic hysterectomy in 3 easy and safe steps with Titiz utero-vaginal manipulator. AGES, ASM, March 2014, AAGL, ASM, November 2014