Total laparoscopic hysterectomy without uterine manipulator: description of a new technique and its outcome
Introduction Hysterectomy remains the most common major gynecological operation. This is the first study that describes a new technique
of TLH without using any kind of uterine manipulator or vaginal tube (TLHwM) and analyzes the intra- and postoperative surgical
outcome of the first 67 cases.
Patients and methods Between October 2008 and December 2009, 67 patients underwent TLH without uterine manipulator or vaginal tube. We analyzed
the differences in the outcome by using three different kinds of surgical instruments: in 21 cases the TLHwM was performed
using conventional 5 mm bipolar and scissors, in 22 cases using Sonosurgical, and in 24 cases using PKS cutting forceps.
Results There was no intra- or postoperative complications. The overall mean operating time was by TLHwM with salpingo-oophorectomy
98 min and without salpingo-oophorectomy, 80 min. The mean operating time using cutting forceps was significantly lower. The
mean uterine weight was 263 g.
Discussion Uterine manipulator seems to be a safe and practical surgical method, especially for patients with vaginal stenosis and in
cases of enlarged uterus. With its short operation time and no complication rate, we believe that this method is an enrichment
of the laparoscopic hysterectomy techniques.