Abstract
Due to vaginal narrowing or cervical atrophy, it is sometimes difficult to safely perform conization in menopausal women. Total hysterectomy is recommended in patients with positive conization margins or cervical intraepithelial neoplasia who do not desire children. In such patients, we performed total laparoscopic hysterectomy (TLH) following approval from the Ethics Committee of our hospital.
Nine patients underwent TLH between June 2010 and March 2012. TLH was performed using four trocars placed in a diamond configuration in the same manner as that for benign diseases. In principle, we did not use uterine manipulators, and lifted the uterus with a 2-0 nylon thread using a straight needle. When separating the bladder from the uterine cervix, a vaginal pipe was inserted. The ureter and uterine artery were identified first, and then the latter was ligated and cut. Total hysterectomy was performed with the extrafascial technique. None of the patients required conversion from laparoscopic to open abdominal hysterectomy, or underwent re-surgery due to complications, and all of them were discharged on the fifth postoperative day. Unlike when performing total hysterectomy for fibroids or adenomyosis, surgery is performed without the insertion of manipulators; therefore, we need to exercise some ingenuity to lift the uterus. Although TLH poses some problems in post-conization patients, such as "the site of incision is difficult to see even if a vaginal pipe is inserted," it can be performed with some ingenuity.
