A case of total laparoscopic hysterectomy using Tsukahara uterine forceps without vaginal pipe or manipulator for a virgin patient with multiple uterine myomas

Abstract

　We present a case of total laparoscopic hysterectomy (TLH) for a virgin patient with multiple large uterine myomas. Thirty-five-year-old primiparous patient was diagnosed with multiple large uterine myomas which size was maximum of 120 mm diameter by magnetic resonance imaging. The patient underwent TLH. We didn’t use the uterine manipulator to avoid the hymen and vaginal laceration, therefore, we only use Tsukahara uterine forceps instead of using uterine manipulator. Firstly, the myomectomy was performed during TLH to obtain good visibility of operative field and enough space of smooth manipulation of the instruments. Then, cervical amputation was conducted after treatment of uterine upper ligaments and uterine vessels, because large uterus could not be handled enough by Tsukahara uterine forceps. After cervical amputation, bilateral ureters were easily detected, and residual uterine cervix was removed safely. By using Tsukahara uterine forceps, and performing myomectomy and cervical amputation during TLH, we completed TLH in virgin case with multiple large uterine myomas without any complications.