Total laparoscopic hysterectomy in 26 min

Excerpt

Approximately 600,000 hysterectomies are performed in the United States every year and are mostly done via the open route. For decades, abdominal hysterectomy has been the only available operation before the introduction of vaginal hysterectomy; and lately, laparoscopically assisted vaginal hysterectomy (LAVH) and total laparoscopic hysterectomy (TLH) have been increasingly used for benign indications. Most gynecologists have reasonable skills at performing total abdominal hysterectomy (TAH) and total vaginal hysterectomy (TVH) as these are part of residency training. This is not the case with TLH. Most residency programs do not have proficiency requirements in the area of laparoscopic hysterectomy. Data in the literature clearly show that at least 30 total laparoscopic hysterectomies are needed to get through the initial learning curve [1‐3]. From our personal experience, we would argue that improvement occurs up to the first 100 cases. After more than 20 years practice in gynecologic laparoscopy, we can now perform a TLH in less than 30 min, in rare cases where everything goes ideally, for a normal size uterus without additional procedures. Hysterectomies in Table 1 were indicated for chronic pelvic pain, dyspareunia, menometrorrhagia, or uterovaginal prolapse. The last case we did was completed in 26 min. All case times included laparoscopic resuspension of the vaginal cuff to the uterosacral cardinal ligament complex as part of the running #0 polydioxanone (PDS) cuff closure and all cases had cystoscopy with IV indigo carmine. There were no intraoperative complications or re-admissions to the operating room. All these patients were discharged in less than 24 h. …