Surgical strategy and tricks in the complex laparoscopic hysterectomy
DOI:
https://doi.org/10.18597/rcog.571Keywords:
hysterectomy, laparoscopy, techniqueAbstract
The strategies to perform the laparoscopic hysterectomy depend on the experience of the surgeon and its team. Therefore, a selection of a suitable patient for the procedure must take place. Adequate equipment is very important including, but no limited to, a good electrosurgery unit, bipolar forceps 3 mm wide, and an uterine manipulator that allows the uterus to move during the procedure.
The different steps involved in a laparoscopic hysterectomy are: section and removal of annexes; dissection of the uterine bladder space; separation of the wide ligament; identification, skeletization, coagulation, and section of the uterine vessels; and identification of the ureter in its intraligamentary trajectory, preventing an injury during the coagulation and section of the uterine arteries at the cervical level. The surgeon must be very careful in the dissection of the uterine-bladder space, especially if the patient had any previous cesarean operation, because this increases the possibility of bladder rupture. The procedure ends through the vagina, by removing the uterus when the fixed ligaments are loose. The shutting or closing at the vagina dome can be done from the vagina or by laparoscopy.
Author Biography
Jaime Saavedra S.
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