scholarly journals A novel approach to minimally invasive hysterectomy without the use of a uterine manipulator: Kamran’s TLH

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Ahmed M. Gendia ◽  
Noel E. Donlon ◽  
Waseem M. Kamran
Keyword(s):  
Operative Time ◽  
Intraoperative Complications ◽  
Postoperative Outcome ◽  
Laparoscopic Hysterectomy ◽  
Total Laparoscopic Hysterectomy ◽  
Postoperative Course ◽  
Conversion To Open Surgery ◽  
Uterine Manipulator ◽  
Novel Approach ◽  
Minimally Invasive Hysterectomy

Abstract Background Hysterectomy remains one of the most common major gynaecological procedures, with total laparoscopic hysterectomy (TLH) now established as the technique of choice over conventional open approaches. This approach depends on the use of a uterine manipulator to facilitate uterine retraction and colpotomy. This study describes a novel approach in performing total laparoscopic hysterectomy without the use of uterine manipulator or vaginal tubes and reports the intra- and postoperative outcome of this technique. Methods A single-centre retrospective analysis of patients who underwent TLH without uterine manipulator or vaginal tube “Kamran’s TLH” for benign conditions was performed from January 2017 to October 2019. Data collected included patients’ demographics, intraoperative finding and postoperative course. Results A total of eighty-six hysterectomies were performed utilizing the Kamran’s TLH (KTLH) approach. Mean age was 52.2 (± 11) years old and BMI was 28.2 (± 7). TLH with bilateral salpingo-oophorectomy was performed in 63 (73.3%) patients and TLH with preservation of ovaries in 23 (26.7%) patients. Mean operative time was 64.7 (± 27.9) min and estimated bloods loss was 46.2 (± 54.6) ml. No intraoperative complications were recorded and there was no conversion to open surgery. Only one patient required readmission and surgery for vaginal vault dehiscence during their postoperative course. Conclusion Uterine manipulator is a key component in performing laparoscopic hysterectomy. However, our approach demonstrated that TLH can be safely performed without the use of any uterine or vaginal manipulation.

scholarly journals A Novel Approach to Minimally Invasive Hysterectomy Without the Use of a Uterine Manipulator; Kamran’s TLH.

2020 ◽  
Author(s):  
Ahmed Gendia ◽  
Kamran M. Waseem ◽  
Noel E Donlon
Keyword(s):  
Operative Time ◽  
Intraoperative Complications ◽  
Laparoscopic Hysterectomy ◽  
Total Laparoscopic Hysterectomy ◽  
Postoperative Course ◽  
Conversion To Open Surgery ◽  
Uterine Manipulator ◽  
Novel Approach ◽  
Operative Outcome ◽  
Minimally Invasive Hysterectomy

Abstract Background: Hysterectomy remains one of the most common major gynaecological procedure, with total laparoscopic hysterectomy (TLH) now the established as the technique of choice over conventional open approaches. This approach depends on the use of a uterine manipulator to facilitate uterine retraction and colpotomy. This study describes a novel approach in performing total laparoscopic hysterectomy without the use of uterine manipulator or vaginal tubes and reports the intra- and post-operative outcome of this technique.Methods: A single centre retrospective analysis of patients who underwent TLH without uterine manipulator or vaginal tube “Kamran’s TLH” for benign conditions was performed from January 2017 to October 2019. Data collected included patients demographics, intraoperative finding and postoperative course.Results: A total of eighty six hysterectomies were performed utilizing the Kamran’s TLH (KTLH) approach. Mean age was 52.2 (±11) years old and BMI was 28.2(±7). TLH with bilateral salpingo-oophorectomy was performed in 63(73.3%) patients and TLH with preservation of ovaries in 23 (26.7%) patients. Mean operative time was 64.7(±27.9) minutes and estimated bloods loss was 46.2(±54.6) ml. No intraoperative complications were recorded and there was no conversion to open surgery. Only one patient required readmission and surgery for vaginal vault dehiscence during their postoperative course.Conclusion: Uterine manipulator is a key component in performing laparoscopic hysterectomy. However, our approach demonstrated that TLH can be safely performed without the use of any uterine or vaginal manipulation.

scholarly journals A novel approach to minimally invasive hysterectomy without the use of a uterine manipulator: Kamran’s TLH technique

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Ahmed M. Gendia ◽  
Noel E. Donlon ◽  
Waseem M. Kamran
Keyword(s):  
Minimally Invasive ◽  
Laparoscopic Hysterectomy ◽  
Total Laparoscopic Hysterectomy ◽  
Uterine Manipulator ◽  
Operative Duration ◽  
Novel Technique ◽  
Novel Approach ◽  
Minimally Invasive Hysterectomy

Abstract Background There are a number of techniques documented in the literature to perform laparoscopic hysterectomy, and here, we propose a safe and novel technique that obviates the need for a pelvic assistant, removes the need for a uterine manipulator and can potentially reduce operative duration. Results Total laparoscopic hysterectomy can be approached without the use of uterine manipulator or vaginal tubes using the steps demonstrated. Conclusions This novel technique is safe, efficient and conducive to standardising minimally invasive hysterectomy practices obviating the need for a uterine manipulator and pelvic assistant.

scholarly journals Body Mass Index and Its Role in Total Laparoscopic Hysterectomy

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Shilpa Bhandari ◽  
Pallavi Agrawal ◽  
Aparna Singh
Keyword(s):  
Body Mass Index ◽  
Blood Loss ◽  
Body Mass ◽  
Operative Time ◽  
Intraoperative Complications ◽  
Laparoscopic Hysterectomy ◽  
Total Laparoscopic Hysterectomy ◽  
Perioperative Outcomes ◽  
Obese Patients ◽  
Duration Of Surgery

Objective. To evaluate operative and perioperative outcomes in patients undergoing total laparoscopic hysterectomy according to their body mass index. Method. A retrospective study was performed for patients undergoing total laparoscopic hysterectomy at a tertiary care center for a period of 4 years. Patients were divided into two groups: obese (BMI > 30 Kg/m2) and nonobese (BMI < 30 Kg/m2). Duration of surgery, intraoperative blood loss, successful laparoscopic completion, and intraoperative complications were compared in two groups. Result. A total of 253 patients underwent total laparoscopic hysterectomy from January 2010 to December 2013. Out of them, 105 women (41.5%) had a BMI of more than 30 kg/m2. Overall, the mean blood loss was 85.79 ± 54.17 mL; the operative time was 54.17 ± 19.83 min. The surgery was completed laparoscopically in 244 (96.4%) women while laparotomy was done in 4 cases and vaginal suturing and closure of vault were done in 5 cases. Risk of vaginal assistance was higher in obese patients whereas out of the 4 conversions to laparotomy 3 had BMI < 30 kg/m2. The operative time was increased as the BMI of patient increased. Conclusions. Total laparoscopic hysterectomy is a safe and effective procedure for obese patients and can be performed with an efficacy similar to that in nonobese patients.

scholarly journals Analysis of 300 Total Laparoscopic Hysterectomy Cases Performed by The Same Surgeon

2021 ◽  
Vol 3 (2) ◽  
pp. 20-24
Author(s):  
Esra Tamburacı ◽  
Barış Mulayim
Keyword(s):  
Hospital Stay ◽  
Open Surgery ◽  
Operative Time ◽  
Length Of Hospital Stay ◽  
Laparoscopic Hysterectomy ◽  
Technical Difficulty ◽  
Demographic Characteristics ◽  
Total Laparoscopic Hysterectomy ◽  
Conversion To Open Surgery ◽  
Operative Complications

Aim: This study aimed to evaluate the results of 300 cases of total laparoscopic hysterectomy (TLH) performed by the same surgeon. Material and methods: During the study period, a total of 300 TLH operations were performed between January 2017 and December 2018. Demographic characteristics, indications of hysterectomy, uterine weights, intra-operative and post-operative complications, duration of the operation, length of hospital stay, blood loss of patients, visual analogue scores and amount of analgesics needed were retrospectively evaluated. Complications were analysed and compared with literature. Results: Parameters analysed for 300 patients included in the study were as follows: mean age 47.82 ± 6.18 years, mean parity 3.4 ± 2.0 (0–11), BMI 27.41 ± 4.36 (kg/m²), mean uterine weight 367.67 ± 266.21 g (50–1600 g), mean operative time 89.07 ± 37.94 min (30–240 min), mean hospital stay 54.37 ± 21.95 h (24–168 h) and total complication rate 28 (9.3%). Conversion to open surgery was required in 29 (9.7%) patients. The level of technical difficulty and existence of prior abdominal surgery were associated with a higher risk of complications and conversions to laparotomy. Conclusion: Total laparoscopic hysterectomy is a well-designed surgical procedure for the management of benign gynaecological conditions, and after adequate training, it seems to be a safe and effective procedure for patients.

scholarly journals The Retrograde and Retroperitoneal Totally Laparoscopic Hysterectomy for Endometrial Cancer

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Eugenio Volpi ◽  
Luca Bernardini ◽  
Anna Maria Ferrero
Keyword(s):  
Endometrial Cancer ◽  
Operative Time ◽  
Laparoscopic Hysterectomy ◽  
Total Laparoscopic Hysterectomy ◽  
Retroperitoneal Approach ◽  
Laparoscopic Technique ◽  
Uterine Manipulator ◽  
Original Procedure ◽  
Disposable Instruments ◽  
Totally Laparoscopic

Introduction. We retrospectively report our experience with the utilization of an original procedure for total laparoscopic hysterectomy based on completely retrograde and retroperitoneal technique for surgical staging and treatment of the endometrial cancer. The surgical, financial, and oncological advantages are here discussed.Methods. The technique used here has been based on a combination of a retroperitoneal approach with a retrograde and lateral dissection of the bladder and retrograde culdotomy with variable resection of parametrium. No disposable instruments and no uterine manipulator were utilized.Results. Intraoperative and postoperative complications were observed in 10% of the cases overall. Operative time length and mean haemoglobin drop value results were 129 min and 125 mL, respectively. Most patients were dismissed on days 3–5 from the hospital. Seventy-eight percent of the patients were alive with no evidence of disease at mean followup of 49 months.Conclusions. Our original laparoscopic technique is based on a retroperitoneal approach in order to rapidly control main uterine vessels coagulation, constantly check the ureter, and eventually decide type and site of lymph nodes removal. This procedure has important cost saving implications and the avoidance of uterine manipulator is of matter in case such as these of uterine malignancy.

scholarly journals A multimodal concept for vaginal cuff closure by modification of the Bakay technique in total laparoscopic hysterectomy: a randomized clinical study

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Üzeyir Kalkan ◽  
Kadir Bakay
Keyword(s):  
Hospital Stay ◽  
Operative Time ◽  
Laparoscopic Hysterectomy ◽  
Total Laparoscopic Hysterectomy ◽  
Controlled Study ◽  
Complication Rates ◽  
Vaginal Cuff ◽  
Total Operative Time ◽  
Vaginal Length ◽  
Vaginal Cuff Closure

Abstract Background The aim of this study was to compare the outcomes of modified Bakay technique (MT) to standard colpotomy (ST) and cuff closure in total laparoscopic hysterectomy (TLH). Methods This two-centre, randomized-controlled study included a total of 160 patients who were scheduled for TLH for benign diseases (ClinicalTrials.gov Identifier is NCT05080114 and the first posted date was 15/10/2021). The patients were allocated into two groups by a computer-based randomization programme as ST group and MT group. Total operative time, cuff closure time, length of hospital stay, intra- and postoperative complications according to the Clavien-Dindo classification, pre- and postoperative vaginal length, and patient satisfaction according to the Patient Global Impression of Improvement (PGI-I) questionnaire were assessed. Results Seventy-seven patients in the ST group and 80 patients in the MT group underwent TLH. The total operative time was significantly shorter in the MT compared to the ST (55.5 vs. 59 min, respectively; p = 0.001). The median total operative time for colpotomy, extraction of uterus, and vaginal cuff closure steps was 9 (range 6–12 in MT vs. 6 to 11 in ST) min in both groups. The median hospital stay was 2 (range 1–4) days in both groups. Intraoperative blood loss was not significantly different between the groups (90 mL in ST vs. 80 mL in MT; p = 0.456). The mean uterine weight for the ST group and MT group was comparable (258.6 ± 88.6 g vs. 232.9 ± 102.5 g, respectively; p = 0.107). The preoperative vaginal length was not significantly different between the groups (p = 0.502). The median postoperative vaginal length was significantly higher in the MT group compared to the ST group on Day 90 (8 cm vs. 7,5 cm, respectively; p = 0.001). The PGI-I questionnaire score on Day 90 postoperatively was 2 (range 1–5) in both groups (p = 0.636). The complication rates were similar between the groups (p = 0.230). Conclusion The MT can be safely performed in most of the cases requiring TLH with the advantages of vaginal cuff closure before the alteration of pelvic anatomy, support to primary healing of the vaginal cuff, and routine concomitant apical support.

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