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Modified uterine manipulator and vaginal rings for total laparoscopic radical hysterectomy
  1. P. T. RAMIREZ*,
  3. R. DOS REIS,
  4. M. R. MILAM*,
  5. M. W. BEVERS*,
  6. C. F. LEVENBACK* and
  7. R. L. COLEMAN*
  1. *Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
  2. Hospital de Clinicas de Porto Alegre, Gynecologic Oncology Service, Universidade Federal Do Rio Grande do Sul, Ramiro Barcelos, Porto Alegre, Brazil
  1. Address correspondence and reprint requests to: Pedro T. Ramirez, MD, Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, P.O. Box 301439, Unit 1362, Houston, TX 77230–1439, USA. Email: peramire{at}


At present, there is no standard technique that allows surgeons performing total laparoscopic radical hysterectomy to complete the colpotomy and remove an adequate (2-cm) margin of upper vaginal tissue while maintaining adequate pneumoperitoneum. We evaluated the feasibility and safety of using a modified uterine manipulator for total laparoscopic radical hysterectomy in patients with cervical or endometrial cancer. A retrospective review was performed in all patients who underwent total laparoscopic radical hysterectomy using a modified uterine manipulator at our institution during the period April 2004 to December 2006. This analysis included 30 patients who underwent surgery with the modified uterine manipulator. There were no reports of difficulty with placement of the instrument, multiple attempts at placement, difficulty with uterine manipulation, or uterine perforation. In no patient was a vaginal incision or episiotomy required to fit the instrument through the introitus. In no case was there loss of pneumoperitoneum during colpotomy. Additional upper vaginal tissue had to be removed after intraoperative assessment of the adequacy of the surgical specimen in five (16.7%) of 30 patients. Use of the modified uterine manipulator according to our technique is safe and feasible, allowing for adequate vaginal resection and maintenance of pneumoperitoneum

  • cervical cancer
  • laparoscopy
  • radical hysterectomy
  • uterine manipulator

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