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Abstract
Introduction/Background Hysterectomy is a common surgical procedure for benign gynecological conditions, involves laparotomy, laparoscopy, or vaginal routes. Uterine manipulation is essential to move the uterus for anatomical dissection. This presentation focuses on a laparoscopic hysterectomy with intra-abdominal uterine manipulation to ensure safety margins and prevent ureteral injury.
Methodology Case: A 65-year-old postmenopausal woman presented with abnormal uterine bleeding. Imaging revealed uterine myomas and a 28mm hypo-echogenic cervical mass with blood flow. MRI showed a 3.5cm mass in the upper vaginal canal with high signal intensity on T2-weighted imaging. Intramural uterine myomas were detected, the largest on the right posterior wall.
Procedure Laparoscopic hysterectomy was performed under general anesthesia. A three-port laparoscopic technique was performed. After inspecting pelvic cavity, bilateral infundibulopelvic ligaments were ligated with endoscopic clips and advanced bipolar device. Then, using the advanced energy device, the round ligaments were ligated and the anterior and posterior broad ligaments were opened to expose uterine vessels. Uterine vessels were also ligated using the same method. Circumferential incision was made in the vagina with a 1 cm-margin from the cervix with monopolar scissors. The resected uterus was removed through the vagina and opened vaginal stump was closed by suturing intra-abdominally.
Results Uterus size: 7.0x5.0x4.0cm, specimen weight: 63.4gm. A 4.0x3.0cm vaginal tumor was resected, not involving the cervix. The tumor was a cellular angiofibroma. Total operation time was 115 minutes, blood loss estimated at 50cc. The patient‘s postoperative recovery was uneventful and discharged on the second day.
Conclusion Uterine manipulation offers many advantages during laparoscopic hysterectomy including preventing ureteral injuries, making anatomical dissection and colpotomy. Transvaginal uterine manipulation may cause perineal injury such as hymen injury or episiotomy. This case describes the feasibility of surgical procedure with intra-abdominal uterine manipulation during total laparoscopic hysterectomy with vaginectomy.
Disclosures I don’t have a conflict of interest.
