Anazitisi Nosokomeia Thessalonikis Epikoinwnia Thessgiatro
Eggrafi Melwn  Oroi Xrisis Thessgiatro  Oroi Xrisis

Total laparoscopic hysterectomy HD


Hysterectomies are one of the most common surgical procedures in the United States, with greater than 600,000 performed each year. For decades, abdominal and vaginal approaches accounted for the vast majority of hysterectomies. The advent of better laparoscopic technology resulted in the first total laparoscopic hysterectomy (TLH) in 1989. Use of TLH has increased in the last 20 years. TLH accounted for 9.9% of all hysterectomies in 1997 and 11.8% in 2003. 
A TLH is defined by the laparoscopic ligation of the ovarian arteries and veins with the removal of the uterus vaginally or abdominally, along with laparoscopic closure of the vaginal cuff. This is in contrast to other methods of removing the uterus, fallopian tubes, and ovaries. A laparoscopic supracervical hysterectomy is completed in a similar fashion, with the exception that the cervix is amputated after occluding the ascending vascular pedicles. A laparoscopic-assisted hysterectomy (LAVH), a precursor to the TLH, is a technique to secure the ovarian and uterine vasculature via laparoscopy; the remainder of the procedure is completed vaginally.
The laparoscope is often reinserted after closure of the vaginal cuff to inspect the abdomen and vaginal cuff for adequate hemostasis at the end of the procedure. This procedure requires adequate uterine descent to safely complete the vaginal portion of the procedure. Laparoscopic radical hysterectomy has emerged as an alternative to abdominal radical hysterectomy for patients with stage I cervical cancer. Emerging advancements include robotic-assisted laparoscopic hysterectomy, single-incision laparoscopy, and laparoscopic pelvic reconstruction surgery.
The advantages of TLH compared to abdominal hysterectomy have been well documented. Visualization of pelvic anatomy and the ability to minimize blood loss is superior with TLH. Substantial and dynamic access to the uterine vessels, vagina, and rectum is possible from many angles, especially after introduction of the uterine manipulator in 1995. The advantages of TLH have been firmly established to include reduced short-term morbidity (less blood loss, wound infections, and postoperative pain), shorter hospital stay, and faster resumption of normal activities when compared with abdominal hysterectomy. The primary focus of this chapter is to review the indications, surgical technique, and advantages of TLH for women who are candidates for a hysterectomy.


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