Minimal Access Hysterectomy, Without Laparoscopy

Nagy Rafla, East Kent Hospitals NHS Trust. Email: nagy@rafla.net

Fifty patients underwent minimal access hysterectomy without laparoscopy through a mean of 4.8cms transverse supra-pubic incision. There were no intra-operative complications, two patients had post-op Urinary tract infection, and one had two units of blood transfusion. Theses patients were compared with 50 comparable patients who underwent routine hysterectomies by the same surgeon; the mean uterine size was 11 weeks versus 14.7 wks; the mean hospital stay was 3.7days versus 5.7; the length of the procedure was 1.11 hrs versus 1.07 hrs and blood loss was 173mls versus 327mls respectively.

The new technique presented is associated with a small scar, reduced post operative hospital stay and low complication rate and does not require expensive laparoscopic equipment. In addition, a small transverse incision of around 4.7cms could be cosmetically more appealing than multiple port incisions dotted around the abdomen which are more visible.

In this technique: The abdomen is opened through small transverse incision, the broad ligament is opened and the ovarian pedicles ligated, the bladder is dissected off the cervix, then both uterine arteries are cut, the uterus is then split in the anterior wall and further on the sides to allow its delivery through a limited opening by pulling on suspensor sutures. The body of uterus is removed first; then the cervix could then be pulled up and two Le Forte clamps applied below the cervix on both sides and the cervical stump is then removed. The vaginal vault is then closed. The post-operative care is similar to that of regular abdominal hysterectomy.