Laparoscopic type 7 total hysterectomy and adnexectomy with or without Burch colposuspension: operative technique with the LigaSure device and results.

摘要

The purpose of the present study was to investigate the use of an operative technique incorporating the LigaSure vessel sealing system in patients undergoing type 7 total laparoscopic hysterectomy (TLH) and adnexectomy with or without Burch colposuspension.Data were collected for 68 patients who underwent type 7 TLH with adnexectomy. Analyzed variables included patient characteristics (age, body mass index (BMI), parity, medical and surgical history, indications for hysterectomy, weight of the removed uterus), operative data (operative time, procedures performed in addition to TLH, intraoperative blood loss), complications, difference between preoperative and postoperative hemoglobin levels, and length of hospital stay.Mean age was 53.7 ± 6.9 years (range 46-74) and mean body mass index was 27.9 ± 6.1 kg/m(2) (range 19.4-45.7). Overall mean operative time was 100.4 ± 31.7 min (range 60-180), mean intraoperative blood loss was 98.1 ± 96.9 ml (range 0-700), and the mean difference between preoperative and postoperative hemoglobin levels was 1.39 ± 0.6 g/dl (range 0-3.4). Mean weight of the removed uteruses was 229.4 ± 174.8 g (range 60-750). Mean hospital stay was 1.12 ± 0.7 days (range 1-7). Additional operative procedures included Burch colposuspension (15; 22.1%), adhesiolysis (9; 13.2%), cholecystectomy (2; 2.9%), transabdominal preperitoneal hernia repair (1; 1.5%) and repair of intraoperative bladder injury (1; 1.5%). Major intraoperative complications were encountered in two patients. In one, the left ureter was injured and in the other the bladder was injured. Conversion to open surgery was not needed in any of the patients.The procedure we describe here for type 7 TLH with adnexectomy, performed alone or with additional Burch colposuspension, appears to be safe and effective.