The Technical Aspects Of Laparoscopic Subtotal Hysterectomy

Laparoscopic subtotal hysterectomy can be performed more easily with the new technique using triple ligation method in selected cases when hysterectomy is indicated and no risk of remaining cervix cancer is assumed. The new technique is as follows : Technically, the first step of our procedures is to dissect the vesicouterine peritoneum and to make a window in the relatively avascular plane of broad ligament. Then the posterior leaf of the broad ligament is opened down to the level of uterosacral ligament. An endoligature is placed medial to the adnexa through the window in the broad ligament, then an extracorporeal Roder knot is tied, and 2 security knots are made. The same procedures are performed on the opposite side. A polydioxanone endoligature is placed around the cervicocorporeal junction at the level of the uterosacral ligament through the window and five security knots are tied. Both adnexac are separated from the uterus, which is then amputated I cm above the endoligature site by using hook scissor. Two loops are tied over the cervical isthmus to ensure safe hemostasis and the peritoneum is closed over the remaining cervical stump with a chromic catgut suture. The uterus is morcellated and removed with a 20-mm serrated macromorcellator.