Résumé
OBJECTIVE: To review the safety and effectiveness of a new vaginal hysterectomy method, Minilaparatomically Assisted Vaginal Hysterectomy (MAVH), tried on benign diseases with indication of abdominal hysterectomy. MATERIALS AND METHODS: The analysis of the safety and the effectiveness of MAVH is based on randomized consecutive 75 patients who received the operation from Feb. 1, 2002 to Jul. 10, 2002 in the department of Obstetrics and Gynecology at Gacheon Medical University Hospital. OPERATION TECHNIQUE: Access to the pelvic cavity was obtained by the traditional suprapubic minilaparotomical incision that is 2-2.5 cm long and parallel to the pubic hair line. Through this incision site, the adnexa and other pelvic organs around the bladder were brought into sight by manipulating the uterine elevator that was already inserted into the uterine cavity. By this method, the round ligament, uteroovarian ligament, and the fallopian tube were exposed at the incision site, then clamped, cut, sutured and divided. The dissection of the bladder peritoneum was performed and then followed by the traditional transvaginal approach. RESULTS: The MAVH was successful in 73 cases (97.3%) out of 75 attempts. The mean age, parity, weight, and body mass index of the subjects of the 73 cases were 42.6 (+/-7.8) years, 2.0 (+/-0.7), 59.5 (+/-7.5) kg, and 23.6 (+/-2.6). Forty subjects (54.8%) had a previous surgical history. The operational indications were 44 cases (60.3%) of uterine myoma, 19 cases (26.0%) of uterine bleeding, 7 cases (9.6%) of dysmenorrhea, and 3 other cases (4.1%). There were 6 cases (8.2%) of cumulative complication. In terms of pathologic diagnosis, 54 cases (74.0%) were uterine myoma with adenomyosis, 12 cases (16.4%) adenomyosis, 2 cases (2.7%) endometrial polyp, 1 case (1.4%) endometrial hyperplasia, 1 case endometrial cancer, and 3 other cases. The weights of uteri ranged from 75 gm to 1150 gm with an average of 286.8 (+/-217.5) gm. The average operation time for MAVH from skin incision to the completion of suture was 75.8 (+/-21.8) minutes. The average bowel function recovery time was 45.9 (+/-12.9) hours. The external bleeding loss was 337.0 (+/-306.8) ml, 11.0% (8/73) required transfusion with an average amount of 1.5 pint. No subject of this study needed reoperation or expired. CONCLUSION: The technique of MAVH is simple and easy to learn. The MAVH involves a relatively small size of incision and less pain and complication with fast recovery and small wound. The method requires a little bit of practice but not an expensive equipment. The MAVH is considered as a safe and effective operational method which could replace the abdominal hysterectomy in most cases.
Sujets)
Femelle , Humains , Endométriose intra-utérine , Indice de masse corporelle , Diagnostic , Dysménorrhée , Ascenseurs et escaliers mécaniques , Hyperplasie endométriale , Tumeurs de l'endomètre , Trompes utérines , Gynécologie , Poils , Hémorragie , Hystérectomie , Hystérectomie vaginale , Léiomyome , Ligaments , Obstétrique , Parité , Péritoine , Polypes , Récupération fonctionnelle , Réintervention , Ligament rond de l'utérus , Peau , Matériaux de suture , Vessie urinaire , Hémorragie utérine , Utérus , Poids et mesures , Plaies et blessuresRésumé
OBJECTIVE: Hysterectomy is one of the most common gynecological operations. The objective of this study was to introduce a new uterine elevator for total laparoscopic hysterectomy. METHODS: Bae's uterine elevator was modified for laparoscopic hysterectomy. Modified Bae's uterine elevator was 5 cm longer than original one and handle was modified to vertical position and stopper, silicon tube and silicon adapter for colpotomizer was installed on the shaft. Three hundred and fifty seven cases of total laparoscopic hysterectomies using modified Bae's uterine elevator were performed from Jan 1999 to Jun 2000. RESULTS: Mean age of the patients was 41.8, operation time was 48.3 minutes and uterine weight was 245.5 gm. Leiomyoma was the most common cause of hysterectomies (70.9%), and followed by adenomyosis (16.2%), endometriosis (7.6%). There were no major operative complications such as vascular, bladder, ureter or intestinal injuries. CONCLUSIONS: Three hundred and fifty seven cases of total laparoscopic hysterectomies using modified Bae's uterine elevator were performed successfully without any major complications. Modified Bae's uterine elevator was very convenient for uterine manipulation during total laparoscopic hysterectomy.