A novel technique of uterine manipulation in laparoscopic pelvic oncosurgical procedures: "the uterine hitch technique".

Aim. To describe a new technique of uterine manipulation in laparoscopic management of pelvic cancers. Material and Methods. We used a novel uterine hitch technique in 23 patients from May 2008 to October 2008. These patients underwent pelvic oncologic surgery including laparoscopic radical hysterectomy (n = 7), laparoscopic anterior resection (n = 4), laparoscopic abdominoperineal resection (n = 3), laparoscopic posterior exenteration (n = 4), or laparoscopic anterior exenteration (n = 5). The uterus was hitched to the anterior abdominal.wall by either a single suture in the fundus or by sutures through the round ligaments. Results. The uterine hitch technique was successfully accomplished in all procedures. It was performed in less than 5 minutes in all cases. It obviated the need for vaginal manipulation. An extra port for retraction could be avoided. There were no intraoperative complications. Conclusion. A practical, cheap and reproducible method for uterine manipulation, during pelvic oncologic surgery is described. It improves the stability of the uterus and also obviates the need for keeping an additional assistant for vaginal manipulation in any of the procedures.

Stretching the Limits of Laparoscopy in Gynecological Oncology: Technical Feasibility of doing a Laparoscopic Total Pelvic Exenteration for Palliation in advanced Cervical Cancer.

INTRODUCTION: Improving quality of life and supportive care are of paramount importance in helping patients of advanced cervical cancer. Pelvic exenteration has both palliative and curative role in the management of cervical cancer. We aim to demonstrate the feasibility of performing laparoscopic total pelvic exenteration in advanced carcinoma of the cervix and to evaluate the immediate morbidity associated with it. METHODS: We performed laparoscopic total pelvic exenteration in 7 patients of advanced cervical cancer at Galaxy Laparoscopy Institute from August 2005 to December 2007. All patients underwent a diagnostic laparoscopy for assessment of resectibility of the tumor followed by pelvic exenteration in the same operative procedure. The purpose of this procedure was palliation. RESULTS: The mean operative time was 230 +/- 15 min and mean blood loss was 250 +/- 50 ml. Five patients received intra-operative blood transfusions. All patients tolerated the procedure well. No patients required conversion to open surgery. The mean postoperative hospital stay was 8 (7-21) days. The mean follow up was 11 (4-24) months and mean symptom free period was 8 (3-24) months. There was no major and unanticipated post-operative morbidity. There was no immediate post-operative mortality in the present study. DISCUSSION: Laparoscopic total pelvic exenteration is technically feasible and can be offered to carefully selected patients with advanced carcinoma of the cervix. The feasibility of this procedure defines newer limits for the use of laparoscopy in gynecological cancers.

A novel technique of total laparoscopic hysterectomy for routine use: evaluation of 140 cases.

Hysterectomy is one of the most commonly performed gynecological procedures. Although the first laparoscopic hysterectomy was performed in 1989, this technique accounts for only a few of all hysterectomies performed today. To assess the safety of total laparoscopic hysterectomy through a novel technique that we have evolved, a retrospective analysis of 140 patients with benign uterine pathologies operated at our institute between 2004 and 2007 was performed. All patients underwent total laparoscopic hysterectomy (TLH) using a simple technique. The highlight of this technique was the omission of any vaginal manipulator. The mean operation time was 88.75 ± 52.72 minutes, the mean blood loss 53.80 ± 35.94 ml and the mean hospital stay 2.21 ± 1.12 days. No conversion to open surgery was necessary. Iatrogenic complications were bowel injury (n=1) and vaginal tears (n=3) and were managed laparoscopically. The new method of TLH proved to be reproducible and safe with decreased morbidity and operation time. This can be attributed to the performance of the same standardized steps each time. Our technique provides a safe procedure suitable for routine use in gynecological surgery.