The basic concept of laparoscopic hysterectomy was developed by Kurt Semm and Liselotte Mettler in the 1980s. However, the instruments and techniques used at the time (endotherm and loop) did not keep pace with the development of intrafascial hysterectomy. Advancements in instruments, technical support, and consistent training have considerably improved the procedure.
Total laparoscopic hysterectomy for the normal-sized uterus has become a standard operation with low complication rates and a regular learning curve. Laparoscopic hysterectomy is associated with reduced blood loss, shorter hospital stays, earlier return to normal activities, and fewer infections. Its major advantage over vaginal hysterectomy is the possibility to simultaneously treat comorbidities, such as endometriosis or adhesions. Laparoscopic supracervical/subtotal hysterectomy is a useful alternative. Its advantages and disadvantages need to be discussed with the patient; the final decision is made jointly by the doctor and the patient.
Antibiotic prophylaxis should be given for all types of hysterectomy. The first step is a correct assessment of the size and location of the uterus (clinical examination and ultrasound scan). The next step is to determine the positions of trocars and the manipulator. The following questions have to be answered: (1) Are disposable instruments required? (2) Are more than two ancillary trocars necessary? What trocar diameter should be used and what is the best location? (3) Is morcellation necessary or can the uterus be removed through the vagina? (4) Do any other operative steps have to be considered, such as the treatment of endometriosis, adnexal masses, or adhesions? (5) How is the vaginal cuff to be closed?
Oophorectomy and/or salpingectomy should be considered; their advantages and disadvantages should be included in the patient’s counseling.
Laparoscopy Hysterectomy Total laparoscopic hysterectomy Vaginalclosure Prolapse prophylaxis
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