Skip to main content
SpringerLink
Log in

Total Laparoscopic Hysterectomy for the Small and Normal-Sized Uterus

  • Chapter
  • First Online:
Hysterectomy

  • 1017 Accesses

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 229.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 299.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 449.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Kovac SR. Route of hysterectomy: an evidence-based approach. Clin Obstet Gynecol. 2014;57(1):58–71.

    Article  PubMed  Google Scholar 

  2. Schollmeyer T et al. Hysterectomy trends over a 9-year period in an endoscopic teaching center. Int J Gynaecol Obstet. 2014;126(1):45–9.

    Article  PubMed  Google Scholar 

  3. Lefebvre G et al. SOGC clinical guidelines. Hysterectomy. J Obstet Gynaecol Can. 2002;24(1):37–61. quiz 74–6.

    Article  PubMed  Google Scholar 

  4. Stang A, Merrill RM, Kuss O. Hysterectomy in Germany: a DRG-based nationwide analysis, 2005–2006. Dtsch Arztebl Int. 2011;108(30):508–14.

    PubMed  PubMed Central  Google Scholar 

  5. Brummer TH, Seppala TT, Harkki PS. National learning curve for laparoscopic hysterectomy and trends in hysterectomy in Finland 2000–2005. Hum Reprod. 2008;23(4):840–5.

    Article  PubMed  Google Scholar 

  6. Prevention, C.f.D.C.a., Women’s reproductive health: hysterectomy fact sheet, D.o.R. Health, Editor. 2009: 1600 Clifton Rd. Atlanta, GA 30333, USA.

    Google Scholar 

  7. Hanstede MM et al. Regional and temporal variation in hysterectomy rates and surgical routes for benign diseases in the Netherlands. Acta Obstet Gynecol Scand. 2012;91(2):220–5.

    Article  PubMed  Google Scholar 

  8. Alkatout I et al. Precarious preoperative diagnostics and hints for the laparoscopic excision of uterine adenomatoid tumors: two exemplary cases and literature review. Fertil Steril. 2011;95(3):1119 e5–8.

    Article  Google Scholar 

  9. Alkatout I et al. Principles and safety measures of electrosurgery in laparoscopy. JSLS. 2012;16(1):130–9.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Hughes E, et al., Ovulation suppression for endometriosis.Cochrane Database Syst Rev. 2007;(3): p. CD000155.

    Google Scholar 

  11. Lethaby A, V Ivanova, NP Johnson. Total versus subtotal hysterectomy for benign gynaecological conditions.Cochrane Database Syst Rev. 2006;(2): p. CD004993.

    Google Scholar 

  12. Thakar R et al. Outcomes after total versus subtotal abdominal hysterectomy. N Engl J Med. 2002;347(17):1318–25.

    Article  PubMed  Google Scholar 

  13. Gorlero F et al. Hysterectomy and women satisfaction: total versus subtotal technique. Arch Gynecol Obstet. 2008;278(5):405–10.

    Article  PubMed  Google Scholar 

  14. Roovers JP et al. Hysterectomy and sexual wellbeing: prospective observational study of vaginal hysterectomy, subtotal abdominal hysterectomy, and total abdominal hysterectomy. BMJ. 2003;327(7418):774–8.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Ascher-Walsh CJ et al. Location of adenomyosis in total hysterectomy specimens. J Am Assoc Gynecol Laparosc. 2003;10(3):360–2.

    Article  PubMed  Google Scholar 

  16. Sarmini OR, Lefholz K, Froeschke HP. A comparison of laparoscopic supracervical hysterectomy and total abdominal hysterectomy outcomes. J Minim Invasive Gynecol. 2005;12(2):121–4.

    Article  PubMed  Google Scholar 

  17. BMI, Demography Report: Report of the German federal government on the demographic situation and future development of the country 2011, German Federal Ministry of the Interior.

    Google Scholar 

  18. Nygaard I, Bradley C, Brandt D. Pelvic organ prolapse in older women: prevalence and risk factors. Obstet Gynecol. 2004;104(3):489–97.

    Article  PubMed  Google Scholar 

  19. Olsen AL et al. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89(4):501–6.

    Article  CAS  PubMed  Google Scholar 

  20. Symmonds RE, Pratt JH. Vaginal prolapse following hysterectomy. Am J Obstet Gynecol. 1960;79:899–909.

    Article  CAS  PubMed  Google Scholar 

  21. Toozs-Hobson P, Boos K, Cardozo L. Management of vaginal vault prolapse. Br J Obstet Gynaecol. 1998;105(1):13–7.

    Article  CAS  PubMed  Google Scholar 

  22. Marchionni M et al. True incidence of vaginal vault prolapse. Thirteen years of experience. J Reprod Med. 1999;44(8):679–84.

    CAS  PubMed  Google Scholar 

  23. Swift SE, Pound T, Dias JK. Case-control study of etiologic factors in the development of severe pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12(3):187–92.

    Article  CAS  PubMed  Google Scholar 

  24. Elessawy M et al. The incidence of complications by hysterectomy for benign disease in correlation to an assumed preoperative score. Arch Gynecol Obstet. 2014;292(1):127–33.

    Article  PubMed  Google Scholar 

  25. Reich H. Laparoscopic oophorectomy and salpingo-oophorectomy in the treatment of benign tubo-ovarian disease. Int J Fertil. 1987;32(3):233–6.

    CAS  PubMed  Google Scholar 

  26. Mettler L et al. Comparative evaluation of classical intrafascial-supracervical hysterectomy (CISH) with transuterine mucosal resection as performed by pelviscopy and laparotomy–our first 200 cases. Surg Endosc. 1995;9(4):418–23.

    Article  CAS  PubMed  Google Scholar 

  27. Semm K. Hysterectomy via laparotomy or pelviscopy. A new CASH method without colpotomy. Geburtshilfe Frauenheilkd. 1991;51(12):996–1003.

    Article  CAS  PubMed  Google Scholar 

  28. Hohl MK, Hauser N. Safe total intrafascial laparoscopic (TAIL) hysterectomy: a prospective cohort study. Gynecol Surg. 2010;7(3):231–9.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Schüssler B, Scheidel P, Hohl MK. Hysterektomie update. Frauenheilkunde aktuell. 2008;3:4–12.

    Google Scholar 

  30. Veress J. Neues Instrument zur Ausführung von Brust- und Bauchpunktionen und Pneumothoraxbehandlung. Dtsch Med Wochenschr. 1938;64:1480–1.

    Article  Google Scholar 

  31. Alkatout I et al. Abdominal anatomy in the context of port placement and trocars. J Turk Ger Gynecol Assoc. 2015;16(4):241–51.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Kramer L. Mixed reviews on removing fallopian tubes to prevent ovarian cancer. CMAJ. 2013;185(9):E391–2.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Kurman RJ, Shih Ie M. Molecular pathogenesis and extraovarian origin of epithelial ovarian cancer–shifting the paradigm. Hum Pathol. 2011;42(7):918–31.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Caceres A, McCarus SD. Fallopian tube prolapse after total laparoscopic hysterectomy. Obstet Gynecol. 2008;112(2 Pt 2):494–5.

    Article  PubMed  Google Scholar 

  35. Altman D et al. Pelvic organ prolapse surgery following hysterectomy on benign indications. Am J Obstet Gynecol. 2008;198(5):572 e1–6.

    Article  Google Scholar 

  36. Thompson JD, Warshaw J. Hysterectomy. In: Rock JA, Thompson JD, editors. Te Linde's Operative Gynecology. Philadelphia-New York: Lippincott Raven; 1996. p. 771–854.

    Google Scholar 

  37. van Herendael B. Strategies to prevent vaginal vault descent during hysterectomy. In: Mettler L, editor. Manual of new hysterectomy techniques. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd; 2007. p. 82–5.

    Google Scholar 

  38. Hur HC et al. Incidence and patient characteristics of vaginal cuff dehiscence after different modes of hysterectomies. J Minim Invasive Gynecol. 2007;14(3):311–7.

    Article  PubMed  Google Scholar 

  39. Cruikshank SH, Kovac SR. Randomized comparison of three surgical methods used at the time of vaginal hysterectomy to prevent posterior enterocele. Am J Obstet Gynecol. 1999;180(4):859–65.

    Article  CAS  PubMed  Google Scholar 

  40. Wall LL. A technique for modified McCall culdeplasty at the time of abdominal hysterectomy. J Am Coll Surg. 1994;178(5):507–9.

    CAS  PubMed  Google Scholar 

  41. Ostrzenski A. A new, simplified posterior culdoplasty and vaginal vault suspension during abdominal hysterectomy. Int J Gynaecol Obstet. 1995;49(1):25–34.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Gynecology and Obstetrics, Kiel School of Gynaecological Endoscopy, University Hospitals Schleswig-Holstein, Kiel, DE, Germany

    Ibrahim Alkatout

Authors
  1. Ibrahim Alkatout
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ibrahim Alkatout .

Editor information

Editors and Affiliations

  1. Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel, Germany

    Ibrahim Alkatout

  2. Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel, Germany

    Liselotte Mettler

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Alkatout, I. (2018). Total Laparoscopic Hysterectomy for the Small and Normal-Sized Uterus. In: Alkatout, I., Mettler, L. (eds) Hysterectomy. Springer, Cham. https://doi.org/10.1007/978-3-319-22497-8_35

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-22497-8_35

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-22496-1

  • Online ISBN: 978-3-319-22497-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation