Total laparoscopic hysterectomy by intracorporeal suture and ligature in the three-port method

Kim, Kwan Sik

Abstract

OBJECTIVE
To optimize a technique and evaluate the outcomes of total laparoscopic hysterectomy (TLH) performed by conventional intracorporeal suture and ligature under the 3-port method.
METHODS
Eighty six patients had TLH at our hospital between July 1998 and June 2000 due to gynecologic benignancies. Operation procedures, the type and number of suture and ligature and the operation time were analyzed through reviewing of their medical records and operation video tapes.
RESULTS
Overall operation time was 93.2 +/- 25.3 (mean +/- SD) minutes. The mean lapsed time was 19.8 +/- 8.5 minutes for securing and dividing the round ligaments, infundibulopelivic or ovarian ligaments, 21.39.3 minutes for securing and dividing the uterine vessels, cardinal and uterosacral ligaments, 18.7 +/- 6.2 minutes for vaginal vault support and closure, 12.1 +/- 6.4 minutes for peritoneal approximation and final inspection. Overall number of suture ligature was 26.8 +/- 2.9. The mean number of suture ligature was 5.5 +/- 1.7 for securing and dividing the round ligaments and infundibulopelivic or ovarian ligaments, 4.2 +/- 1.2 for securing and dividing the uterine vessels, cardinal and uterosacral ligaments, 5.2 +/- 0.9 for vaginal vault support and closure, 12.0 +/- 1.8 for peritoneal closure and final laparoscopic inspection. The uterine weight was 205 +/- 100.3 (range: 50.0-530.0) g. No conversion to laparotomy and major operative complications were occurred except for a case of postoperative transient voiding difficulty and a case of postoperative transfusion.
CONCLUSION
TLH with the 3-port method can be performed safely and reasonably in the technical aspect and operation time by using conventional intracorporeal suture and ligature. Operation techniques could be optimized more especially in the procedure of vaginal and peritoneal closure to get the shorter operation time.