Laparoscopic total abdominal hysterectomy by suturing technique, with no transvaginal surgical approach: a review of 276 cases

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Abstract
Objective: To determine the effectiveness and safety of the new technique of laparoscopic total abdominal hysterectomy with prophylactic retroperitoneal rectovaginal‐pouch of Douglas reconstruction and vaginal vault re‐suspension by suturing method, with no transvaginal surgical approach. Methods: The clinical prospective study included 276 women, and was conducted from July 1990 through December 1995. All women were subjected to a laparoscopic total abdominal hysterectomy with prophylactic retroperitoneal rectovaginal and pouch of Douglas reconstruction and vaginal vault suspension. The entire operation was executed via laparoscope with suturing and tying of extracorporeal sliding and intracorporeal two‐turn flat square knot technique, and no transvaginal surgery was performed. The criteria for postoperative early (within 5 h) discharge plan were designed and assessed. Results: All pre‐planned instances of laparoscopic total abdominal hysterectomy with prophylactic retroperitoneal rectovaginal‐pouch of Douglas reconstruction and vaginal vault re‐suspension were completed; no technique failure was encountered. The average operating time for both hysterectomy and prophylactic surgery was 192 min. Intraoperative complications were two bladder injuries (0.72%); one case of inferior epigastric vessels injury (0.36%); one case of autologous, cells saver processed blood transfusion (0.36%). The immediate postoperative complications were four cases of voiding difficulty (1.45%) and five patients experiencing post anesthesia inordinate nausea and vomiting (1.81%). One patient required postoperative blood transfusion (0.36%). Delayed postoperative complications included 2 patients (0.72%) with superficial incisional skin infection. Estimated hemoglobin loss was from 0.5 g/dl to 5.0 g/dl, mean loss 1.5 g/dl. The extirpated uterine average weight 163 g. Postoperatively, within 24 h, 265 patients (96.01%) out of 276 were discharged home on the day of surgery, within 5 h, 110 patients (41.51%) out of 265 left the surgical unit. There was no single hospital post surgical re‐admission. Conclusions: Laparoscopic total abdominal hysterectomy with prophylactic retroperitoneal rectovaginal‐pouch of Douglas reconstruction and vaginal vault suspension by suturing method is a safe, well‐defined operation, executed with no need for transvaginal surgical approach, and well accepted by patients.