Laparoscopic hysterectomy

Terminology
The laparoscopic method of removing the womb is an alternative to abdominal hysterectomy, it is not a substitute for vaginal hysterectomy. The advantage is mainly minimal damage to the abdominal wall with a subsequent decrease in postoperative paini, morbidity and faster recovery.

History
The technical development and growth of experience with operative laparoscopy culminated in 1988 with the performance of the first laparoscopic hysterectomy (LH). This procedure was performed by the American vaginal surgeon H. Reich, who was disturbed by the high number of abdominal hysterectomies in his practice.

Classification

 * Total laparoscopic hysterectomy (TLH).
 * Supracervical laparoscopic hysterectomy (SLH).
 * Laparoscopically Assisted Vaginal Hysterectomy (LAVH):
 * • laparoscopically assisted vaginal hysterectomy (LAVH superior type);
 * • laparoscopically assisted vaginal hysterectomy (LAVH inferior type) with laparoscopically performed dissection of uterine vessels and vagina.

Seven Basic Steps to Hysterectomy

 * Separation of the ligamentum rotundum and transection of the upper part of the plica lata;
 * separation of the tubo-uterine junction and the utero-ovarian ligament while preserving the adnexa or cutting the infundibulo-pelvic ligament;
 * cutting of the uterine vessels;
 * cutting of the bladder and its pillars;
 * separation of the cardiac and utero-sacral ligament complex;
 * performance of anterior and posterior colpotomy and separation of the throat from the vagina;
 * closure of the vagina with a suture.

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