A novel retrograde approach for total laparoscopic hysterectomy in patients with severe adhesion in the cul-de-sac

Abstract

A novel retrograde approach for total laparoscopic hysterectomy in patients with severe adhesion in the cul-de-sac K. Nakamura1,K. Nakayama1,T. Minamoto1,T. Ishibashi1,K. Sanuki1,H. Yamashita1,R. Ono1, H. Sasamori1,S. Razia1,M.M. Hossain1, S. Kamrunnahar1,M. Ishikawa1,S. Kyo1 1Department of Obstetrics and Gynecology, Shimane University School of Medicine, Izumo (Japan) Summary Purpose of Investigation: The purpose of the present study was to establish retrograde-total laparoscopic hysterectomy (TLH) as a treatment option for patients with severe adhesions. Materials and Methods: A retrospective review of two cases of endometriosis that underwent retrograde-TLH at Shimane University Hospital due to complete cul-de-sac obstruction was performed. Retrograde-TLH has three key steps: processing the round ligament, anterior lobe of the broad ligament of the uterus, and ligamentum ovarii proprium, followed by dissection of the ureteral roof, and finally, the dissection of the vaginal wall. Results: Retrograde-TLH was successfully performed in the two patients, without complications. Conclusions: For surgeons experienced in the technique, the retrograde-TLH approach offers several advantages, including the simple and safe dissection of tissue planes as close as possible to the edge of adhesions, avoidance of bladder and rectal injuries, and reduced bleeding, minimizing the possibility of conversion to exploratory laparotomy. Key words: Retrograde; Total laparoscopic hysterectomy; Endometriosis; Adhesion; Laparoscopic surgery.