Laparoscopic hysterectomy: Challenges and limitations
- 1 June 2005
- journal article
- Published by Taylor & Francis Ltd in Minimally Invasive Therapy & Allied Technologies
- Vol. 14 (3), 145-159
- https://doi.org/10.1080/13645700510034010
Abstract
Twenty years after the first description of vaginal hysterectomy with laparoscopic assistance by Kurt Semm in 1984 (1), and 16 years after the publication of the so-called laparoscopically assisted vaginal hysterectomy (LAVH) by Harry Reich in 1989 (2), it is time to review and evaluate the real benefits of laparoscopic hysterectomy. Although laparoscopic surgery is well accepted by gynaecologists worldwide for the treatment of certain gynaecological conditions, laparoscopic hysterectomy in Germany, and probably worldwide, is still only performed by a few specialists. Highly skilled surgical techniques, longer operating time and expensive technology are suggested to be the deterring factors. Laparoscopic hysterectomy, in its different forms, is an attractive and safe procedure for the management of benign gynaecological conditions and many authorities recommend its use on a larger extent. On the other hand, in our opinion, the use of laparoscopic hysterectomy for oncological indications is still controversial. Extensive experience of over 15 years, of the first author, in practising and teaching various forms laparoscopic hysterectomy, namely, laparoscopically assisted vaginal hysterectomy (LAVH), total laparoscopic hysterectomy (TLH), classic intrafascial supracervical hysterectomy (CISH) and laparoscopic supracervical hysterectomy (LSH), has led us to the firm conclusion that these techniques are advantageous to patients if performed for the appropriate indication. In particular, subtotal or supracervical hysterectomy, with the cervix remaining in its place, is associated with fewer complications and a very favourable outcome for the patient. Radical laparoscopic vaginal hysterectomy (RLVH), the last variant in our exposé, is only successful in an expert's hands. The surgical techniques of these varieties of laparoscopic hysterectomies will be described and illustrated in detail in this paper.Keywords
This publication has 18 references indexed in Scilit:
- Current Restricted or Conservative Approach to Laparoscopic Hysterectomy at a German University Department of Gynecology and ObstetricsEndoskopie heute, 2004
- Laparoscopic radical hysterectomy (type III) with aortic and pelvic lymphadenectomy in patients with stage I cervical cancer: Surgical morbidity and intermediate follow-upAmerican Journal of Obstetrics and Gynecology, 2002
- 437 Classic Intrafascial Supracervical Hysterectomies in 8 YearsThe Journal of the American Association of Gynecologic Laparoscopists, 2001
- Laparoscopic supracervical hysterectomyObstetrics and Gynecology Clinics of North America, 2000
- Value of laparoscopic evaluation of paraaortic and pelvic lymph nodes for treatment of cervical cancer.American Journal of Obstetrics and Gynecology, 1998
- Surgical staging in endometrial cancer stage I including laparoscopic lymphadenectomyGynaecological Endoscopy, 1996
- Laparoscopically Assisted Radical Vaginal HysterectomyGynecologic Oncology, 1993
- Totale Uterus Mucosa Ablatio (TUMA) - C*U*R*T* anstelle Endometrium-AblationGeburtshilfe und Frauenheilkunde, 1992
- Hysterektomie per laparotomiam oder per pelviskopiamGeburtshilfe und Frauenheilkunde, 1991
- Laparoscopic HysterectomyJournal of Gynecologic Surgery, 1989