Hand-assisted laparoscopy for complex hysterectomy.

In rare cases of extreme uterine enlargement, hysterectomy by vaginal and laparoscopic-assisted techniques is not feasible and requires a large abdominal incision. Hand-assisted laparoscopy permits the performance of such cases through a much smaller, glove-size abdominal incision while preserving pneumoperitoneum. In a 45-year-old nullipara with a grossly enlarged, impacted uterus and total vaginal obliteration, hysterectomy was safely performed by hand-assisted laparoscopy using the Pneumo Sleeve system through a 7. 5-cm transverse suprapubic incision, and a 1-cm laparoscopic incision. The operation lasted 150 minutes, blood loss was 220 ml, and the specimen weighed 3050 g. The patient was discharged in excellent condition on the second postoperative day and had an uneventful recovery. (J Am Assoc Gynecol Laparosc 6(2):183-188, 1999)