Salvatore Gueli Alletti1, Stefano Restaino2, Angelo Finelli3, Carlo Ronsini1, Alessandro Lucidi4, Giovanni Scambia3, Francesco Fanfani1. 1. Fondazione Policlinico Universitario A. Gemelli IRCCS (Drs. Gueli Alletti, Restaino, Scambi, and Fanfani), UOC di Ginecologia Oncologica, Dipartimento per la Tutela della Salute della Donna e della Vita Nascente, Roma, Italia. 2. Fondazione Policlinico Universitario A. Gemelli IRCCS (Drs. Gueli Alletti, Restaino, Scambi, and Fanfani), UOC di Ginecologia Oncologica, Dipartimento per la Tutela della Salute della Donna e della Vita Nascente, Roma, Italia. Electronic address: restaino.stefano@gmail.com. 3. Department of Medicine and Aging Sciences (Drs. Finelli and Ronsini), University "G. d'Annunzio" of Chieti-Pescara, Chieti (CH), Italy. 4. Department of Gynecological Oncology (Dr. Lucidi), Hospital G. Bernabeo, Ortona (CH), Italy.
Abstract
STUDY OBJECTIVE: To reveal principles and the feasibility of a total laparoscopic hysterectomy (TLH) with uterine artery ligation at the origin. DESIGN: Step-by-step demonstration and explanation of technique using videos from patients. SETTING: Gynecologic oncology unit at a university hospital. PATIENT: A 54-year-old woman with uterine fibromatosis and metrorrhagia. INTERVENTION: TLH has 7 common components. First, round ligaments are coagulated and cut to enter the retroperitoneum. The ureter is identified. Second, pararectal spaces are entered between the ureter and the internal iliac artery. This maneuver allows the identification of the uterine artery as it leaves its origin from the internal iliac artery. The uterine vessels are stapled with a vascular endoscopic stapler at their origin from the hypogastric vessels or sealed with a bipolar device. Third, adnexal structures are separated from the uterine corpus for subsequent preservation or removal. Fourth, the blood supply is dissected, occluded, and divided before extirpation of the uterine corpus. Fifth, the cardinal ligament complex is transected with colpotomy, and the cervix is amputated from the vaginal apex. Sixth, the specimen is removed. Finally, the vaginal cuff is closed [1]. MEASUREMENTS AND MAIN RESULTS: Laparoscopic hysterectomy was first described by Reich et al. [2] in 1989 and has slowly gained popularity. Today, hysterectomy is the most common gynecologic procedure performed. TLH is where the entire operation (including suturing of the vaginal vault) is performed laparoscopically and there is no vaginal component except for the removal of the uterus. Currently, hysterectomies are performed by different approaches, and individual surgeons have different indications for the approach to hysterectomy based largely on their own array and patient characteristics. TLH requires the highest degree of laparoscopic surgical skills [3], and knowledge of pelvic anatomy defines a safe space for sharp entry into the retroperitoneum and safe identification of pelvic vasculature. CONCLUSION: We present an educational video with step-by-step explanation of the technique to highlight the anatomic landmarks that guides the procedure.
STUDY OBJECTIVE: To reveal principles and the feasibility of a total laparoscopic hysterectomy (TLH) with uterine artery ligation at the origin. DESIGN: Step-by-step demonstration and explanation of technique using videos from patients. SETTING: Gynecologic oncology unit at a university hospital. PATIENT: A 54-year-old woman with uterine fibromatosis and metrorrhagia. INTERVENTION: TLH has 7 common components. First, round ligaments are coagulated and cut to enter the retroperitoneum. The ureter is identified. Second, pararectal spaces are entered between the ureter and the internal iliac artery. This maneuver allows the identification of the uterine artery as it leaves its origin from the internal iliac artery. The uterine vessels are stapled with a vascular endoscopic stapler at their origin from the hypogastric vessels or sealed with a bipolar device. Third, adnexal structures are separated from the uterine corpus for subsequent preservation or removal. Fourth, the blood supply is dissected, occluded, and divided before extirpation of the uterine corpus. Fifth, the cardinal ligament complex is transected with colpotomy, and the cervix is amputated from the vaginal apex. Sixth, the specimen is removed. Finally, the vaginal cuff is closed [1]. MEASUREMENTS AND MAIN RESULTS: Laparoscopic hysterectomy was first described by Reich et al. [2] in 1989 and has slowly gained popularity. Today, hysterectomy is the most common gynecologic procedure performed. TLH is where the entire operation (including suturing of the vaginal vault) is performed laparoscopically and there is no vaginal component except for the removal of the uterus. Currently, hysterectomies are performed by different approaches, and individual surgeons have different indications for the approach to hysterectomy based largely on their own array and patient characteristics. TLH requires the highest degree of laparoscopic surgical skills [3], and knowledge of pelvic anatomy defines a safe space for sharp entry into the retroperitoneum and safe identification of pelvic vasculature. CONCLUSION: We present an educational video with step-by-step explanation of the technique to highlight the anatomic landmarks that guides the procedure.
Authors: Salvatore Gueli Alletti; Emanuele Perrone; Camilla Fedele; Stefano Cianci; Tina Pasciuto; Vito Chiantera; Stefano Uccella; Alfredo Ercoli; Giuseppe Vizzielli; Anna Fagotti; Valerio Gallotta; Francesco Cosentino; Barbara Costantini; Stefano Restaino; Giorgia Monterossi; Andrea Rosati; Luigi Carlo Turco; Vito Andrea Capozzi; Francesco Fanfani; Giovanni Scambia Journal: Front Oncol Date: 2021-09-10 Impact factor: 6.244
Authors: Carlo Ronsini; Aniello Foresta; Matteo Giudice; Antonella Reino; Marco La Verde; Luigi Della Corte; Giuseppe Bifulco; Pasquale de Franciscis; Stefano Cianci; Vito Andrea Capozzi Journal: Medicina (Kaunas) Date: 2022-08-23 Impact factor: 2.948
Authors: Carlo Ronsini; Lavinia Mosca; Irene Iavarone; Roberta Nicoletti; Davide Vinci; Raffaela Maria Carotenuto; Francesca Pasanisi; Maria Cristina Solazzo; Pasquale De Franciscis; Marco Torella; Marco La Verde; Nicola Colacurci; Luigi Cobellis; Giuseppe Vizzielli; Stefano Restaino Journal: Front Oncol Date: 2022-09-16 Impact factor: 5.738