Laparoscopic-assisted vaginal hysterectomy for patients with extensive pelvic adhesions: A strategy to minimise conversion to laparotomy

Aim:  To evaluate a strategy for successful laparoscopic‐assisted vaginal hysterectomy (LAVH) in patients with extensive pelvic adhesion. Methods:  Two hundred and thirty‐six patients who underwent LAVH at National Taiwan University Hospital were retrospectively enrolled. Twenty‐three patients (9.7%...

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Published in:Australian & New Zealand journal of obstetrics & gynaecology 2007-06, Vol.47 (3), p.230-234
Main Authors: HSU, Wen-Chiung, CHANG, Wen-Chun, HUANG, Su-Cheng, SHEU, Bor-Ching, TORNG, Pao-Ling, CHANG, Daw-Yuan
Format: Article
Language:English
Subjects:
Adult
Endometriosis - complications
Female
Humans
Hysterectomy, Vaginal - methods
Laparoscopy - methods
LAVH
Middle Aged
pelvic adhesions
Pelvis - pathology
Retrospective Studies
Tissue Adhesions - complications
Tissue Adhesions - surgery
Treatment Outcome
Ureter - blood supply
Ureter - surgery
ureter dissection
Urologic Surgical Procedures - methods
uterine artery ligation
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Summary:Aim:  To evaluate a strategy for successful laparoscopic‐assisted vaginal hysterectomy (LAVH) in patients with extensive pelvic adhesion. Methods:  Two hundred and thirty‐six patients who underwent LAVH at National Taiwan University Hospital were retrospectively enrolled. Twenty‐three patients (9.7%) had unexpected extensive pelvic adhesions. A special procedure of uterine artery preligation through retroperitoneal downstream ureter tracking was applied to overcome this problem. The clinical characteristics of the study group were analysed. The operative parameters and the outcome were compared between those with and without extensive pelvic adhesions. Results:  Having extensive adhesions, 17 patients were associated with endometriosis and the other six were secondary to previous Caesarean delivery or pelvic inflammation. The cul‐de‐sac was partially and totally obliterated in 10 and 13 patients, respectively. These 23 patients had longer operation time (184 vs 146 min, P 
ISSN:0004-8666
1479-828X
DOI:10.1111/j.1479-828X.2007.00724.x