Title : Complex total laparoscopic hysterectomy ¨severe deep endometriosis¨
Hysterectomy is the most common nonobstetric surgery performed in women, with approximately 600,000 performed annually at a cost of more than $5 billion.1,2 Since the first laparoscopic hysterectomy was performed in 1988 by Harry Reich MD, there has been a 38% decrease in abdominal hysterectomy, as laparoscopic hysterectomy is associated with less post-operative pain, less intraoperative and postoperative complications, shorter hospital stays, and faster recoveries.
The American College of Obstetricians and Gynecologists (ACOG) recommends that minimally invasive approaches to hysterectomy should be performed whenever feasible and explicitly recommends the use of total vaginal hysterectomy (TVH) over total laparoscopic hysterectomy (TLH) or laparoscopic-assisted vaginal hysterectomy (LAVH), citing improved patient outcomes and decreased operative time. Despite these recommendations, there is a national shift toward laparoscopic hysterectomy as the predominant form of hysterectomy.
The number of hysterectomies had been decreasing over the past 5 years, there is an important decrease in abdominal and vaginal hysterectomies and an increase in laparoscopic hysterectomies by more than 100%.
Endometriosis is an inflammatory disease that affects women in their reproductive years, and it is a common cause of pelvic pain and decreases the quality of life. Hysterectomy is one of the surgical treatments but sometimes the surgery becomes complex surgery given the fact that the inflammatory disease gets the pelvic anatomy distorted.
The knowledge of pelvic anatomy es mandatory in order the resolve a complex surgery.
Every pelvic surgeon needs to have complete pelvic anatomy knowledge to have a better performance during complex laparoscopic hysterectomy.
In this presentation, we will give tips and tricks to perfume a successful laparoscopic surgery in a very complex or frozen pelvis.
Audience Take Away:
1. Will remember the pelvic anatomy
2. Will develop skills to get into the retroperitoneal space
3. Will be more confident during surgical gynecological surgery
4. Will have tips and tricks to resolve complex gynecological surgery