Use of uterine manipulator in laparoscopic colorectal surgery.

Laparoscopic colorectal surgery has become more common with the increase in the number of trained surgeons. We have used a disposable uterine manipulator to retract the uterus. This technique has been found to be very useful for laparoscopic low anterior resection and abdomino-perineal resection in females.

A prospective observational study of the safety and acceptability of vaginal hysterectomy performed in a 24-hour day case surgery setting.

OBJECTIVE: To assess the safety and acceptability of vaginal hysterectomy with and without simultaneous oophorectomy in a 24-hour day case surgery setting for women with nonprolapse indications for surgery. DESIGN: Prospective observational study. SETTING: A busy teaching hospital and tertiary referral centre for Obstetrics and Gynaecology. POPULATION: Seventy-one women from one consultant's practice underwent a vaginal hysterectomy with a planned discharge within 24 hours after the procedure. All women had a body mass index less than 40 and a suitable home environment for routine day case surgery, other than that the women were from an unselected population. METHOD: Prospective observational study. MAIN OUTCOME MEASURES: The duration of the operation and mean blood loss were recorded. Any intraoperative complications were noted. In addition, the proportion of women discharged home within 24 hours of the operation was recorded together with any readmissions to hospital. Returns to theatres and any postoperative complications were also recorded. Postoperative pain scores were assessed 6 and 24 hours after procedure in selected women. RESULTS: Seventy-one vaginal hysterectomies were performed as 24-hour day case procedures. The intraoperative complication rate was 1.4%. Sixty-five women were discharged home within 24 hours (91.5%). The readmission rate within this group was 6.2%. The duration of the procedure, mean blood loss, return to theatre rate and incidence of febrile illness were comparable with rates recorded in inpatient studies. CONCLUSIONS: Vaginal hysterectomy performed as a 24-hour day case procedure appears to be as safe as traditional inpatient management, with a high rate of early discharge and a low rate of readmission. This may have additional advantages for the woman and healthcare provider alike.