Comparison of two different laparoscopic hysterectomies: laparoscopic hysterectomy vs. total laparoscopic hysterectomy.

OBJECTIVE: The aim of this study was to compare the efficacy and safety of laparoscopic hysterectomy (LH) and Total Laparoscopic Hysterectomy (TLH). METHODS: Both types of hysterectomy were performed by retroperitoneal uterine artery sealing using LigaSure™ by four-puncture. A total of 45 patients were operated on by LH and 22 by TLH. The mean operation time, amount of intraoperative bleeding, drop in hemoglobin concentration, weight of removed uterus, major and minor per-post operative complications, and rate of conversion to the classical abdominal approach in the two groups were compared. RESULTS: The mean operation time in TLH (110 min.) was significantly longer than in LH (65 min.). This was mainly due to the shorter mean operating time in the vaginal part of LH group (13 min.) compared to laparoscopic dissection of uterosacral ligaments and vaginal suturing (42 min.) in the TLH group. Median blood loss was also significantly higher in the TLH group (278 ml.) compared to the LH group (110 ml.). There were no significant differences in the mean drop of hemoglobin concentration, uterine weight, major and minor complications and conversion to laparotomy between the groups. CONCLUSION: LH seems to be a faster and more demanding method than TLH. With its shorter operation time and less bleeding, LH may be preferred to TLH.

Laparoscopic hysterectomy with retroperitoneal uterine artery sealing using LigaSure: Gazi hospital experience.

OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of laparoscopic hysterectomy by retroperitoneal sealing of the uterine arteries with LigaSure. METHODS: Laparoscopic hysterectomy by retroperitoneal uterine artery sealing with LigaSure was performed by four-puncture laparoscopy in 50 women with various indications for hysterectomy. The mean operation time, amount of intraoperative bleeding, drop in hemoglobin concentration, weight of removed uterus, major and minor per-post operative complications, and the rate of conversion to classical abdominal approach were analyzed prospectively. RESULTS: The mean operation time was 85 min (range 60-125 min). The mean weight of removed uterus was 180 g (range 60-650 g). There was one major complication; one patient had cystotomy due to difficulty in dissecting severe adhesions because of two previous cesarean sections that were repaired laparoscopically. Only one patient converted to laparotomy because of severe bowel adhesions due to rectovaginal endometriosis. All patients were discharged on the first postoperative day. No minor complications occurred. Hemoglobin decreased a mean of 0.4 g/dl (range 0.2-1.4 g/dl) by postoperative day 1. CONCLUSION: Laparoscopic hysterectomy by retroperitoneal uterine artery sealing with LigaSure is an effective, safe, and fast procedure with less intra operative bleeding, short operation time and hospital stay.

Abdominal and pelvic hydatid disease during pregnancy.

BACKGROUND: Hydatid disease is an infection of sheep and cattle. Affected human beings are only chance intermediate hosts. It is a rare condition in pregnancy. CASE REPORT: We present a 15-week pregnant patient with cysts in the liver and in the right adnexa identified by ultrasonography and magnetic resonance imaging. Diagnosis of hydatid disease was confirmed by an indirect hemagglutination test. OUTCOME: The patient underwent laparotomy and a healthy baby was delivered at term.