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WJOLS

Laparoscopic-assisted Vaginal Hysterectomy vs Hand-assisted Laparoscopic Hysterectomy

Fig. 3: An incision is made with scissors in the anterior vesico- Fig. 4: The bladder is dissected away from the anterior cervix
uterine peritoneum by sharp dissection

A window was created in the broad ligament with phase, the uterus is removed vaginally (Fig. 5). After
endoscopic scissors above the level of the ureter, extend- removal of uterus, laparoscopic view to assure hemostasis
ing from the infundibulopelvic ligament to the uterine was done (Fig. 6).
vessels which are controlled with clip applier or ligature.
An incision was made with scissors in the anterior Group 2: Hand-assisted laparoscopic
vesicouterine peritoneum. The bladder was pushed hysterectomy
away from the anterior cervix by sharp dissection (Figs 3 The procedure is like group 1, but the intra-abdominal
and 4). Posterior peritoneum was incised by diathermy hand does most of the retracting action and also tactile
and uterosacral ligament was transected. sensation of the ureters. After freeing the whole uterus,
The vaginal phase consists of posterior colpotomy, the hand device is removed and the vagina is incised
followed by clamping, cutting, and suture-ligating the and the specimen is retrieved through the abdomen
remaining paracervical tissues. The uterine vessels are (Figs 7 and 8). The vaginal stump is closed with
sought and controlled. After completing the vaginal continuous vicryl sutures. Closure of LAP DISC wound

Fig. 5: Vaginal phase of posterior colpotomy and uterus is Fig. 6: After removal of uterus, laparoscopic
removed vaginally view to assure hemostasis

A B
Figs 7A and B: (A) Incision made in the pubic area to insert the LAB DISC; and (B) insertion of the LAB DISC
World Journal of Laparoscopic Surgery, May-August 2016;9(2):63-70 65