Reverse hysterectomy: another technique for performing a laparoscopic hysterectomy.

STUDY OBJECTIVE

To show and evaluate outcomes of a modified laparoscopic hysterectomy technique (total reverse laparoscopic hysterectomy).

DESIGN

Observational study (Canadian Task Force classification II-2).

SETTING

Department of Women's and Children's Health, Obstetrics and Gynecology Clinic, University of Padova, Padova, Italy.

PATIENTS

One hundred one women underwent total reverse laparoscopic hysterectomy for benign disease. Indications for surgery, patient characteristics, surgical data, complications, and patient satisfaction were recorded.

INTERVENTIONS

Total reverse laparoscopic hysterectomy.

MEASUREMENTS AND MAIN RESULTS

The modified procedure was performed starting with the incision of the vesicouterine fold and the pubocervical fascia followed by the dissection of only the anterior layer of the broad ligament, thus preserving the integrity of the posterior leaf (retrograde hysterectomy). This technique permits identification of the ureter until the cross with the uterine artery, creating a "safe triangle" for closure of the uterine vessels. The remaining surgical time did not differ from the standard technique. The average operating time was 112.1 ± 35.6 minutes, and the average intraoperative mean blood loss was 79.5 ± 138.4 mL. Ninety-one (90%) patients were very satisfied after surgery. No injuries to the ureter or bladder occurred in any patients. No other major complications were recorded.

CONCLUSION

Reverse hysterectomy is another technique for performing laparoscopic hysterectomy, and it has been proven to be safe and efficient.