Miyabe Yuki, Kanayama Naohiro
Department of Gynecology, Shintoshi Hospital, Iwata, Japan.
Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Gynecol Minim Invasive Ther. 2019 Aug 29;8(3):123-128. doi: 10.4103/GMIT.GMIT_99_18. eCollection 2019 Jul-Sep.
In recent years, laparoscopic hysterectomy (LH) has increasingly been used in total hysterectomy for uterine fibroids. In our department, approximately 95% of total hysterectomies for benign uterine disease are performed by LH; however, in the 5% patients for whom LH is contraindicated, how to provide minimally invasive surgery was a challenge.
To avoid open surgery with a large vertical midline incision, we introduced a hand-assisted LH (HALH), whereby a lower abdominal transverse incision of 8 cm was made above the pubic symphysis apart from an incision needed for the operating port for laparoscopy.
The procedure was performed on five patients between January 2015 and February 2016. The mean weight of the resected uteri was 1382 g, and the mean estimated blood loss was 541 ml. No patients required allogeneic blood transfusion, and there were no complications. Recovery was rapid and postoperative progress was good.
HALH is a procedure that avoids traditional open surgery using a large vertical midline incision in patients for whom LH is contraindicated and for those with large uterine fibroids.
近年来，腹腔镜子宫切除术（LH）在子宫肌瘤全子宫切除术中的应用越来越广泛。在我们科室，约95%的良性子宫疾病全子宫切除术采用LH进行；然而，对于5% LH禁忌的患者，如何提供微创手术是一项挑战。
为避免采用大的垂直中线切口进行开放手术，我们引入了手辅助腹腔镜子宫切除术（HALH），即在耻骨联合上方做一个8 cm的下腹部横切口，这与腹腔镜手术操作端口所需的切口分开。
2015年1月至2016年2月期间对5例患者实施了该手术。切除子宫的平均重量为1382 g，平均估计失血量为541 ml。无患者需要异体输血，也无并发症发生。恢复迅速，术后进展良好。
HALH是一种避免在LH禁忌患者及子宫肌瘤较大患者中使用大的垂直中线切口进行传统开放手术的术式。
