Chapron C, Dubuisson J B
Service de Chirurgie Gynécologique, Clinique Universitaire Baudelocque, CHU Cochin Port-Royal, Paris.
Ann Chir. 1995;49(7):613-20.
The standard technique for total laparoscopic hysterectomy is characterised by two essential points. The first is that all instruments are reusable and the second is that hemostasis is ensured by bipolar coagulation. It is a safe technique with a cost comparable to that of vaginal or abdominal hysterectomies. The routine use of disposable material and automatic disposable staplers for laparoscopic hysterectomies is debatable, as the considerable increase in cost is not accompanied by benefit for the patient or the community. Although laparoscopic hysterectomy is a feasible technique, all hysterectomies should not be performed by this route. If the operation is feasible quickly and under good conditions via the vaginal route, laparoscopic surgery is not indicated. Laparoscopic surgery is only indicated when vaginal surgery is difficult and/or contra-indicated. The elective indications for total laparoscopic hysterectomy are severe adhesions, deep endometriosis and especially a limited vaginal accessibility associated with a narrow vagina and a fixed or non prolapsed uterus. While a average of three quarters of hysterectomies (excluding cases of uterogenital prolapse) are currently performed via a laparotomy, laparoscopic surgery can reduce this rate to approximately 10 to 20 per cent.
全腹腔镜子宫切除术的标准技术有两个要点。第一，所有器械均可重复使用；第二，通过双极电凝确保止血。这是一种安全的技术，其成本与阴道或腹部子宫切除术相当。对于腹腔镜子宫切除术常规使用一次性材料和自动一次性吻合器存在争议，因为成本大幅增加并未给患者或社会带来益处。虽然腹腔镜子宫切除术是一种可行的技术，但并非所有子宫切除术都应通过此途径进行。如果经阴道途径能在良好条件下迅速完成手术，则不建议进行腹腔镜手术。仅在阴道手术困难和/或有禁忌时才考虑腹腔镜手术。全腹腔镜子宫切除术的选择性适应证包括严重粘连、深部子宫内膜异位症，尤其是阴道可及性受限，伴有阴道狭窄以及子宫固定或未脱垂。目前平均四分之三的子宫切除术（不包括子宫脱垂病例）通过剖腹手术进行，而腹腔镜手术可将这一比例降至约10%至20%。
