Chapron C, Dubuisson J B, Aubert V, Morice P, Garnier P, Aubriot F X, Foulot H
Service de Chirurgie Gynécologique, Clinique Universitaire Baudeloque, C.H.U. Cochin-Port-Royal, Paris.
J Gynecol Obstet Biol Reprod (Paris). 1995;24(8):802-10.
Total hysterectomy was performed via laparoscopy alone in 50 patients. In all cases, the operation was carried out using conventional, re-usable instruments (grasping forceps, laparoscopic scissors, bipolar coagulation). The mean duration of the operation was 163 min (range: 110-270 min). The mean drop in haemoglobin was 1.97 g/100 ml (range: 0-4 g/100 ml) and the average length of hospital stay was 3.9 days (range: 2-13 days). In one case (2%), we converted to laparotomy because a lateral myoma made it impossible to achieve haemostasis of the uterine pedicule under suitably safe conditions. No serious peri or post-operative complications were encountered. No second surgery was necessary and no transfusion was required. These results confirm that total laparoscopic hysterectomy via laparoscopy is a safe, feasable and reproductible technique. Future work will establish the exact place and methods for laparoscopic surgery for hysterectomy. Laparoscopic surgery is only indicated when vaginal hysterectomy is contraindicated or impossible. Laparoscopic hysterectomy constitutes an alternative to laparotomy rather than the vaginal hysterectomy. The combination of an immobile uterus and poor vaginal accessibility is the prime indication for total hysterectomy via laparotomy.
50例患者仅通过腹腔镜进行了全子宫切除术。在所有病例中，手术均使用传统的可重复使用器械（抓钳、腹腔镜剪刀、双极电凝）进行。手术平均持续时间为163分钟（范围：110 - 270分钟）。血红蛋白平均下降1.97 g/100 ml（范围：0 - 4 g/100 ml），平均住院时间为3.9天（范围：2 - 13天）。有1例（2%）因侧方肌瘤在适当安全条件下无法实现子宫蒂止血而转为开腹手术。未遇到严重的围手术期或术后并发症。无需二次手术，也无需输血。这些结果证实，腹腔镜下全子宫切除术是一种安全、可行且可重复的技术。未来的工作将确定腹腔镜子宫切除术的确切位置和方法。仅在阴道子宫切除术禁忌或无法进行时才考虑腹腔镜手术。腹腔镜子宫切除术是开腹手术的一种替代方式，而非阴道子宫切除术的替代方式。子宫固定不动且阴道暴露困难是开腹全子宫切除术的主要指征。
