Lift-Assisted Laparoscopy in Hysterectomy: A Retrospective Study of 32 Consecutive Cases

A large uterus is the most commonly reported obstacle to laparoscopic hysterectomy. It reduces the intra-abdominal free space, limits visualization and instrumentation, causes technical difficulties, and increases the potential for complications. The logical solution to this dilemma is to address the underlying problem and increase the intra-abdominal free space. This can be done readily by supplementing the conventional pneumoperitoneum by concurrent mechanical lifting of the abdominal wall using the camera trocar as an anchoring device. Such lift-assisted laparoscopy augments the intra-abdominal free space formation, and lifts the laparoscope to a higher position to give a panoramic view, even when the uterus is large. This retrospective study of 32 consecutive cases of laparoscopic hysterectomy indicates that the use of lift-assisted laparoscopy is safe for the patient and that a large uterus is not a contraindication. The operations were long, but complications were few. Lift-assisted laparoscopy is an option to improve patient care by modifying surgical procedures. Operating time, per se, is not a valid measure of quality in laparoscopic hysterectomy. The more traumatic abdominal hysterectomy procedures need not be selected in preference over lengthy minimally invasive techniques. Other techniques, such as solo surgery and in-office surgery, are also discussed. 1. Introduction In contrast to open abdominal hysterectomy (AH), minimally invasive techniques such as laparoscopic hysterectomy (LH) and vaginal hysterectomy (VH) cause little or no trauma to the abdominal wall and less postoperative pain. Studies have shown that minimally invasive techniques for benign hysterectomy are safe for the patient and give reduced morbidity, shorter hospital stay, and a faster return to normal activities compared with open procedures. Open techniques increase the risk of intra-abdominal adhesions, wound infection and hernias, and often leave an aesthetically unacceptable scar. The trauma is worse for patients with a large uterus and a thick abdominal wall. Despite its potential for greater short- and long-term morbidity, open AH continues to be the surgical approach used most commonly in the USA and Sweden [1, 2]. The Swedish Gynop Register for Hysterectomy 2011, which included 45 clinics, shows that surgery was performed abdominally in 19%–97% of cases (2/3 of all registered hysterectomies), laparoscopically in 0%–62% (1/10), and vaginally in 3%–65% (1/4), with great variation between clinics. The American Association of Gynecologic Laparoscopists (AAGL) states