The surgical technique begins by placing the uterine mobilizer, setting the vaginal highlighter on the cervix, and inflating the balloon occluder vaginal. It then proceeds to play through three abdominal punctures (10 mm below or supraumbilical, and 5 mm in iliac fossae or flanks) the HTL, with or without salpingo-oophorectomy (Annaiah & Gemmell). It then continues with the usual surgical technique, as described elsewhere, in which it is noteworthy that the vascular pedicle (infundibulopelvic and utero-ovarian or uterine vessels), the tubes and round ligaments are cauterized with bipolar current first and sectioned. Then, without using sutures or clips. The cardinal ligaments and the vaginal vault with monopolar current are cut on the lip marked by vaginal highlighter (Jing-he, et al.). Dissection of the bladder and posterior leaf of broad ligament are made immediately before the cauterization of the uterine vessels, after hydrodissection with dilute vasopressin.
It should be noted that is done laparoscopically section uterine vessels, cardinal ligaments and vaginal vault, leaving the uterus completely free in the abdominal cavity, which is why is called laparoscopic hysterectomy (Cho, et al.). The uterus is removed through the vagina, closing the dome vaginal or laparoscopic gynecologist according to preference. The surgeries were performed always between two experienced gynecologists in laparoscopic surgery. In each surgery is only used a 10 mm disposable trocar for the first puncture, and the disposable portion of the uterine mobilize (Bryson). No other disposable items used or mechanical sutures. The optics used in all cases was 10 mm and 0 degrees. Stand out as essential instruments for this surgery the 5-mm bipolar forceps, hook clamp or hook, monopolar laparoscopic needle, scissors, graspers, forceps, Maryland type and suction irrigation cannula (Tiwari). The camera used was a video endoscopy chip (Wolf) and neumoinsufladores 10 liters / Mto (wolf or Cabot Medical). The light sources used were 250 W and 350 W (Wolf). Were used on any patient GnRH analogues prior to surgery, to reduce the uterine size.
Discussion & Elaboration of Critical Factors
Trying to compare the abdominal or vaginal hysterectomy different laparoscopic techniques, as if these varieties were one, it creates more confusion and draw conclusions difficult practices (Hassan). For hysterectomy, abdominal approach is preferred around the world, with a frequency between 80 and 95%. As experience is gained with the various techniques Laparoscopic hysterectomy (LH), the frequency of abdominal hysterectomy (AH) decreases. In the period covered by this study, the HTL performed in 64% of cases, against 33% for HA and 3% for Vaginal hysterectomy (VH). Dorsey et al in 1049 patients reported 26% for HL, 54% HA and 20% HV, and in 339 patients Hawe et al report a 84.3% for all techniques of HL, 11% for HA and 5% for HV (Everett & Crawford).
Most studies found in relation to the HL, AH or HV compared with Laparoscopic Assisted Vaginal Hysterectomy (LAVH). In the LAVH laparoscopic procedure usually stops short of severing the uterine vessels, ending vaginal hysterectomy in a while (Cosson & Querleu). This technique may ...