VIDEO ARTICLE Year : 2023  |  Volume : 12  |  Issue : 1  |  Page : 46-47

A safe and standardized strategy for laparoscopic hysterectomy in patients with a history of cesarean section

Kenro Chikazawa, Ken Imai, Masahiro Misawa, Tomoyuki Kuwata
Department of Obstetrics and Gynecology, Jichi Medical University, Saitama Medical Center, Kawagoe, Saitama, Japan

Date of Submission08-Jul-2022Date of Decision22-Nov-2022Date of Acceptance24-Nov-2022Date of Web Publication9-Feb-2023

Correspondence Address:
Dr. Kenro Chikazawa
No. 1-847 Amanuma, Omiya, Saitama, Saitama 330-8503
Japan

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/gmit.gmit_80_22

How to cite this article:
Chikazawa K, Imai K, Misawa M, Kuwata T. A safe and standardized strategy for laparoscopic hysterectomy in patients with a history of cesarean section. Gynecol Minim Invasive Ther 2023;12:46-7
How to cite this URL:
Chikazawa K, Imai K, Misawa M, Kuwata T. A safe and standardized strategy for laparoscopic hysterectomy in patients with a history of cesarean section. Gynecol Minim Invasive Ther [serial online] 2023 [cited 2023 Feb 10];12:46-7. Available from: https://www.e-gmit.com/text.asp?2023/12/1/46/369419   Objective 

The objective of this study was to demonstrate a technique for safe and easy laparoscopic hysterectomy for patients with a history of cesarean section using narrated video footage.

  Design 

Step-by-step video demonstration of the surgical technique.

  Setting 

Laparoscopic hysterectomy for patients with a history of cesarean section.

  Interventions 

The surgical technique is shown in a step-by-step manner to facilitate viewer comprehension, to improve the performance of the procedure in a simple and safe manner, and to minimize bleeding and bladder injury.[1],[2] The steps of the procedure are as follows [Figure 1]:

Dissecting the ureter, ligating the cut round ligament, posterior layer of the broad ligament, uterosacral ligament, and infundibulopelvic ligament/ligamentum ovarii propriumDissection under the bladder pillar bilaterally, followed by dissection under the bladder caudal to the adhesion from the cesarean sectionIf we could not dissect the bladder using step 2, it implied that the adhesions were widespread and we thus would perform dissection more caudally. Therefore, we ligated the uterine artery and the ureteric branches of the uterine artery and dissected the ureter laterally. To reach the vesicouterine pouch from a more caudal and dorsal direction, a dissection under the layer of the uterine artery and superior vesical artery was performed.[3],[4] In other words, we reached the vesicouterine pouch under the ureteric tunnel, as is the case during uterine cancer surgery.[5] Thereafter, we approached an area which was more caudal to the adhesion area. This area is usually dissected in a modified radical hysterectomy.   Results 

We were able to dissect below the bladder caudally to the adhesion from the cesarean section.

  Conclusions 

Our technique includes dissection of the area more caudal to the adhesion than usual. Currently, the order of dissection is not fixed and is left up to each facility. We dissected the area without touching the previous cesarean section because it minimizes the risk of bladder injury. This is helpful for laparoscopic hysterectomy, which has weaker traction than open laparotomy.

Ethical statement

Institutional Review Board approval was obtained before the experiment was started (approval number: S20-219).

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that hername and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 

  References 
1.Rooney CM, Crawford AT, Vassallo BJ, Kleeman SD, Karram MM. Is previous cesarean section a risk for incidental cystotomy at the time of hysterectomy? A case-controlled study. Am J Obstet Gynecol 2005;193:2041-4.  
    2.Xu Y, Wang Q, Wang F. Previous cesarean section and risk of urinary tract injury during laparoscopic hysterectomy: A meta-analysis. Int Urogynecol J 2015;26:1269-75.  
    3.Chikazawa K, Kanao H, Wang L, Kuwata T, Konno R. Taking care of vesicohypogastric fascia: Enveloping bladder, uterine vessels, and ureter for safe laparoscopic hysterectomy. Taiwan J Obstet Gynecol 2020;59:348-9.  
    4.Yabuki Y, Sasaki H, Hatakeyama N, Murakami G. Discrepancies between classic anatomy and modern gynecologic surgery on pelvic connective tissue structure: Harmonization of those concepts by collaborative cadaver dissection. Am J Obstet Gynecol 2005;193:7-15.  
    5.Nakamura M, Tanaka K, Hayashi S, Morisada T, Iwata T, Imanishi N, et al. Local anatomy around terminal ureter related to the anterior leaf of the vesicouterine ligament in radical hysterectomy. Eur J Obstet Gynecol Reprod Biol 2019;235:66-70.  
    
  [Figure 1]