MODIFIED TOTAL LAPAROSCOPIC HYSTERECTOMY WITH V CARE MANIPULATOR VERSUS LAPAPAROSCOPIC ASSISTED DODERLINE HYSTERECTOMY IN MANAGEMENT OF BENIGN GYNECOLOGICAL CONDITIONS: A RANDOMIZED CONTROL TRIAL

Abstract

Hysterectomy is one of the commonest major gynecological operations, with over 100 000 procedures performed annually in England and 600,000 in the United States Laparoscopic assisted vaginal hysterectomy (LAVH) and Total laparoscopic hysterectomy (TLH) has gained widespread acceptance as alternatives to standard abdominal hysterectomy.

Currently, total laparoscopic hysterectomy (TLH) is used to treat a number of benign gynecological disorders. However, the technical challenges, such as positioning of instruments, bleeding and prolonged operative times involved remain important issues for the laparoscopic gynecologist and another challenge is the internal suturing , hence the modification which in suturing the vaginal vault vaginally after delivery of the uterus ( MTLH ) . The potential advantages of the uterine manipulator ( V care ) that it can perform the follow¬ing functions: Raises the uterus and brings it closer to the laparoscopic surgical instruments, facili¬tating the procedure. Manipulates the uterus, thus stretching the side being operated upon Increases the distance between the uterus and the bladder, the ureters, and the rectum, thus reducing the chance of injury .Also, reduce the operation time, bleeding.Besides that , it can Facilitates identification of the utero¬vesical peritoneum, the cul-de-sac, and the vaginal cuff just below the cervical attachment and pull the uterus vaginally after its complete detachment, but the main problem was the preserving the pneumoperitoneum fol¬lowing colpotomy.

Laparoscopic assisted Doderlein hysterectomy (LADH) is a variation of the standard LAVH where the laparoscopic component is the same as for a standard LAVH but, vaginally, an anterior vaginal incision (colpotomy) is performed and the fundus of the uterus is delivered into the vagina by rotating the uterus around its remaining supports The potential advantages of the Doderlein variation on LAVH include clamping of the uterine arteries under direct vision before the uterosacral–cardinal complex, which makes ureteric injury less likely, and reducing the traction on the uterine arteries when the uterine arteries are the final pedicles, as in an LAVH, and are therefore at more risk of tearing