Difficult Laparoscopic Hysterectomy Investigate 140 Cases

BackgroundMinimally invasive technology was applied in gynecological surgery in last Midcentury. It was accepted by the majority of physicians and patient,because of smaller incisions, less blood loss,leading to lower morbidity, less postoperative pain and shorter hospital stays,eliminating patient " pain of Seppuku ".In recent years, the concept of minimally invasive continue to be respected widely used in clinical, Huge uterus( uterine weight of 280 grams or more, or ≥ 12 weeks pregnant uterus), a huge broad ligament fibroids, cervical fibroids( myoma diameter greater than 5cm), pelvic adhesions( cesarean section surgery, severe endometriosis) and other difficulties hysterectomy is considered a contraindication for laparoscopic surgery in the past, were adopted by the conventional open approach.However, with the extensive development in recent years, minimally invasive surgery, minimally invasive patient awareness and increase requirements, gradually breaking the limitations [ 1 ], to gynecologists who presented new challenges. So now they are more concerned about clinical gynecologist huge uterus( uterine weight of more than 280 grams, or ≥ 12 weeks pregnant uterus), the history of the great broad ligament fibroids, cervical fibroids( myoma diameter greater than 5cm), pelvic adhesions( cesarean section surgery severe endometriosis) and other difficulties hysterectomy surgery which way to take better for patients with the most favorable.PurposeBy combining our hospital 140 cases of laparoscopic hysterectomy difficult to explore the great womb( uterus or uterine weight of 280 grams or more ≥ 12 weeks gestation), a huge broad ligament fibroids, cervical fibroids( myoma diameter greater than 5cm), pelvic adhesions( cesarean section surgery, severe endometriosis) and other safety and feasibility of laparoscopic hysterectomy in difficulty. Further expand laparoscopic hysterectomy surgical indications, and provide scientific basis for clinical application.MethodsAccording to certain criteria for selection of cases hysterectomy First Affiliated Hospital of Soochow University in January 2012 to February 2015 lines for screening. Difficulties in collecting the study group under laparoscopic hysterectomy 140 cases. Patients aged 39 to 58 years. While difficult laparoscopic hysterectomy is divided into four subgroups : Large group uterus(uterine weight of 280 g to 1750 g / womb 12 weeks pregnant 22 weeks pregnant size) 49 cases, huge broad ligament fibroids, cervical fibroids group( fibroids diameter greater than 5cm) 46 cases of pelvic adhesions group( cesarean section surgery, severe endometriosis) 25 cases, the coexistence of a variety of factors difficult group of 20 cases.Control group 1 abdominal hysterectomy difficulties in 150 cases. Age 45-61 years old, 12 weeks pregnant uterine size 25 weeks pregnant, or the presence of one or more of the difficulty factor. Under the control group 2 conventional laparoscopic hysterectomy in 126 cases. Aged 45 to 65 years old, uterus < 12 weeks of gestation. Comparison of the three groups of patients after surgery cases. Study group also discussed each subgroup incidence of complications.The data were collected for IBM SPSS 20.0 statistical software for statistical analysis, measurement data t- test and analysis of variance, P <O. 05 regarded as statistically significant.ResultsResearch group of applications based on the position of the uterus at the end of abdominal puncture point shift, free ureter, bladder water separation, rectal examination under the guidance of separation methods such as uterine complex laparoscopic hysterectomy. None of the study group were converted to laparotomy, all patients had no intraoperative complications occurred.ConclusionDespite the difficulties hysterectomy operation a little longer, but after improved surgical methods, surgical instruments improvement, clinical experience operating doctor surgery, blood loss was significantly less than the laparotomy group, patients without serious complications. Laparoscopic hysterectomy is still difficult is feasible and safe.