INTRODUCTIONAdequate exposure is a vital factor in total laparoscopic hysterectomy, and uterine manipulators have been used in achieving that. The Hohl uterine manipulator has been considered to be one of the safer manipulators. Beside adequate exposure, it is associated with lower intraoperative complications. However, we report a case of iatrogenic uterine rupture with the Hohl manipulator which also caused bowel penetration.PRESENTATION OF CASEA 52-year-old woman with endometrial hyperplasia was scheduled for total laparoscopic hysterectomy. Prior to entering into the abdomen, the Hohl uterine manipulator was introduced into the uterine cavity without force. During the laparoscopic exploration, we noted that the tip of the Hohl manipulator had perforated the posterior uterine fundus and penetrated the bowel. Therefore, laparotomy was performed, and the bowel injury was repaired by a colorectal surgeon.DISCUSSIONThe Hohl uterine manipulator is safe and easy to use, and is associated with decreased intraoperative injuries. However, the complications observed due to the improper use of an uterine manipulator can overshadow any advantages of manipulator. In the present report, we describe a case of uterine perforation and bowel penetration caused by the Hohl uterine manipulator during total laparoscopic hysterectomy, which required conversion to laparotomy. The cause for this complication is associated with improper usage of the uterine manipulator.CONCLUSIONUterine manipulator may cause uterine perforation and bowel penetration at the beginning of the hysterectomy procedure. These types of complications can be prevented by proper application of the Hohl manipulator into the uterus under direct pelvic visualization.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.