One hundred cases of laparoscopic subtotal hysterectomy using the PK and Lap Loop systems

Laparoscopic Subtotal Hysterectomy: Evidence and Techniques

“…All procedures are performed with the patient under general anesthesia, and the bladder is catheterized. Four-port operative laparoscopy is used by most surgeons [18][19][20]. More recently, single-port laparoscopic and robotic laparoscopic approaches have been described [21][22][23][24].…”

“…More recently, single-port laparoscopic and robotic laparoscopic approaches have been described [21][22][23][24]. Many surgeons use a uterine manipulator to access pelvic structures, enabling optimal uterine angulation [19,20,25]. The round ligament and vascular supply are secured and transected, the ovarian or infundibulopelvic ligaments are secured and transected (depending on performance of concomitant oophorectomy), and the uterine arteries are secured using sutures, clips, or a laparoscopic energy source (e.g., bipolar forceps, bipolar vessel-sealing/transection device, or ultrasonic energy) according to vessel caliber and surgeon preference.…”

“…The Lap Loop is reported to reduce the time taken to separate the corpus and cervix by 80% (n 5 30) [27] and may decrease the risk of inadvertent injury to adjacent structures because a large portion of the loop is insulated and the loop is retracts back into the introducer during cervical amputation [25]. Another reported advantage is that the loop enables the uterine corpus to be separated at or above the level of the coagulated uterine vessels, thereby minimizing the risk of slippage or retraction of these vessels (evidence level II-2) [20].…”

“…In case series, LSH proponents report rapid postoperative recovery, with same-day discharge offered in specific centers that incorporate stringent patient selection criteria and a comprehensive postoperative follow-up protocol [19,20,25,38].…”

Laparoscopic approach to hysterectomy

“…The most recent vessel sealing devices are the Ligasure™ and the Plasma Kinetic™ (PK) systems. These devices use bipolar enery modality and seal wide-diameter vascular pedicles [26]. Another newly-developed device, the 5 mm EnSeal™ instrument, provides a tissue-controlled energy deposition, with the "smart electrode" resulting in high seal strengths in vessels ranging in diameter from less than 1 mm to 7 mm.…”