Route of Hysterectomy: “Straight-Stick” Laparoscopy

Abstract

The laparoscopic, or ''straight-stick'' approach to hysterectomy accounts for *30% of hysterectomies performed. Enhanced magnification and visualization, decreased blood loss, and fewer complications have made laparoscopic hysterectomy a preferred approach and the modality recommended by the American College of Obstetricians and Gynecologists and the American Association of Gynecologic Laparoscopists when vaginal hysterectomy is not possible. Laparoscopic hysterectomy is ideal for managing fibroids, adnexal masses, and endometriosis by providing excellent visualization of the pelvis while offering the benefits of minimally invasive surgery. Large pathologies, such as fibroids or adnexal masses, can be navigated safely using an angled laparoscope. In patients undergoing surgery for pelvic pain, laparoscopy allows the surgeon to inspect the abdomen fully to determine if anatomical abnormalities or pathology are present. The laparoscopic approach is useful for patients who desire supracervical hysterectomy and for those having concomitant pelvic support procedures such as sacrocolpopexy. Advantages of laparoscopic hysterectomy include the ability to allow same-day discharge with no increase in intraoperative or postoperative complications, readmission rates, or 30-day morbidity, compared with patients admitted to the hospital. Patients are able to return to normal activities sooner and experience decreased postoperative pain, compared to patients who undergo abdominal hysterectomy. Shorter hospitalization and decreased complications have also enabled the laparoscopic approach to become more costeffective than the abdominal approach. To facilitate a safe and effective laparoscopic hysterectomy regardless of surgical complexity, the surgeon must be comfortable with adhesiolysis, retroperiteoneal dissection, and suturing. There are several limitations to laparoscopy, including numerous prior surgeries, extensive pathology, comorbidities, and concern for malignancy. In these cases, an alternative route to hysterectomy may be preferred. Many of these challenges may be overcome with alternative entry points, modifications to trocar placement, an angled lens, and appropriate instrument selection. Surgeons who perform laparoscopic hysterectomy must anticipate potential concerns and consider patient-specific characteristics carefully when choosing this route of surgery. Surgeon skillset and expertise is essential to performance of straight-stick hysterectomy ( J GYNECOL SURG 37:107

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“…Other researchers have also reported the use of Jain Point in situations to avoid previous surgical scars in gynecology, general surgery and oncology. [42][43][44][45][46][47][48][49][50][51] The rate of conversion to laparotomy in laparoscopic surgery as reported by Walker et al 52 and Scribner et al 53 was 25.8% and 36.4%, respectively. In our study there was no conversion to laparotomy; along with forty years of surgical unit and expertise, rigorous pre op and intra op work up.…”

Jain Point : To avoid trocar injuries in multiple previous surgeries A retrospective analysis of 720 cases

“…This endorsement underscores the utility of Jain Point in navigating potential adhesions and enhancing the safety of laparoscopic entry. 39 Bedaiwy and associates have documented the advantages of Jain Point technique, especially in cases where periumbilical adhesions are anticipated. 40 Their findings support the use of Jain Point as a means to facilitate safe subsequent 10 mm supraumbilical port entry.…”